Transcript Sleep disorders

Sleep Disorders
Disorders of Sleep
One in Three Individuals are Dissatisfied with
Their Sleep
 58% Adults Snore
 36% Complain of Insomnia
 15% note persistent Excessive
Daytime Sleepiness
 3% Unusual Nocturnal Behaviors
 28% Workforce on night or rotating
shifts
Age and Sleep Disorders
Traditional classification of sleep disorders
 Dyssomnias: They are associated with
difficulty initiating or maintaining the sleep or
daytime sleepiness.
 Parasomnias: Abnormal behavioral or
physiological events occurring during sleep
but don’t involve the sleep mechanisms.
Sleep Disorders
• Currently, 107 distinct sleep disorders
(82 recognized in ICSD2, 25 proposed)
• 4 x Disorders to be examined:
• Sleep Apnea
• Insomnia
• Narcolepsy
• Somnambulism (sleep walking)
Dyssomnias
Obstructive Sleep Apnea
 Repetitive episodes of airway collapse associated with
arousals and oxygen desaturation.
 Patients have hundreds of events per night.
Sleep Apnea – the facts
 Obstructive Sleep Apnea occurs in;
 9-24% Adults Males
 3-9% Adult Females
 3-15% of Children
 More likely with:
 Obesity
 Smoking,
 Narrow airway,
 Heart disease
 Brain disease
Problems with Sleep Apnea
 Increases the manifestations of other medical and
psychiatric disorders:
 Heart failure,
 Stroke,
 Epilepsy,
 Depression
 Sudden infant death syndrome (SIDS) is sleep apnea
Treatments:
• Sleeping pills are not perfect—most bind to GABA
•
•
•
•
receptors throughout the brain.
Continued use of sleeping pills:
Makes them ineffective
Produces marked changes in sleep patterns that persist
even when not taking the drug
Can lead to drowsiness and memory gaps
OSA Treatment
 Surgery
 Dental Device
 Weight Loss
 Medication
 Avoidance of alcohol
 Sleep on side

Continuous Positive Airway Pressure
Machine pumping
in air
Fat bloke
Tube and mask
for air supply
INSOMNIA
Total sleep deprivation compromises the
immune system and leads to death.
The disease fatal familial insomnia is
inherited—in midlife people stop sleeping
and die 7-24 months after onset of the
insomnia.
I. Insomnias – the facts





Prevalence: 33-36%
Accompanied with daytime consequences: 10%
Last more than 1 year: 85% (persistent insomnia)
Male:female = 1:1.4
Increase with age: above 65 years: 50%
Qu. Why Are Women Not Getting
the Sleep They Need?
• Lifestyle impacts sleep;
• Working mothers (72%) and single
working women (68%) are more
likely to experience insomnia
• 84% pregnant women report
insomnia for a few nights each week
• Other factors;
• Noise (39%)
• Giving care to children (20%)
• Pets (17%)
Other factors causing Insomnia?
Primary insomnia – caused by biological factors
2. Inadequate sleep hygiene (10%)
3. Insomnia due to mental disorder (30-40%)
4. Insomnia due to drug or substance
1.
Treatment of Insomnia?
 Pharmacologic treatment
 Treating the medical or psychiatric conditions
 Nonpharmacologic:
 behavioral treatments: normalizing the circadian rhythm
 sleep hygiene
 cognitive behavior therapy
 sleep restriction therapy
Frequency of Using Sleep Aids
(At least a few nights a week)
29%
Net: Any
15% Prescribed
Anti-depressants 12%
Prescribed Sleep medication 3%
Net: Prescription
12%
Net: OTC
Alcohol, beer or wine
Eye mask/Earplugs
0%
5%
3%
20%
40%
60%
80%
100%
Pharmacologic treatment
•
Benzodiazepines
•
Selective GABA drugs
Melatonin receptor sensitising drugs
•
Problems with insomnia research?
Parasomnias
Narcolepsy
 SYMPTOMS:
 Have frequent sleep attacks
and excessive daytime
sleepiness
 Do not go through SWS
before REM sleep
 May show cataplexy—a
sudden loss of muscle tone,
leading to collapse.
Causes of Narcolpsy?
 Narcoleptic dogs have a mutant
gene for a hypocretin receptor.
 Hypocretin normally prevents
the transition from wakefulness
directly into REM sleep.
 Interfering with hypocretin
signaling leads to narcolepsy.
Treatments of narcolepsy?
SLEEP PARALYSIS
• Sleep paralysis is the brief
inability to move just before
falling asleep, or just after
waking up.
• It can be broken by being
touched by someone.
• It may be caused by the
pontine center continuing to
signal for muscle relaxation,
even when awake.
Qu. When do people get the most incidents of
sleep paralysis?
Changing sleeping
position reduces
sleep paralysis
SLEEP WALKING
• Somnambulism (sleepwalking)
occurs during stages 3 and 4 SWS,
and may persist into adulthood.
• 25% children will sleep walk, but
most adults lose ability.
(3) REM Sleep Disorder
I was a halfback playing football, and after the quarterback
received from the centre, he passed it to me and I’m supposed
to go around and then cut back in. As I cut back in there is this
big 280-pound tackle waiting so I, according to the rules,
shoulder barged him…..
-
When I came to I was standing in front of our dresser and I
had gotten out of bed and run and knocked lamps, mirrors and
everything off the dresser, hit my head against the wall and
my knee against the dresser Schenck et al. (1986)
Critique of Sleep Studies?
 Labor intensive
 Require technologists to attend patient
all night
 Technologist must score and summarize
the physiology for the recording