Transcript Sleep Disorders - Presented at the Grosse Pointe Men`s Club

Making Your Sleep
Healthy and Happy: Sleep
Disorders
Dr. Barbara C. Fisher
United Psychological Services
Director
Certified Behavioral Sleep Medicine
47818 Van Dyke Rd.
Shelby Twp., MI 48317
586.323-3620
www.unitedpsychologicalservices.com
Seminar Objectives
1. Defining sleep
2. Sleep parameters: Process S and C,
sleep stages
3. Aging changes
4. Common sleep disorders: Circadian
Rhythm, Sleep Apnea, RLS, PTSD
5. Good sleep hygiene
6. Behavioral therapies
Sleep Disorders
• Two factors influence how sleepy or alert
anyone is during a 24 hour period of time.
• 1. Sleep-Wake Balance Process S: How long
it has been since you last slept- the longer
you stay awake the sleepier you become
• 2. Circadian Rhythm Process C: Your body’s
biological clock; the natural timing system
which tells you when to sleep and when to be
awake.
Circadian Rhythm
• Master clock
• Modulates daily cycles of:
– Core body temperature
– Blood pressure
– Hormone secretion
– Immune response
– Sleep wake cycle
Normal Adult Sleep
• Average amount of sleep per night: range
of 6.5 to 8.3 hours
• Normal sleep latency: 10 minutes
• Normal sleep structure
– 5% stage 1
– 50% stage 2
– 15-25% stages 3 and 4 (slow wave sleep)
– 25% REM
• Napping occurs at the beginning and the
end of life (in our culture)
Poor sleep at night leads to:
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Mood and emotional changes
Aggressiveness, poor impulse control
Augments depression
Cognitive deficits: attention, memory,
confusion, not thinking clearly, easier
to make mistakes
Sleep Changes with Age
• Increased awakenings and arousals
• Decreased REM sleep
• (Probably) decreased SWS
• Increased stage shifts
• Fewer “cycles”
• Reduced sleep efficiency
• Phase advancement
Circadian Rhythm Sleep Disorders
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Delayed Sleep Phase type
Advanced Sleep Phase type
Irregular sleep-wake type
Free Running Type
Jet Lag type
Shift Work type
Due to medical condition or substance
abuse
Sleep Related Breathing Disorders
• Central Sleep Apnea (Cheyne Stokes, High
altitude, Medical condition, Substance abuse,
Infancy)
• OSA (arrthymia 58%)
• Sleep related Hypoventilation/Hypoxemic
Syndrome
• Sleep related Hypoventilation/Hypoxemic due
to medical condition
• Sleep Related Breathing Disorder/ Upper
Airway Resistance Syndrome (UARS)
Sleep Apnea
• Decreased REM sleep, sleep not refreshing
• Chronic, loud snoring, gasping or choking
episodes
• Excessive daytime sleepiness (drowsy when
driving)
Automobile or work related accidents due to
fatigue
• Personality changes or cognitive difficulties:
Neuropsychological evaluation reveals
memory deficits and frontal deficits
Causes of Sleep Apnea
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Age (tonicity decreases)
Smaller than normal jaw
Enlarged tonsils
Lateral pharyngeal walls close in
Large tongue
Tongue moves posterior which displaces
the soft palate
 Tissues that partially block the entrance to
the airway
Insomnia
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Adjustment Insomnia
Psychophysiological Insomnia
Paradoxical Insomnia
Idiopathic Insomnia
Inadequate Sleep Hygiene
Behavioral Insomnia of Childhood
Insomnia due to substance abuse
Insomnia due to a medical condition
Factors Affecting the Development
of Insomnia
Perpetuating
factors
Conditioning
Substance Abuse
Performance Anxiety
Poor sleep hygiene
Insomnia
Predisposing
factors
Personality
Sleep-Wake cycle
Circadian Rhythm
Coping Mechanisms
Precipitating
factors
Situational
Environmental
Medical
Psychiatric
Prescription Medication
Periodic Limb Movement Disorder
(PLMD)
• Stereotypic, repetitive movements of the
legs (or arms)
• During sleep / inactivity
• Every 20-40 seconds
• May be associated with arousals from
sleep
• Occur in minimum clusters of 4
Patient Complaints with RLS
• Sleep disturbances
• Difficulty falling asleep and staying asleep
• Need to walk around (“nightwalkers”)
• Daytime sleepiness
Associated Conditions
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Neuropathies, myelopathies, and radiculopathies
Pregnancy
Anemia (iron deficiency)
Chronic renal failure
Folate / B12 deficiency
Medications (tricyclics, SSRI’s, caffeine)
Obesity
Hypothyroidism
RLS and ADHD
• RLS were greater in patients who had
ADHD versus those who did not(p<0.001)
• Recommendation if patient diagnosed
with ADHD need to screen for RLS
• Recommendation if patient diagnosed
with RLS need to screen for ADHD
• Consider medication such as dopamine
agonists
PTSD Sleep Problems
• Universal complaints, fragmented sleep
• Inability to sleep, difficulty initiating &
maintaining
• Anxiety arousals are common in PTSD
• REM and non-REM nightmares
• Repetitive nightmares are common
• Nightmares often represent a "re-living" of
the original trauma and associated emotions
Good Sleep Habits
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Regular routine to unwind
at night
Avoid all products containing caffeine
(soda and chocolate)
Avoid smoking and smokeless tobacco
Avoid use of alcohols
No stimulating activities in the evening
Promote calm family atmosphere prior to
bedtime
Good Sleep Habits
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Avoid falling asleep while
watching television or video
Establish regular exercise routine and
healthy diet
Avoid late afternoon and evening bright
light
Avoid changing pattern on weekends
Avoid napping-short power nap only
American Academy of Sleep Medicine, 2002
Identify the Sleep Factors
• Sleep History and Sleep Schedule
• Sleep logs/diary: morning and bedtime
habits
• Actigraphy
• PSG
• Bedtime routine, bedroom environment
• Sleep related cognitions
• Daytime sleepiness, memory
Behavioral Treatment
• Sleep hygiene
• Daytime, evening, morning habits
• Exercise-evening walk for the aged
• Limit napping
• Nocturnal activities hour
• Bedroom environment
• Cognitive behavioral therapy (CPT): 6
sessions for Insomnia
Problematic Sleep Habits
Night time habits:
• Irregular sleep wake schedule
• Too much time in bed: TIB
• Falling asleep to the radio/TVs
• Trying too hard to sleep
• Clock watching
• Long awakenings
Problematic Sleep Habits
Morning Habits
• Lingering in bed awake in morning
• Extra sleep on weekends
• Bedroom disturbance
(noise, sun light)
Address the Sleep Problem:
Don’t Wait
• Daytime sleepiness is a big deal!
• Don’t try to do everything at nightschedule your day for maximum
performance
• Set specific times in office or
home for paperwork vs. phone
calls on daily basis-avoid
build-up and worry
Don’t Worry-Be Happy
• Too anxious: Exercise twenty minutes on
a daily basis-often running or biking are
helpful
• Feeling overwhelmed: Watch the stress &
feeling overwhelmed- too many things are
going on at one time
Don’t Worry-Be Happy
• Too much to do and no time to do it:
Manage time by specifically estimating each
task- add up time for exact time estimatesto decrease over-planning
• Distractibility increased:
– Stress & lack of food tend to
increase distractibilityincreased lack of focus
Don’t Worry-Be Happy
• Staying up late to complete all your goals:
Issue of diminishing returns: Time spent vs.
being tired-examine from larger perspectivewhat really has to be done in the grand
scheme of things.
• Is that last task more important than health?
Don’t Worry-Be Happy
• Easily frustrated- short fuse:
Result of too much stress, lack of food, feeling
totally overwhelmed. These are wake up calls
for life changes & “nice moments of time”
• More tired= Energy loss, channel clickers
• Wake up call for life changes: Check sleep,
eating habits. These are often the result of
continually compensating for something else
such as a sleep disorder or ADD/ADHD.
Sleep is a necessary
function of life
Make it Healthy: Increase
your happiness
Good Night and Good Luck