3010 - Sleep-wake disorders

Sleep-wake disorders are involved in

healing issues, memory, hormones

consequences of sleep deprivation

memory issues, depression, irritability, weaker immune system, increased perception of pain; brain more active than normal, hormones increase to eat more food (carb, sugar)

leptin signals what

when you are full

microsleep

3-15 sec. sleep episode that occurs in the middle of wakeful activity

fatal familial insomnia

an inherited disorder in which humans sleep normally at the beginning of their life but in midlife stop sleeping and, 7-24 months later, die--genetic mutation of prion protein

polysomnography (PSG) evaluation

comprehensive picture of sleep habits

Electroencepholograph

brain electrical activity

electrocardiogram

record of the electrical activity of the heart

Electromyography (EMG)

the electrical recording of muscle activity and tension

electrooculograph

records ocular muscle activity and tension

other bodily functions observed for measuring sleep activity

breathing rate, temperature

sleep efficiancy

measured based on the amount of time they were asleep divided by the amount of time spent in bed

beta sleep waves

13-24 cps, alert and problem solving

Alpha waves

8-12 cps, resting and relaxation

Theta waves

4-7cps, low alertness and sleep (just entering sleep/stage 1; dream but cannot recall)

Delta waves

less than 4cps, deep dreamless

how often does a cycle of sleep last?

90 min

Stages 1-3 characteristics

non-rem sleep, no eye movements, progression of relaxed state, less likely to recall vivid dreams if woken up, may be confused

NREM stage 1

transition stage: alpha --> theta (hypnic jerks, myoclonic jerks; hypnagogic imagery) -- wake up clearly

NREM stage 2

char. by more mixed brain wave activity, brain slows down: sleep spindles and K-complexes

k-complexes

slow single rise

NREM stage 3 sleep

slow-wave sleep/deep sleep - delta brain-wave patterns, deepest stage of sleep

REM sleep

vivid dreams, quick eye movements, EEG similar to wake, initially shorter, progressively longer, as cycle continues

who/when discovered REM sleep

Kleitman & Aserinsky in 1952

Ratio of time spent in sleeping stages

20% in deep sleep, 30% dreaming, 50% light sleep

Dyssomnias

disorders that negatively impact the quantity and quality of sleep

Parasomnias

abnormal events that occur during sleep

Sexsomnia

engaging in sexual behavior while asleep

insomnia disorder

difficulty falling asleep, maintaining sleep, restorative sleep, occurs 3 nights a week for 3 months

Nonrestorative sleep

refers to sleep that is of adequate duration, but does not result in the individual feeling refreshed and alert the next day

percentage of adults that exp. insomnia

16.2% adults

percentage of adults with severe insomnia

7.9%

percentage of adults that meet the criteria for insomnia in Canada

16.3%

Insomnia is more common in

women

What is one cause of insomnia related to physical conditions?

Pain

What is a cause of insomnia related to lifestyle?

Physical inactivity

What biological factor can contribute to insomnia?

Biological clock

How does light exposure affect insomnia?

It can disrupt sleep patterns.

What temperature-related factor can cause insomnia?

Increase in body temperature when it normally falls

What type of substance use can lead to insomnia?

alcohol, cannabis, opioid use, cocaine and stimulants such as methamphetamine.

What type of factors can contribute to insomnia from the environment?

What vulnerabilities make you vulnerable to insomnia

light sleeper, family history of sleeping disorders

psychological reasons for insomnia causes to disorders

psychological stress, cognitions (unrealistic expectations)

what shows insomnia increased during COVID?

8% increase in the use of sleeping medication

Maladaptive reactions for insomnia causes

self-medication, daytime naps disrupt night sleep, appetite napping (15min after lunch nap)

cultural factors to insomnia

used to co-sleeping, independent sleep --> sleeping issues

Hypersomnolence DIsorder

Sleeping too much or excessive sleep

Experience excessive sleepiness as a problem

consequences from hypersomnolence disorder

less successful academically, complain of tiredness, personally upsetting

onset types of hypersomnolence disorder

acute ( less 1 month), subacute (1-3months), persistent ( more 3months)

Narcolepsy

daytime sleepiness, sudden onset of REM sleep

Type 1 narcolepsy

fewer cells that produce orexin/hypocretin, presence of cataplexy (sudden loss of muscle tone) -- type 2 opposite

sleep paralysis

period after awakening when person can't move/speak

hypnagogic hallucinations/imagery

vivid experiences that begin at the start of sleep and unbelievable realistic

Breathing related sleep disorders

breathing disrupted during sleep, disrupted sleep and sleepiness during the day, experience brief arousals throughout night, only min. aware of breathing difficultires

sleep apnea

difficulty breathing at night, morae common in men and older adults; comorbid with obesity

Obstructive sleep apnea hypopnea syndrome

type of sleep apnea, airflow STOPS despite continued respiratory system

Central sleep apnea

complete CESSATION OF RESPITORY ACTIVITY for brief periods and is often associated with certain central nervous system, disorders

Cheyne Stokes Respiration

abnormal breathing pattern with gradual increases/decreases in breathing depth followed by temporary pauses, type of central sleep apnea; wake up frequently

circadian rhythm sleep disorder

brain unable to synch sleep patterns with day/night clock

cause of circadian sleep-wake disorders

light levels --> retina --> suprachiasmatic nucleus (SCN) of hypothalamus --> pineal gland --> secretion of melatonin which adjusts biological clock; when messed up --> works not great

Jet lag type of CRSWD

difficulty falling asleep at proper time due to travel

shift-work type of CRSWD

working off hours interferes with sleep cycles

Delayed/advanced sleep phase type (night owls)

sleep later than normal bed time

irregular sleep-wake type

varied (non-24 sleep-wake type), sleeping on a 25 or 26 hour cycle with later and later bedtimes

Parasomnias

Abnormal behaviors such as nightmares or sleepwalking that occur during sleep.

Nightmare disorder

REM sleep disorder

Causes of nightmare disorder

genes, trauma, medication use, psychological disorders (Substance use, anxiety, borderline personality, schizophrenia spectrum disorder)

REM sleep behaviour disorder

individual talks or moves while sleeping, sometimes acting out a dream

What are sleep terrors?

A disorder of arousal characterized by episodes of intense fear during NREM sleep.

What is sleepwalking?

A disorder of arousal where a person walks or performs other complex behaviors while still asleep.

In which age group is sleepwalking most common?

Children

What is sleep-related eating behavior syndrome?

A disorder where a person eats while still asleep.

What is sexsomnia?

A disorder characterized by sexual behavior occurring during sleep.

What disorders are associated with sleepwalking in adults?

Other disorders, such as anxiety or sleep disorders.

What percentage of Canadians use medications for sleep-wake disorders?

10%

What are the two types of benzodiazepines used for sleep-wake disorders?

Short-acting and long-acting

What is a consequence of using benzodiazepines for sleep-wake disorders?

Excessive sleepiness

Are benzodiazepines meant for long-term or short-term use?

Short-term use

What issue can arise from the dependence on benzodiazepines for insomnia?

Rebound insomnia

Stimulants prescribed for hypersomnolence and narcolepsy

Methylphenidate (Ritalin)

Effects of Ritalin

increases brain activity, helps with awakeness and alertness during the day

Treatment for breathing-related sleep disorders

weight loss, medications stimulate respiration, CPAP (continuous positive air pressure

Environmental treatments of sleep-wake disorders

Phase delays (moving the bedtime later) easier than phase advances (moving bedtime earlier)

Bright light (>2500 lux) used to trick the brain into readjusting the internal clock

Psychological treatments for sleep disorders

combination of medication and CBT, CBT-1, stimulus control, bedtime routines, cognitive restructuring, progressive/cognitive relaxation

cognitive restructuring

focus on changing unrealistic expectations and beliefs about sleep, reducing anxiety and thinking about sleep needs

progressive/cognitive relaxation

meditation, imagery techniques are effective

treatment for children struggling to sleep alone

graduated extinction (checking on child at longer intervals, help them to learn to sleep independently)

Paradoxical Intention

involves doing the opposite of the desired behaviour, trying to stay awake instead of trying to fall aslweep

Why does warm milk help you sleep?

tryptophan -- precursor of 5-HT, precursor for melatonin and peptides that help with relaxation