10. Psychopathology of sleep.

10. Psychopathology of sleep.

wakefulness

• the ability to remain intentionally awake & with sufficient diffuse attention to external & internal events

Sleep

• state of low awareness of environmental stimuli

• rapid reversibility

How many phases of sleep?

• Five phases = cyclic repetition at night

• each complete sleep cycle lasting about 90-110 minutes & repeating 4-5 times per night for most people.

The first sleep cycles

• short REM sleeps & longer periods of deep sleep.

REM during sleep

•  periods lengthen & deep sleep periods decrease

Stage 1

• Light sleep

• Can be awakened easily.

• Eye movement & muscle activity slow down (sudden muscle contractions and sensation of falling).

Stage 2

• Brain waves become slower

• Eye movements stop.

• The body prepares for deep sleep (body tº drops & heart rate slows down).

Stage 3

• first stage of deep sleep.

• Combination of slow waves (delta waves) with faster waves.

• Parasomnias frequently occur in this sleep stage.

Stage 4

• brain is making slow delta waves exclusively.

• Very difficult

to wake someone up. Both stages of deep sleep are important for

feeling rested in the morning.

REM sleep

• Dreaming occurs.

• Breathing becomes fast and irregular.

• The eyes will move rapidly, & muscles are relaxed & immobile.

• Heart-rate & blood pressure increase.

Why do we remember nightmares or dreams?

• because we wake up during the REM-phase

DYSSOMNIAS

• Insomnia disorder

• Nocturnal myoclonus

• Restless legs syndrome

• Narcolepsy

• Hypersomnolence

• Cataplexy

• Sleep paralysis

Problems in the amount, timing & quality of sleep (e.g.,

difficulties falling asleep at night)

PARASOMNIAS

• Nightmares

• Sleep terrors

• Sleepwalking (somnambulism)

dreaming

• a process of transferring information from stm to ltm

Dyssomnias: Insomnia disorder

• Sleep disorders

• Microsleeps

• Temporary or stable in time

• Comorbid → depression, anxiety disorders, neurocognitive disorders.

If insomnia is temporary

• acute stressful situations

• unfavorable environmental changes

• drug treatments

• consumption of stimulant substances

When insomnia is stable in time

• psychiatric pathology

• medical causes

• substance addiction

Microsleeps

• problems initiating/maintaining sleep

When insomnia becomes a chronic inability without organic or  psychiatric pathology

• hyperarousal insomnia

• hypoarousal insomnia

hyperarousal insomnia

increased muscle tension, basal temperature & pulse

hypoarousal insomnia

absence of physiological indicators

Nocturnal myoclonus/ periodic limb movement disorder (PLMD)

• Repetitive movements of the legs during sleep or even wakefulness.

• Characterized by a typical periodicity & momentary

• Often occurring in association with sleep arousal

• Normal subjects & developing with advancing age.

sleep myoclonus occurs only in

• sleep

 Symptomatic nocturnal myoclonus is typically associated with

• restless legs syndrome

Dyssomnias: Restless legs syndrome (RLS)/ Willis-Ekbom Disease

• Unpleasant or uncomfortable sensations in the legs & an irresistible urge to move them.

Symptoms commonly in RLS appear

• late afternoon or evening hours

• severe at night when a person is resting

• inactive & sitting for extended periods → when watching a movie

RLS is a sleep disorder because

• Symptoms are triggered by resting & attempting to sleep

• it can also be a movement disorder, & neurological sensory disorder

Dyssomnias: Cataplexy

• Sudden temporary muscle weakness or loss of muscular control.

• Attacks may be mild & involve only a momentary sense of minor weakness in a limited number of muscles

• Severe attacks result in a total body collapse → individuals are unable to move, speaks or keep their eyes open

Typical symptoms of Cataplexy

• Jaw dropping

• Head slumping down

• Legs collapsing uncontrollably

• Slurred speech

• Double vision

• Finding it difficult to focus

Attacks during Cataplexy

• people remain fully conscious

• usually triggered by an emotion, such as excitement, laughter, anger or surprise

• total body collapse → unable to move, speak or even open their eyes

Dyssomnias: Sleep paralysis

• Temporary inability to move or speak when waking up or falling asleep.

• Episodes last from a few seconds to several minutes.

• Can be frightening experience.

• Resembles cataplexy except it occurs at the edges of sleep

• People remain fully conscious

After the episode of sleep paralysis ends

• people rapidly recover their full capacity to move &

  speak

Dyssomnias: Narcolepsy

• Rare long-term brain condition

• Suddenly fall asleep at inappropriate times.

• unwillingly fall asleep → in the middle of an activity like driving, eating, or talking.

People experiencing narcolepsy feel

• usually feel rested after waking but then feel very sleepy throughout much of the day.

• uneven & interrupted sleep that can involve waking up frequently during the night.

In narcolepsy the brain

• the brain is unable to regulate sleeping & waking patterns normally

Brain is unable to regulate sleeping and waking patterns

normally, which can result in

• excessive daytime sleepiness

• sleep attacks

• cataplexy

• sleep paralysis 

• excessive dreaming & waking in the night 

excessive daytime sleepiness

feeling very drowsy throughout the day & finding it difficult to concentrate & stay awake

sleep attacks 

falling asleep suddenly & without warning

cataplexy

• temporary loss of muscle control resulting in weakness & possible collapse

Sleep paralysis

temporary inability to move/speak when waking up or falling asleep

excessive dreaming & waking in the night

• dreams often come as you fall asleep (hypnogogic hallucinations)

• or

• just before or during waking (hypnopompic hallucinations)

Dyssomnias: Hypersomnolence

• Recurrent episodes of excessive daytime sleepiness or prolonged night-time sleep

• Nap repeatedly during the day → inappropriate times (at work, during meals) →

• not providing relief from symptoms.

• Difficulty waking from a long sleep & may feel disoriented

Hypersomnolence occur due to

• Typically affects adolescents & young adults.

• Can result from a physical problem

• Medical conditions

• Can co-occur with another mental or medical disorders