Exam 3 Science of Sleep - Sleep Disorders

What are insomnias?

difficulty falling or staying asleep

What are the Co-Morbidities of Insomnia?

Major Depression, Anxiety, Substance Abuse, ADHD in children, Dementia, Physical problems

What is Acute insomnia? What else is it called?

short-term ; also called Adjustment Insomnia (transient insomnia)

Transient insomnia is difficulty sleeping due to...

some upcoming event (vacation, test)

Adjustment sleep disorder:(transient insomnia)

• Transient or short term insomnia

• Usually due to acute __________ or ________ change that causes _______ arousal (could be associated with a death, a wedding, a tests, a new job etc).

• Estimated 15% to 20% of adults experience this

• More common in ______ than ________

• More common in _________ compare to _________ and _______

- stress or environmental change; emotional

- women than men

- elder adults compared to children and young adults

Chronic Insomnia:

- Complains of difficulty falling asleep and/or staying asleep- At least _____ nights a week- At least past _____ months

• Chronic insomniacs often feel ______ during the day but not ______ (they typically report they are unable to take a nap)

- 3; 3

- tired; sleepy

Psychophysiological Insomnia

• Learned or conditioned insomnia

• Features - heightened ______ and learned sleep preventing _______.

• Typically sleep much better away from ________ sleep environment

• (case study)

- arousal ; assocaitions

- their own

What is Psychophysiological insomnia?

conditioned or learned insomnia

What is the following case study an example of:

Woman slept fine but then her son got involved in drug trafficking and she slept horribly. She then went to a sleep center and slept great. She had learned to sleep poorly in her own environment.

Psychophysiological insomnia

What does idiopathic insomnia arise from?

(idiopathic = arising from some unknown cause)

What is another name for idiopathic insomnia?

also called childhood onset insomnia (poor sleepers since childhood),

Idiopathic Insomnia could possibly due to...

some neurological problem (brained just wired to sleep poorly) or a genetic component

What will someone with paradoxical insomnia complain of? What happens when they are studied in a sleep center?

person complains of very little sleep; say they haven't slept in a month; when studied in a sleep center they sleep well (completely normal) but feel like they did not sleep at all/slept poorly; "see I slept terribly"

What is another name for Paradoxical Sleep Insomnia?

Sleep State Misperception

Inadequate sleep hygiene is difficulty sleeping associated with __________.

poor sleep habit; usually results in complaint of insomnia; may be common

Menstrual Related Hypersomnia:

- Episods usually last _______.

- May be related to a __________ since oral contraceptives usually resolve sleepiness.

- a week

- hormone imbalance

Narcolepsy:

- usual onset during ________ decade

- may have a _______ component

- short naps are __________

- second decade

- genetic

- often refreshing

Sleep Onset Association disorder might have a slight increase in...

males

What is the main contributor to poor sleep?

inadequate sleep hygiene (bad sleep habits)

Good sleep hygiene can be a treatment for ________.

insomnia

What are good sleep habits:

1. Get up about the ________ every day.

2. Go to bed only when ______.

3. Do not ______ or _______ in bed (Reserve bed for _______)

4. Avoid ________ close to bed time

5. Don't drink ________ when sleepy.

6. ______ regularly. Confine vigorous ______ to at least ______ hours before bedtime.

7. Keep a regular schedule for _______,__________,_______, etc.

8. Avoid ingestion of _______ within _______ hours of bedtime.

9. Establish relaxing ________ rituals.

10. Avoid ________, especially if you know it may _______ with your sleep. (if you need to ______, a short ________ is generally better than a long _______)

1. same time

2. sleepy

3. watch TV or read; sleeping

4. Smoking

5. alcohol

6. Exercise; exercise; 6

7. meals, medications, chores

8. caffeine; 6

9. pre-sleep

10. napping; interfere; nap; nap; nap

Most people who have chronic insomnia complain about being ________ during the day but usually say they cannot ________

fatigued; take naps

How many types of insomnia are there in children?

2

What are the two types of insomnia in children?

limit setting sleep disorder and sleep onset association sleep disorder

In Limit Setting Sleep Disorder, the child has difficulty sleeping due to what?

parent not enforcing regular sleep times (child refuses or stalls going to bed; 1. kid may push to stay up later and sometimes parents give in and sometimes they don't (this is like partial reinforcement); not terribly uncommon

In sleep onset association sleep disorder, the child has difficulty sleeping to due absence of a ___________ or _________.

certain object or circumstance (1. ex: no one is rocking them to bed anymore and have trouble sleeping because they are used to getting rocked)

What psychological disorders have some relation to sleep problems?

anxiety, depression, schizophrenia

What are some physiological disorders that are related to sleep?

Parkinson's, Alzheimer's, Alcoholism

CBTI techniques used for insomnia try to _________.

readjust their thinking

What disorder is the following situation an example of:

Child cannot sleep without their favorite stuffed animal)

Sleep Onset Association Sleep Disorder

What are the methods available for cognitive behavioral therapy for insomnia (CBT-I)?

1. relaxation techniques (breathing, progressive muscle relaxation)

2. meditation

3. wind down time - allow at least 30 minutes

4. worry journal or to do list

What are the opposite of insomnias?

hypersomnias

Hypersomnias included complaints of ______________ and/or sleeping ________.

excessive sleepiness; long hours

What are the various types of hypersomnias?

narcolepsy, recurrent hypersomnia (Kleine Levin Syndrome, Menstrual Related Hypersomnia), Idiopathic Hypersomnia, Behaviorally Induced Insufficient Sleep Syndrome

Narcolepsy is __________ sleepiness.

excessive

Narcolepsy- Symptoms:

1. ______

2. ________ Symptoms (intrusion of ______ into _________ or _________)

- cataplexy

- hypnogogic hallucinations

- sleep paralysis

1. sleepiness

2. auxiliary symptoms; (REM into wakefulness or sleep onset)

Diagnosis for narcolepsy on the MSLT shows short sleep _________ (less than _____ minutes to fall asleep) and short REM _________ (within ______ minutes of falling asleep on at least ______ of the MSLT subtests)

latencies; 8; latencies; 15; 2

Treatment for narcolepsy is ______ stimulant medication.

lifelong

What are the three other symptoms most commonly associated with narcolepsy?

cataplexy, sleep paralysis and hypnagogic hallucinations

What do people with narcolepsy have?

People with narcolepsy have short latencies to fall asleep and a short amount of time to go into REM.

What are examples of Chronic Hypersomnias?

narcolepsy (with cataplexy, without catalplexy- Due to medical condition with Cataplexy- Due to medical condition without Cataplexy), Idiopathic Hypersomnia with long sleep time, Idiopathic Hypersomnia without long sleeptime, Behaviorally Induced Insufficient SleepSyndrome

What are examples of recurrent hypersomnias?

Kleine Levin Syndrome and Menstrual Related Hypersomnia

Chronic Hypersomnias: Idiopathic Hypersomnias

- Idiopathic (unknown cause) - _______ narcolepsy

- Sleepy all the time, may sleep __________ every night but still tried

- Fall asleep within _____ minutes but don't go into _______ like in narcolepsy

- Naps are generally _________

- Not narcolepsy but still really _____.

- Treatments are _______ and ______.

- non-REM narcolepsy

- 10-12

- 8; REM

- not refreshing

- sleepy

- Ritulin and adderall

Narcolepsy is a _______ disorder.

chronic

What is cataplexy?

A sudden loss of muscle tone while awake, usually triggered by emotion.

What is sleep paralysis?

brief inability to move just before falling asleep or just after waking.

What are hypnagogic hallucinations?

vivid sensory phenomena (hallucinations) that occur during the onset of sleep

The most common treatment for narcolepsy are __________ medications such as ______ or ________.

stimulant; Ritalin or modafinil

The diagnostic feature for narcolepsy is going into _________ sleep within _______ to ________ minutes of falling asleep.

REM; 10 to 15

What are symptoms of idiopathic hypersomnia? What is another name for this disorder?

- excessive sleepiness

- may sleep long hours, byt do not go into REM sleep quickly

- naps are generally not refreshing,

- often have very high sleep efficiencies (total sleep time/total recording time)

- like narcolepsy so sometimes called non-REM narcolepsy

Menstrual-related hypersomnia is a _______ hypersomnia (since they are not ________ all the time. It is sleepiness around the time of the __________.

recurrent; sleepy; menstrual cycle

Behaviorally induced insufficient sleep is sleepiness associated with...

not getting enough sleep (chronic sleep restriction)

Behaviorally induced insufficient sleep syndrome is because you are likely not...

- not getting enough sleep on a routine basis

- E.g. only getting 5 hours of sleep a night and sleeping later on weekends - probably have this

Parasomnias in REM sleep

- are more common in....

- and they occur...

adults than children (except nightmares).

• Occur throughout the night but rarely in the first 90 minutes.

Behaviorally induced insufficient sleep syndrome:

- Occurs slightly more in ______ than _______

- May result in _________ disturbances, ________ work performance, marital _______, increased likelihood of traffic or work _______.

• Treatment: __________

- men than women

- mood; poor; problems; accidents

- GET MORE SLEEP

What are the various disorder that fall under "sleep disordered breathing?"

Primary Central Apnea, Central Apnea Due to Cheyne-Stokes Breathing Pattern, Central Apnea due to High Altitude Periodic Breathing, Central Sleep Apnea due to Drug or Substance, Primary Sleep Apnea of Infancy, Obstructive Sleep Apnea, Sleep Related Non-obstructive Alveolar Hypoventilation, Congenital central Alveolar Hypoventilation

Central Sleep Apnea is when there are ______ in breathing but person is ______________ to breathe.

pauses; not even trying

What may Central Sleep Apnea be associated with?

heart issue (heart failure or certain arrythmias), central nervous system problem, or some drugs

Central Sleep Apnea due to High Altitude Periodic is Breathing is when some people at _______________ have difficulty sleeping due to developing central sleep apnea. What could resolve this problem? What is it often associated with?

higher elevations; going to a lower elevation (usually resolves with the administration of oxygen); hypoxemia at high altitudes(may appear as central apneas)

Obstructive Sleep Apnea is pauses in breathing but person is still _________ to breath. In this condition, their throat or airway has become _________.

trying to breath; obstructed (closed-off/narowing)

Symptoms of Obstructive Sleep Apnea

1. Snoring, Snorting, Gasping

2. Unrefreshing sleep

3. Excessive daytime somnolence

4. Headaches

5. Insomnia

6. Nocturia

7. Memory Problems

8. Impotence

What are signs of obstructive sleep apnea?

crowded naso-pharynx, obesity, inappropriate sleepiness, hypertension, decreased cognitive functioning

What are effects of Obstructive Sleep Apnea?

- EDS (________)

- ______ BP

- Irritability

- Cardiac __________

- Cardiovascular _______

- ________ disease

- ______ mortality

- Increased risk of ______

- Mood ______

- Neurocognitive _______ (loss of memory)

- Impotency

- accidents

- high

- irritability

- arrhythmias

- disease

- pulmonary

- increased

- stroke

- disorders

- deficits

- impotency

Disorders that feature undesirable physiological phenomena that occur primarily during sleep are known as...

parasomnias

Obstructive sleep apnea is usually worse during ________ sleep compared to ________ sleep. It is usually worse when sleeping on the _______ then when sleeping on the _______. ______ and _______ make it worse.

REM; non-REM; back; side; alcohol and cigarette smoking

Obstructive Sleep Apnea: Etiology

- ________ airway anatomy

- ______ habitus

- __________ factors

- _________ abnormalities

- upper

- body

- neuromuscular

- cranio-facial

Obstructive Sleep Apnea:

- ____________ - a decrease in airflow with an accompanying 4% oxygen desaturation

- Apnea + Hypopnea Index (AHI) - number of apneas and hypopneas per _______ of sleep

• Obstructive sleep apnea can be diagnosedwith an AHI of > ______

- hypoapnea

- hour

- 5.0

What parasomnia is the following an example of:

Typical case presentation: child sits up in bed begins screaming, eyes wide open, tachypnic, tachycardic, seems terrified, may try to"escape." Parents try to console the child but nothing works.Episode sometimes goes on for an hour or more. Afterward the child has no memory of the event.Entire family's sleep is disrupted, parents are distraught.

Sleep Terrors

Sleep terrors entail abrupt arousals from _________ sleep.

N3

What are the various forms of treatment for Obstructive Sleep Apnea?

surgical intervention (UPPP, Tonsillectomy, Maxillomandibular Advancement, Repose Screw Procedure, Repose Screw Procedure), Dental Appliance (Inspire), Positional Therapy, Weight Loss, Positive Airway Pressure (CPAP, APAP, Bilevel)

Which is harder to treat central or obstructive sleep apnea?

central

Treatment of Obstructive Sleep Apnea - CPAP - continuous positive airway presure. What is it?

Little machine sits on side of bed and blows air into airway to prevent throat from collapsing

• Amount of air is custom set for each patient

• Pressure range of typical CPAP machine isfrom 4.0 to 20.0 cm wp (water pressure)

• Pressure for an individual is determined by anin-lab sleep study

What are the differences between central and obstructive apneas?

Central- brain doesn't send proper signals to muscles that control breathing; different from obstructive sleep apnea in which breathing stops because the throat muscles relax and block the airway; central sleep apnea is less common that obstructive sleep apnea

Other signs and symptoms of obstructive sleep apnea :

- High ____

- Hypertension

- obesity

-

Bad sleep is not _______ for the body

good

CPAP is designed to treat...

obstructive sleep apnea and can sometimes be used for other fortms of apnea

Apnea =

cessation of airflow

Parasomnias are ______ going on in the night. They do not necessarily cause a ______ falling asleep, _____ asleep, or excessive _______ sleepiness

weird things ; difficulty, staying; dayime

Parasomnias:

- Generally do not produce symptoms of _________ or _________

- Other than the primary problem, sleep is generally _________

- Disorders of ______, __________, or ________ transition.

- Differential diagnosis often includes ________________.

- insomnia or excessive daytime sleepiness

- "normal."

- arousal, partial arousal, sleep state

- seizure disorder

What are examples of parasomnias - disorders of arousal (NREM)?

confusional arousals, sleep walking, sleep terrors

What are examples of parasomnias usually associated with REM sleep?

REM Behavior Disorder, Recurrent Isolated Sleep Paralysis, Nightmare Disorder

What are examples of other parasomnias?

sleep enuresis, sleep related groaning, exploding head syndrome, sleep related hallucinations, sleep related eating disorder

Parasomnias: Sleep walking is moving around out of stage _________ sleep and is mostly seen in ________.

3 (doing things during non-REM); kids/young people

Sleep-Walking:

- Begins in _______ and usually resolves after ________, but can persist into _______

- Often there is a ___________, particularly for adult sufferers.

• Most episodes last ______ minutes, but can include long episodes and very complex _________ behaviors such as ________, and _______ and (rarely) violent behaviors.

- early childhood; adolescence; adulthood

- family history

- 1-5 minutes; automatic; driving and cooking

Parasomnias: REM Sleep Behavior Disorder is when an individual is __________ or _________ during ________ sleep. It includes ___________ dreams.

thrashing or hitting; REM; acting out

REM Behavior Disorder:

- Characterized by a history of disruptive, often violent _________ during sleep which is related to _________.•

- The _______________ that is a normal feature ofREM sleep is lost in these patients, and as aresult they "act out" their dreams

.• Motor activity is _______ and ________, may involve jerking, kicking, punching, leaping outof bed and running into objects.

- motor activity ; dream content

- muscle atonia

- explosive and sudden

REM Behavior Disorder:

- _______ to self or bed partner is common

- Episodes often end by _____________

- Dream content may be unusually _________

- Usually presents in the _______ or ________ decade

- Much more common in _________

- Often associated with concomitant _________. Has been produced experimentally in ______ by dorsal pontine lesions.

- injury

- subject awakening

- violent

- sixth or seventh

- males

- neuropathology; cats

What are the similarities between REM Sleep Behavior Disorder and Sleep walking?

- both are ________

- both involve ________

- symptoms may be increased by __________ due ot _______

- risk of _______ to self of others

- differential diagnosis includes _______________

- parasomnias,

- movement

prior sleep deprivation due to rebound effect

- injury

- seizure disorders

Sleep-Related Groaning:

- Sounds on ________ typically during ______ sleep.

• Usually a _______ occurrence.

• No respiratory ________

• May sound like groaning, moaning or"mournful sounds"

• Considered ________.

- exhalation; REM

- nightly

- distress

- May sound like groaning, moaning or"mournful sounds"

- rare

Sleep Related Hallucinations:

- Hallucinations, usually ________, that occur as the person is ______ or ________ during the night

- May be accompanied by ________

- Often occurs with ________ sleep.

- visual; falling asleep or waking up

- sleep paralysis

- REM

Nightmares and Sleep Paralysis:

- ________ experience these phenomena at some point in life, but for most they will be ______ occurrences

• ________ derivation may increase the occurrence by the ______ effect

• Sleep paralysis is a feature of narcolepsy but can exist in an _____ or _______ form.

- almost everyone ; rare

- REM ; rebound

- isolated or familial

Sleep Enuresis:

- Bed wetting past ________ age

- more common in _________ than _______

- normal age (5)

- boys than girls

Sleep walking:

- Predominance in __________ of sleep.

- Age of onset during _________.

- __________ to awaken.

- _______ specific dream content/recall.

- Episodes lasting __________ minutes with _______ behaviors, rare _________.

- Exacerbated by _______ medications.

- first hour

- childhood

- difficult

- no

- several; complex, injuries

- sedating

REM Sleep Behavior Disorder:

- Predominance in _________ hours.

- Age of onset during _________.

- __________ awakened.

- ___________ dream content/recall.

- ___________ episodes with ________ movement bouts, __________ common

- Usually respond to ___________.

- early morning

- 6th and 7th decade

- easily

- specific

- shorter; "explosive"; injuries

- clonazepam

REM sleep behavior disorder is primarily in _____ people and can cause _______ to bed partner

older; harm

Night terrors are mostly in ________. They entail abrupt awakenings out of Stage ______ sleep.

kids; 3

What happens during night terrors?

screaming, heart racing, and unable to communicate

Do people recall night terrors the next day?

no

Nightmares are ______ dreams and occur during _________ sleep. Individual experiencing these may be ________ but afterward, can tell you what is _________ on.

scary; REM; frightened; going

What are the similarities between Sleep Terrors and Nightmares?

both are parasomnias and both cause kids to be frightened