Sleep-Wake Disorders

The Biology of Sleep

Consequences of Poor Sleep

Further Health Risks

people who get > 6 hours of sleep a night are (vs more than 7 hours)
- 48% more likely to die of heart disease
- 15% more likely to develop a stroke
- 15% shorter life expectancy

How Much Sleep Do I Need?

for adults - depends on your overall health, daily activities, previous sleep deprivation, etc.
preschoolers (2-5 years): 10-13 hours
elementary children (5-10 years): 9-11 hours
adolescents (10-17 years): 8-10 hours
adults: 7-9 hours

REM Sleep

Insomnia

Insomnia Disorder (DSM 5-TR)

1) dissatisfaction with sleep associated with 1+
- difficulty initiating sleep
- difficulty maintaining sleep (frequently waking up; difficulty returning to sleep)
- early-morning awakening with inability to resume sleep
2) sleep disturbance causes distress or impairment
3) 3 nights a week for at least 3 months
difficulty occurs despite adequate opportunity for sleep
not better explained by something else; not due to substance use
Insomnia Severity Index

Insomnia Etiology

important to distinguish between sleep disturbance/difficulty sleeping + insomnia disorder
stress, irregular sleep schedule, lifestyle, mental health disorders, physical pain, medications, neurological disorders, age, other sleep disorders, pregnancy
- some of these would “rule out” a diagnosis
hyperarousal in the body
stress → racing brain waves, rapid heart rate, elevated body temperature
lifestyle factors → too much exercise in afternoon + evening
cognitive factors maintain insomnia
- during the day + at night while trying to sleep, individuals worry about whether they will sleep → creates cognitive + physiological arousal
- hypervigilant for things that might keep them awake
- believe they get less sleep than they actually do + attribute daytime problems to insomnia
- counterproductive behaviors to try to sleep
  - alcohol consumption, avoiding social engagements at night

CBT for Insomnia (CBT-I)

6-8 weeks (short)
cognitive: examine + modify thoughts about sleep
behavioral:
- stimulus control - associate bed/bedroom with sleep, avoid anything other than sleep in the bed
  - no phones, reading, etc
  - get out of bed if you haven’t fallen asleep by X amount of time
- relaxation training - breathing exercises, meditation, etc.

Narcolepsy (DSM-5-TR)

A) excessive daytime sleepiness at least 3x week for at least 3 months (periods irrepressible need for sleep, lapsing into sleep, or daytime napping)
B) the presence of 1 or more of the following
- episodes of cataplexy (brief, bilateral loss of muscle tone) occurring a few times a month
- hypocretin (hormone) deficiency
- REM sleep disturbances as determined by a formal nocturnal sleep study or multiple sleep latency test (MSLT)
severity specifiers
- mild: 1-2 naps/day needed
  - sleep disturbance/cataplexy (when present) is mild and infrequent
- moderate: multiple naps needed a day
  - sleep may be moderately disturbed
  - cataplexy (when present) occurs daily or every few days
- severe: nearly constant sleepiness
  - often higher disturbed nocturnal sleep
  - cataplexy (when present) is drug-resistant, with multiple attacks a day

Hypersomnolence Disorder (DSM-5-TR)

excessive sleepiness despite a main sleep period of 7+ hours with at least 1+ of the following
- recurrent periods of sleep or lapses into sleep within the same day
- getting more than 0 hours of sleep that is not restorative (i.e. refreshing)
- difficulty being fully awake after abrupt wakening
occurs 3x a week for 3 months
accompanied by distress or impairment in cognitive, social, occupational, other important areas
not better explained by something else (e.g., another sleep disorder), not attributable to a substance or medication
specify if:
- acute: duration less than 1 month
- subacute duration of 1-3 months
- persistent duration of more than 3 months
specify if:
- mild: difficulty maintaining daytime alertness 1-2 days/week
- moderate: difficulty maintaining daytime alertness 3-4 days/week
- severe: difficulty maintaining daytime alertness 5-7 days/week

Narcolepsy + Hypersomnolence Etiology + Treatment

etiology
- loss of neurons in the hypothalamus
- lack of orexin
- low levels of histamine
treatment
- medication - Modafinil (stimulant medication); other stimulants (e.g., low dose amphetamines) can help
- behavioral approaches - planned napping; sound sleep hygiene (improve nighttime sleep)

What Does Good Sleep Hygiene Look Like?