Dyssomnias

Circadian-Rhythm Sleep Disorder

Circadian rhythm sleep disorders (CRSD) are a family of sleep disorders affecting, among other things, the timing of sleep. People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs.

Prevalence

68 percent of adults ages 18 to 29 report experiencing symptoms of insomnia, compared with 59 percent of adults ages 30 to 64, and only 44 percent of people over the age of 65. Not surprisingly, parents report more insomnia symptoms than adults without children in the household (66 vs. 54 percent).

Advanced sleep phase disorder (ASP) (Common Circadian-Rhythm Disorders)

ASP occurs when a person regularly goes to sleep and wakes up several hours earlier than most people. People with ASP tend to be "morning types" who typically wake up between 2 a.m. and 5 a.m. and go to sleep between 6 p.m. and 9 p.m. If able to go to bed at the preferred early time on a regular basis, a person with ASP will have a very stable sleep pattern. ASP affects approximately 1% in middle-aged and older adults and increases with age.

Alcohol-induced Sleep Disorder (extrinsic)

Alcohol taken to promote sleep Acts as a sedative, then a stimulant as the effects wear off Keeps people in the lighter stages of sleep: deep sleep and REM sleep are prevented Causes daytime fatigue and sleeplessness Treatment: Addiction prevention, sleep management counseling

Delayed Sleep Phase Disorder (DSP) (Common Circadian Rhythm Disorders)

DSP occurs when a person regularly goes to sleep and wakes up more than two hours later than is considered normal. People with DSP tend to be "evening types" who typically stay awake until 1 a.m. or later and wake-up in the late morning or afternoon. If able to go to bed at the preferred late time on a regular basis, a person with DSP will have a very stable sleep pattern. DPS is more common among adolescents and young adults with a reported prevalence of 7-16%. It is estimated that DPS is seen in approximately 10% of patients with chronic insomnia in sleep clinics. A positive family history may be present in approximately 40% of individuals with DPS.

Insomnia

Definition: Difficulty falling asleep or staying asleep Symptoms: sleepiness, fatigue, decreased alertness, poor concentration, decreased performance, depression, muscle aches, and an overly emotional state (i.e. being cranky). Acute insomnia-brief, often happens because of life circumstance. Often resolves without treatment. -Causes: stress (night before an exam), illness, pain, diet, medications, receive bad news Chronic insomnia- disrupted sleep that occurs at least three nights per week and lasts at least three months. -Causes: Changes in the environment, unhealthy sleep habits, shift in work, other clinical disorders, and certain medication

Narcolepsy (intrinsic)

Definition: Frequent daytime sleepiness; falling asleep spontaneously even if the afflicted person gets a normal amount of sleep at night. Must occur at least 3 times per week over a 3 month period. These "sleep attacks" can last from several seconds to more than 30 minutes and can include cataplexy (loss of muscle control during emotional situations), hallucinations, and temporary paralysis upon awakening. Causes: Usually hereditary, though it can be brought on by brain damage or neurological disease. Treatment: Use of stimulants, including amphetamine or amphetamine-like compounds, and modafinil. The most common amphetamine-like drugs are dextroamphetamine, pemoline methamphetamine, and methylphenidate (Ritalin). These are classified as Central Nervous System (CNS) stimulants.

Sleep Apnea (intrinsic)

Definition: The patient stops breathing during regularly sleep. The term apnea literally means "without breath." The period of stoppage is usually short (10-30 seconds) before breathing resumes. Causes: Airflow stops despite continued activity by the respiratory system -Airway is too narrow -abnormality or damage interferes with the ongoing effort to breathe -higher risk: obesity and increasing in age Treatment: The most common treatment for obstructive sleep apnea is continuous positive airway pressure (CPAP). While CPAP machines increase the quality of sleep, excessive sleepiness does not always go away.

Common Circadian-Rhythm Disorders

Each circadian rhythm sleep disorder involves one of these two problems: • You have a hard time initiating sleep. • You struggle to maintain sleep, waking up frequently during the night. • You tend to wake up too early and are unable to go back to sleep. • You sleep is nonrestorative or of poor quality.

3 Different Styles of Dyssomnia

Intrinsic (insomnia, apnea, narcolepsy) Extrinsic (insomnia due to substance use/abuse) Circadian Rhythm (delayed sleep phase type, advanced sleep phase type)

Prescription-induced Sleep Disorder (extrinsic)

Medications prescribed to manage sleep disorders cause insomnia Americans spend an estimated $16 billion to manage sleep disorders annually. Sleep aides have a high dependence → chronic insomnia develops with poor drug dosage reduction Stimulant ingestion is often used to combat daytime fatigue Treatment: physicians gradually reduce dosage of medication, sleep management counseling

Dyssomnias

Problems in the amount, timing, or quality of sleep. Problems getting to sleep, staying asleep, or of excessive sleepiness.

Current Research

Research supports new CBT treatment for insomnia (CBT-I) Patients complete sleep assessments & sleep diaries to learn how to change the way they sleep High demand for qualified practitioners to deliver therapy Benefit: no prescribed medications → no drug dependence Research regarding insomnia Johns Hopkins researchers report that people with chronic insomnia show more plasticity and activity than good sleepers in the part of the brain that controls movement.

Causes

Shift work · Pregnancy · Time zone changes · Medications · Changes in routine such as staying up late or sleeping in · Medical problems including Alzheimer's or Parkinson disease · Mental health problems

Substance- related Insomnia (extrinsic)

Sleeplessness due to use/abuse of alcohol, stimulants, drugs, poison exposure (e.g. lead) Resulting fatigue and sleeplessness is often treated with stimulants: caffeine, bronchodilators, decongestants, antidepressants, nicotine Identifying the cause of sleeplessness is often difficult because substances are often used together Common substance-related sleep disorders caused by: Alcohol Prescription drugs

REM & Non-REM Sleep Stags

Stage 1: a light doze, not very restorative. Stage 2: middle sleep, restorative Stage 3: slow-wave deep sleep, the most restorative of all. There are three phases of non-REM sleep. Each stage can last from 5-15 minutes. You go through all three phases before reaching REM sleep. REM Cycle-- Usually, REM sleep happens 90 minutes after you fall asleep. The first period of REM typically lasts ten minutes. Each of your later REM stages gets longer, and the final one may last up to an hour. Your heart rate and breathing quickens.

Cultural/Gender Issues

Women report insomnia twice as often as men Infants in the U.S. vs infants in other cultures Traditions, cultural values and local conditions and environment

Effects

sleep loss, excessive sleepiness, insomnia, depression, impaired work performance, disrupted social schedules, stressed relationships.

Treatment 2

• Lifestyle changes: People may cope better with certain circadian rhythm sleep disorders by doing such things as adjusting their exposure to daylight, making changes in the timing of their daily routines, and strategically scheduling naps • Sleep hygiene: These instructions help patients develop healthy sleep habits and teach them to avoid making the problem worse by attempting to self-medicate with drugs or alcohol. • Bright light therapy: This therapy synchronizes the body clock by exposing the eyes to safe levels of intense, bright light for brief durations at strategic times of day. • Medications: A hypnotic may be prescribed to promote sleep or a stimulant may be used to promote wakefulness • Melatonin: This hormone is produced by the brain at night and seems to play a role in maintaining the sleep-wake cycle. Taking melatonin at precise times and doses may alleviate the symptoms of some circadian rhythm sleep disorders.

Treatment

•Behavioral strategies: -Establish a bedtime routine -Relaxation techniques & breathing exercises -Avoidance of caffeine and alcohol -Cognitive behavioral therapy with a psychologist •Medication Treatment: -Both over-the-counter and prescription sleep medicines work to help people get to and stay asleep.