Sleep Disorders

sleep disorders

• Parasomnias: disorders of arousal or sleep stage transition

• Dyssomnia

  • Disorders of initiating or maintaining sleep

  • Daytime sleepiness is always a criteria

• Primary versus secondary (due to another mental illness) sleep disorders

  • Leads to great difficulty in determining prevalence rates

• Diagnosis ideally based on sleep study in a laboratory

  • People are very poor at accurately quantifying their sleep
    duration

Dyssomnias

• Insomnia: difficulty initiating sleep, maintaining sleep,
  or experiencing non-restorative sleep

• The sleep difficulty occurs at least 3 nights per week.

• The sleep difficulty is present for at least 3 months.

• The sleep difficulty occurs despite adequate opportunity for sleep

• Narcolepsy

  • Irresistible attacks of refreshing sleep that occur at least three times per week over the past 3 months

  • Cataplexy (sudden bilateral loss of muscle tone) and/or intrusion of REM into sleep transitions

  • Hypnagogic (while falling asleep) and hypnopompic (before waking) hallucinations

• Circadian rhythm sleep disorder

  • Excessive sleepiness or insomnia due to mismatch between sleep-wake schedule required by environment and patient's circadian sleep-wake pattern

  • Jet-lag, shift-work, delayed sleep phase

hypersomnolence disorder

• Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the
  following symptoms:

  • Recurrent periods of sleep or lapses into sleep within the same day.

  • A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing).

  • Difficulty being fully awake after abrupt awakening

parasomnias

• Nightmare disorder

  • Repeated awakenings from sleep with detailed recall of extremely frightening dreams

  • When awoken, rapidly become oriented and alert

  • Usually occurs in the last half of sleep period

• non-REM Sleep Arousal disorders

  • Recurrent episodes of incomplete awakening from sleep with amnesia for the episode

  • Sleepwalking, sleep terrors, relatively unresponsive to comforting

  • Occurs in the first third of sleep period

• REM sleep behaviour disorder

  • Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors

  • Last third of night

  • Behaviour is consistent with dream content

  • Fully awake and oriented upon awakening

sleep disorders - treatment

• Treatment usually involves looking for and treating the underlying cause (substance use, another mental illness, stress)

• Medications for sleep dyssomnias:

  • Insomnia is treated with benzodiazepines and others drugs that act on GABA receptors (zopiclone), but often have problematic side effects

  • Narcolepsy is usually treated with stimulant medication (methylphenidate and modafinil)

• Behavioural treatment of nightmare disorder include lucid dreaming therapy and self-exposure therapy

• For all sleep problems, psychologists use psychoeducation regarding sleep hygiene:

  • Regular bedtimes

  • Don't stay in bed if you cannot sleep

  • Minimize lights and sounds

  • No caffeine, heavy meals, or alcohol within a few hours of sleep

  • Only use bed for sleeping and s*x (no TV/phone/computer in the bedroom)

Insomnia

• A. A predominant complaint of dissatisfaction with sleep quantity or
  quality, associated with one (or more) of the following symptoms:

  • 1. Difficulty initiating sleep

  • 2. Difficulty maintaining sleep

  • 3. Early-morning awakening

• B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning

• The sleep difficulty occurs at least 3 nights per week.

• The sleep difficulty is present for at least 3 months.

• The sleep difficulty occurs despite adequate opportunity for sleep.

• The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).

• The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication)

• other diagnostic features

  • Sleep-onset insomnia (or initial insomnia)

  • Sleep maintenance insomnia (or middle insomnia)

  • Late insomnia

  • Difficulty maintaining sleep is the most common single symptom of insomnia

  • Followed by difficulty falling asleep

• associated features supporting diagnosis

  • physiological arousal

  • cognitive arousal

  • conditioning factors

  • excessive attention and efforts to sleep contribute to the development of insomnia