Lec 5- Sleep wake disorders

What is the formal definition of sleep?

"A behavior state characterized by specific postures (laying down, eyes closed), reduced motor activity, suspended consciousness, and decreased interaction/responsivity with low metabolism."

What are the four components of the multi-method approach to sleep assessment?

"Clinical Interview, Self-report Questionnaires & Symptom Checklists, Sleep Diary, and objective measurements (Polysomnography & Actigraphy)."

What is a sleep diary and why is it important?

"A commonly used assessment tool where patients record daily sleep patterns. It is a key element in the evaluation of insomnia and guides the implementation of CBT for insomnia."

What is Polysomnography (PSG)?

"The ""gold standard"" for objective sleep measurement where an individual spends a night in a sleep lab under supervision, with multiple channels of data collected (EEG, EOG, EMG, etc.)."

What is Actigraphy?

"A small, wristwatch-sized device that measures wrist movements to assess sleep or waking state over an extended period in a natural setting."

Describe the EEG pattern for Alpha waves.

"Large, extremely regular brain waves (8-13Hz) associated with drowsiness and a relaxed state."

Describe the EEG pattern for Beta waves.

"Fast brain-wave activity pattern (>13-30Hz) associated with a waking EEG and increased during REM sleep."

Describe the EEG pattern for Theta waves.

"Irregular, jagged, and low in voltage (4-<8Hz). Mainly seen during light sleep (stage N1)."

Describe the EEG pattern for Delta waves.

"Slow brain-wave activity pattern (<4Hz) associated with deep sleep (stage N3)."

What are the three distinct states that define sleep architecture?

"Wake, Non-rapid eye movement (NREM) sleep, and Rapid eye movement (REM) sleep."

What is the Two-Process Model of sleep regulation?

"The model proposing that sleep is regulated by two processes: the homeostatic sleep process (Process S - sleep drive builds with time awake) and the circadian process (Process C - biological clock generates alerting signals)."

Where is the internal biological clock located?

"In the suprachiasmatic nucleus (SCN) in the hypothalamus."

What is a Zeitgeber?

"External cues (like light) that entrain or synchronize our biological rhythm to the Earth's 24-hour light/dark cycles."

What hormone is key to regulating the sleep-wake cycle and where is it secreted?

"Melatonin, secreted by the pineal gland."

What is the downside of weekend sleep compensation?

"It disturbs the biological clock, leading to difficulty falling asleep on Sunday night and difficulty waking up on Monday morning, creating a vicious cycle."

What are the two major types of sleep disorders in the DSM-5?

"Dyssomnias (problems in amount, timing, or quality of sleep) and Parasomnias (abnormal behavioral/physiological events during sleep)."

What are the three required symptoms for Insomnia Disorder (Criterion A)?"

"1. Difficulty initiating sleep. 2. Difficulty maintaining sleep. 3. Early-morning awakening with inability to return to sleep."

What are the frequency and duration requirements for Insomnia Disorder?

"Frequency: At least three nights per week. Duration: Present for at least 3 months."

What key criterion was added in DSM-5 to rule out voluntary sleep restriction?

"The sleep difficulty must occur despite adequate opportunity for sleep."

How has the DSM-5 changed regarding comorbid conditions for Insomnia Disorder?

"It now allows comorbid medical and mental conditions, as long as they do not completely explain the insomnia."

What is the new concept of insomnia in relation to mental/physical illnesses?

"Insomnia is now seen as a stand-alone or comorbid clinical condition that warrants independent clinical attention, not just a symptom of another disorder."

What is the bidirectional relationship between insomnia and depression?

"Insomnia increases the risk of developing depression, and depression increases the risk of developing insomnia."

What is a common cause of insomnia according to classical conditioning?

"The bedroom/bedtime can become a conditioned cue for arousal and frustration rather than sleep."

Name two classes of pharmacological treatments for insomnia.

"Non-benzodiazepine hypnotics (e.g., Zopiclone, Zolpidem) and Benzodiazepines (e.g., Lorazepam, Diazepam)."

What are two disadvantages of pharmacotherapy for insomnia?

"Tolerance/dependence and daytime sedation/cognitive impairment."

What is CBT-I?

"Cognitive Behavioral Therapy for Insomnia, a collection of interventions targeting behavioral, cognitive, and physiological factors that perpetuate insomnia."

How does the long-term efficacy of CBT-I compare to medication?

"CBT-I retains its efficacy and has more durable, long-term effects compared to medication."

What is the core feature of Circadian Rhythm Sleep-Wake Disorders (CRSD)?

"A persistent or recurrent misalignment between an individual's sleep-wake pattern and the sleep-wake schedule desired or required by their environment."

What is Delayed Sleep Phase Type?

"A pattern of delayed sleep onset and awakening times, with an inability to fall asleep and awaken at a desired earlier time. Presents as sleep-onset insomnia."

What is Advanced Sleep Phase Type?

"A pattern of advanced sleep onset and awakening times, with an inability to stay awake until the desired bedtime or asleep until the desired wake time. Presents as early-morning awakening insomnia."

Name two treatments for CRSD.

"Chronotherapy (progressively delaying sleep time) and Bright Light Therapy (e.g., morning light for delayed phase)."

What is the core pathophysiology of Narcolepsy?

"Hypocretin (orexin) deficiency, a neurotransmitter involved in maintaining stable wakefulness and suppressing REM sleep."

What is Cataplexy?

"Brief, sudden episodes of bilateral loss of muscle tone with preserved consciousness, typically triggered by strong emotions like laughter or joking."

What are the three ways to fulfill the second diagnostic criterion for Narcolepsy (Criterion B)?"

"1. Presence of cataplexy. 2. Hypocretin deficiency measured in CSF. 3. Nocturnal PSG showing REM sleep latency ≤ 15 mins or MSLT showing mean sleep latency ≤ 8 mins with ≥2 sleep onset REM periods."

What is a key non-pharmacological management for excessive daytime sleepiness in Narcolepsy?

"Scheduled naps, though it is rarely effective alone and must be combined with medication."

What is a Parasomnia?

"Abnormal behavioral or physiological events that accompany sleep, occurring during entry into sleep, within sleep, or during arousals from sleep."

What disorder combines the former diagnoses of Sleepwalking Disorder and Sleep Terror Disorder?

"Non-Rapid Eye Movement (NREM) Sleep Arousal Disorder."

Describe a Sleep Terror episode.

"Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream, accompanied by intense fear and signs of autonomic arousal, with unresponsiveness to comfort."

Describe a Sleepwalking episode.

"Repeated episodes of rising from bed and walking about during sleep, with a blank stare, relative unresponsiveness, and difficulty being awakened."

What is the prevalence of sleepwalking in childhood vs. adulthood?

"Childhood: ~5-30%; Adulthood: ~2-5%."

What is the clinical feature of REM Sleep Behavior Disorder (RBD)?

"A spectrum of dream-enacting behaviors due to the loss of normal muscle atonia during REM sleep, ranging from simple limb twitches to complex, violent movements."

What is the critical link associated with RBD?

"It is a precursor to neurodegenerative disorders such as Parkinson's disease and Dementia with Lewy Bodies."

What are the first-line pharmacological treatments for RBD?

"Clonazepam and Melatonin."

According to DSM-5

what is a Nightmare Disorder?,"Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity."

How does a person wake up from a nightmare compared to a sleep terror?

"In Nightmare Disorder, the person rapidly becomes oriented and alert upon awakening. In sleep terrors, they are confused and unresponsive."

What did the Li et al. (2010) study find about sleep disturbances and suicide risk?

"Both insomnia and frequent nightmares were independently associated with an increased risk of suicide attempts, with a synergistic effect for those with comorbid insomnia and nightmares."

Why is formal assessment of sleep disorders important?

"Sleep problems are often comorbid with other physical and mental health problems and are associated with detrimental consequences (e.g., increased suicide risk, progression to neurodegeneration) if left untreated."