Sleep disturbances

Question 1

Define sleep disorders

Answer 1

A collection of (9) sleep disturbance disorders in the DSM5 characterised by reduced capacity to fall asleep or stay asleep resulting in daytime sleepiness / fatigure that interferes with an individual ability to function in their IADL’s.

Question 2

What are the treatment types (groups) for sleep disorders.

Answer 2

1. Sleep hygine (routine, exercise, diet),
2. Stimulus control (minimise light / noise & screens),
3. Behaviour therapy (relaxation techniques),
4. Medication (Non-benzos), &
5. Rarely benzos.
   * Note medications of any sort should be used for less than 2 months.

Question 3

List specific sleep hygine components for the managment of sleep disorders.

Answer 3

1. Sleep routine (going to sleep and waking at the same time every day).
2. Regular exercise (not right before bed).
3. Avoiding caffine and smoking in the evening.
4. Avoiding alcohol.
5. Avoiding day time naps.
6. Don’t go to bed hungry.

Question 4

List specific stimulus control methods to manage sleep disorders.

Answer 4

1. Avoid bright lights and noise (earplugs and eye masks helpful if unavoidable).
2. Use the bed only to sleep (not watch movies etc).
3. Avoid bright screens / phones before bed.

Question 5

List specific behaviour managment techniques for the treatment of sleep disorders.

Answer 5

1. CBT - aid in managing life stressors and individual stress responses.
2. Relaxation techniques.
3. Light phase shift therapy - important for circadian rhythem disturbances.

Question 6

List specific medications that can be used in the treatment of sleep disorders.

Answer 6

Diphenhydramine (antihistamine - lower evidence - benifits = harm).
Melatonin (low evidence - benifits = harm).
Benzos (harm outweighs benifits except for tamazapame (short dose ie 2-4 weeks tops).

Question 7

What is the criteria for the DSM5 diagnosis of Insomnia?

Answer 7

1. Difficulty falling asleep or staying asleep that,
2. Results in a sleep pattern that effects an individuals life functioning (IADL’s),
3. That occurs for more than 3 nights per week over 3 or more months.
4. Symptoms cannot be better explained by an alternative medical condition, medication or other sleep condition.

Question 8

What are the two main stay tests used to assess sleep in patients.

Answer 8

1. EEG (measures brain waves) and
2. Polysomnography (measures brain waves, respiratory cycles, chest and abdomen expansion, O2 saturation ie in sleep aponea).

Question 9

What is the net change observed in an EEG throughout the stages of sleep?

Answer 9

As a person moves from Sleep state 1 through to state 3 the EEG wave forms slow and become less frequent. In REM sleep (a wakefulness period) the EEG wave forms increase in frequency again. An average person has 4 to 5 cycles per night.

Question 10

What waves are observed on EEG when an individual is away and have their eyes open?

REM sleep shows wave activity very similar to awake waves.

Answer 10

Beta waves

Question 11

What waves are observed on EEG when an individual is awake and eyes closed?

Answer 11

Alpha waves

Question 12

What waves are observed on EEG when an individual is in non-REM sleep stage 1?

Answer 12

Theta waves

Question 13

What waves are seen on EEG when an individual is deep sleep (non-REM stage 3)?

Answer 13

Delta waves

Question 14

What neurotransmitters are considered of primary importance to wakefullness and sleep?

Answer 14

Wakefulness - Glutamate (among others)
Sleep - GABA