CHAPTER 16 SLEEP DISORDERS AND TREATMENT

Insomnia

Persistent problem where people have trouble falling asleep or staying asleep. •Sleep is often unsatisfactory and can lead to sleep deprivation effects like fatigue, moodiness and low energy levels.

Dysomnias

Problems falling asleep and staying asleep

Sleep Apnoea (parasomnias)

- Disorder where people stop breathing during sleep for between 10 and 60+ seconds. The person wakes up, gasps for breath and falls back asleep. •Linked to chronic snoring, can lead to low blood-oxygen levels due to not breathing causing hypertension and heart disease. •Can lead to daytime sleepiness and other sleep deprivation effects. •Children can suffer from obstructive sleep apnoea - tonsils and adenoids are often removed to remove blockages. •People with small airways or large tongues, people over 40, overweight people and Hispanic and Pacific Islanders are most at risk. •Most sufferers are unaware they have the condition •Sleep diaries and sleep labs are often used in diagnosis - CPAP used to treat

Parasomnias

Sleep problems that include unusual or abnormal behaviours are called parasomnias. Includes nightmares, sleepwalking, sleep aggressions, cessation or breathing during sleep.

Sleep onset insomnia (dyssomnia)

• Insomnia can be occasional (acute) or longer-term (chronic). Stress, pain, shift work, lifestyle can all contribute to chronic insomnia. •Often insomnia is co-morbid - it exists alongside other psychological or physiological conditions. •It is the most common sleep disorder in Australia with 10-40% of people suffering at any one time. •Females, the elderly and new parents are most likely to suffer. •Diagnosis is usually through a sleep diary, questionnaire or interview, sleep lab study or through blood tests. •Multiple treatment options, including CBT

Jet lag (circadian phase disorder)

•"west is best" •Easier to go to bed later and wake up later than go to bed earlier and wake up earlier. •TO MINIMIZE THE EFFECTS YOU SHOULD: •Try to start adjusting before you leave •Avoid stimulants like coffee •Resist the desire to sleep during the day - but if you have to, make it a short nap •Have a dark and quiet sleeping area. •Get out in the daylight as much as possible. •Use an alarm clock to set you to local wake up times. •Melatonin can be prescribed to help treat jetlag

CBT (cognitive behavioural therapy) to treat sleep-onset insomnia

•Cognitive behavioural therapy to treat insomnia (CBT-I) examines our thoughts and behaviours and how they contribute to poor sleep. •CBT-I works to set a healthy sleep pattern to overcome the insomnia. •Causes for the insomnia are investigated and then an individual plan is devised. This might involve learning new behaviours, changing routines and ensuring the environment promotes sleep. •A number of sessions (six to eight weekly sessions) are required to target the problematic behaviours that lead to insomnia •Common techniques include: Change what you do in bed (stimulus control therapy), Reduce time spent lying awake (sleep restriction therapy), reducing harmful habits before bed (sleep hygiene), Learning techniques to relax (relaxation training), creating a comfortable sleep environment (sleep environment improvement).

CPAP to treat obstructive sleep apnoea

•Continuous positive airway pressure •Machine provides a continuous flow of air to keep their airways open

Adolescent sleep-wake cycles (circadian phase disorder)

•DELAYED SLEEP-WAKE PHASE DISORDER - tendency to stay awake late and sleep in the next day. •Females tend to return normal sleep patterns at 19.5 years and males at 21 years •Teenagers need 9-10 hours of sleep, most don't get this •Release of melatonin (which makes us sleepy) and cortisol (which wakes us up) is released 1-2 hours later •Most adolescents have a sleep debt of at least 5 hours per week. •TV and phone screens at night might expose the brain to light- preventing melatonin release further •EFFECTS OF THE SHIFTED SLEEP CYCLE- daytime tiredness, impaired cognitive functioning, difficulty concentrating, increase in moodiness, diminished motivation, reduces memory creativity and learning, more susceptible to illness, more at risk of insomnia and depression.

Narcolepsy (Dysomnias)

•Debilitating sleep disorder that causes sudden sleep attacks during the day •Sufferers suddenly lapse into REM sleep and usually experience loss of muscle tone •Cataplexy may be experienced where they remain conscious but physically paralysed. Cataplexy is thought to be triggered by strong emotional responses. •Narcoleptics also show abnormal REM/NREM cycles - falling straight into REM sleep rather than moving through NREM phases •Sufferers sleep around the same amount as the average person but still experience extreme sleepiness throughout the day •There is no treatment or cure to narcolepsy but attacks can be minimised by • Maintaining a strict sleep routine • Carrying out regular exercise • Following a healthy diet • Having naps during the day • Avoiding alcohol, coffee and heavy meals • Avoiding strong emotional responses

Tips for a better night's sleep

•Follow a regular routine •Relax before bedtime •Avoid staying up late on weekends •Limit weekends sleep •Avoid caffeine after 3:00pm •Keep bedroom dark •Go to bed early Sunday night -Avoid stimulating activities before bed

Shift work (circadian phase disorder)

•Morning, afternoon, night shifts on rotation •Shift work disorders are most problematic •Disruptions are mainly caused by external (environmental, zeitgeners) factors. •If the shift workers body clock cannot adjust sufficiently, sleep is interrupted resulting in chronic sleep deprivation. •Night shift workers need to maintain their reversed sleeping patterns when not at work to help their cycle adjust •Avoiding the light by wearing sunnies is also thought to help. •Vitamin D deficiency can be a problem due to lack of sunlight exposure. •EFFECTS INCLUDE: sleep disorders, obesity, digestive problems, diabetes, hypertension, sexual dysfunction, chronic fatigue, mood swings, depression, and headaches.

types of sleep apnoea

•Obstructive sleep apnoea - blockage in the airways •Central sleep apnea - brain not regulating breathing

Sleep walking (somnambulism) - (parasomnias)

•Sleep walking occurs in stages 3 and 4 and people usually carry out simple automatic processes which require little conscious awareness. •Sleep walking does not accompany a dream and you can wake someone who is sleepwalking if needed. •7% of children and 2% of adults sleepwalk and this behaviour can run in families. •There is not a lot to be done to treat sleepwalking. Best solution is to keep the house safe.

TYPES of insomnia

•Sleep-onset insomnia - trouble falling asleep •Sleep maintaining insomnia - difficulty staying asleep •Early morning awakening insomnia - waking too early.

Bright light therapy to treat Circadian Phase disorders

•The bright light is administered to advance or delay sleep. •It acts as a zeitgener to adjust the body clock to stop melatonin production (which promotes sleep) or promote cortisol (which wakes us up.) by signalling the body's Suprachiasmatic nucleus. •There are minimal side effects but its use is managed by a specialist. There can be dry skin, headaches and nausea from the light - especially early on.

Suprachiasmatic nucleus (SCN)

•The circadian rhythms of our body are controlled by the Suprachiasmatic nucleus (SCN). This is a cluster of neurons in the hypothalamus that is linked to the pineal gland where melatonin is released. •The SCN is also linked with our visual system and reacts to changes in light •DAY - SCN signals to body to decrease melatonin and increase cortisol •NIGHT - Eyes tell SCN of low light causing pineal gland to produce melatonin and decrease cortisol

Circadian phase disorders

•When a person's circadian rhythms (internal sleep-wake clock) are disrupted resulting in disturbed sleep and daytime tiredness. •Daytime effects - excessive tiredness and desire to sleep, lethargy, difficulty following schedule, •Difficulty accessing memory and learning, mood swings and decreased emotional control. •Nighttime effects- difficulty falling asleep at required time, maintain sleep for desired time and waking frequently.