6.8 Sleep disorders, insomina

Insomnia

Most common sleep disorder.

. Individuals affected by this Narcolepsy often enter

REM sleep at the onset of sleep or within 10-15 minutes of falling asleep, which is abnormal. This indicates abnormal sleep-wake regulation as opposed to an increased need for REM sleep.

The FDA has approved several stimulant medications for the treatment of narcolepsy including commonly known drugs

Ritalin and Adderall. Xyrem is a CNS depressant that can be used to treat daytime sleepiness and episodes to cataplexy. SSRIs have also been successfully utilized to treat cataplexy

Narcolepsy

a sleep disorder that is characterized by excessive daytime sleepiness that is not relieved by a normal amount of nighttime sleep.

Secondary or comborid insomia

accompanies other medical conditions such as anxiety, depression, Alzheimer's disease, Parkinson's disease.

Sleep paralysis

also a disturbing symptom of narcolepsy. It can occur at the onset of sleep or upon awakening, leaving the person feeling as if they are unable to move, speak, or even breathe.

The most common class of prescribed sedatives

are the benzodiazepines and benzodiazepine receptor agonists (BZDAs), e.g., Ambien, Sonata, and Lunesta. They are commonly used because of their rapid onset and short duration of action

chronic insomnia

as 30 days or more of the previously described symptoms. This type of insomnia is almost always a result of another health issue as previously mentioned. Drug use can also cause insomnia. This can range from the effects of caffeine to recreational drug use.

OTC sedatives

can also be used including antihistamines (Benadryl). The adverse side effects of antihistamine use include daytime drowsiness and feeling as if you are "in a fog." Melatonin (natural or synthetic) is also a commonly used OTC sleep aid.

Patient education should be presented

covering sleep hygiene, avoidance of sleep deprivation, and safety during high risk activities, e.g. driving. Several short naps per day (approximately 15 minutes in length) have shown to help ease the symptom of daytime sleepiness

Ramelton

is an approved long-term use sedative prescribed specifically for sleep-onset insomnia. It is a melatonin receptor agonist that is selective for the MT-1 and MT-2 receptors and does not have abuse potential.

A diagnosis of narcolepsy

is given if the person exhibits a mean sleep latency time (amount of time it takes to transition from full wakefulness to sleep) of < 8 minutes and two or more episodes of sleep-onset REM during the repeated nap opportunities.

A diagnosis of primary insomnia

is given when other causes have been ruled out

Daytime sleepiness, and actually falling asleep

is typically the first symptom of narcolepsy. This usually occurs during sedentary, monotonous activity and is relieved with movement. These periods of daytime sleep usually last less than 30 minutes and are accompanied by bursts of talking in a nonsensical fashion and even peculiar behavior. Hypnagogic hallucinations occur at the onset of sleep and are extremely vivid.

Chronic inosomnia affects

more women than men and is also common among older adults which be caused by medical conditions and the need for prescribed medical conditions and the need for prescribed medication

Before a diagnosis of narcolepsy can be made

night and daytime sleep studies are performed.

Acute or adjustment

occurs for a short period of time. Sleep is disrupted as a result of an emotional or physical stressor. This can be brought on by a difficult life event or be as simple as going on vacation and not having the comforts of your own bedroom. This insomnia resolves on its own when the stressor is removed, or an adjustment is made

Treatment of acute insomnia should focus on

on proper sleep hygiene and the removal of the stressor that is causing the sleep disturbance.

Nighttime sleep studies will rule out

possible sleep apnea or any other nocturnal sleep disorder. This is followed by a daytime sleep study in which several nap opportunities are given

Chronic insomnia description

requires a thorough assessment to determine the underlying cause of the sleep disturbance.Sleep hygiene as well as relaxation and cognitive therapy should be utilized when applicable. Sedatives should be used with caution as they lose their effectiveness over time and can be habit forming.

Before one can be considered to have insomina,

they must exhibit above symptoms at least one during the time wakefulness

the disorder and a neurotransmitter called hypocretin

which acts to regulate periods of wakefulness. The results of several studies have suggested that a decrease in hypocretin levels may be the cause of narcolepsy with cataplexy

Treatment for any type of insomnia must begin

with patient education to promote good sleep hygiene (sleep habits.) This involves the establishment of consistent sleep patterns (going to bed at the same time each night and only sleeping as long as one needs to feel refreshed during the day), creating a comfortable sleeping environment (optimal room temperature), avoidance of screens and excessive light right before bed, and finally, avoidance of stimulants (caffeine) several hours prior to normal bedtime.

Disturbed nighttime sleep is also observed

with the presence of hypnagogic hallucinations, sleep paralysis, and cataplexy (brief periods of muscle weakness) - all related to REM sleep.

In order to properly diagnose someone with insomnia,

, a thorough sleep history must be done.It is strongly encouraged for the affected individual to keep a diary for at least 2 weeks to determine what types of patterns,Other information to note should include daytime symptomology, use of drugs (caffeine, alcohol, nicotine, and/or prescription) that could affect sleep, and a medical history to determine if there are comorbidities present that commonly cause insomnia. A sleep study may also be ordered to determine an underlying cause.

symptoms during the day time wakefulness

-Daytime fatigue -Impaired attention and/or concentration -Impaired attention and/or concentration -Impaired memory -Poor performance socially, occuptionally, and/or academically -Irritability -Tendency towards accidents(occupational or driving) -Headaches -GI distress

Insomina is considered to have insomnia if they experience

-Difficultly initiating sleep -Difficulty mainintaining sleep -Waking up too early -Chronic nonrestorative or poor sleep