Week 3 - Sleep Disorders Flashcards
(38 cards)
What are the characteristics of normal sleep?
- Reversible state of immobility
- cyclical
- ritualistic
- active (
- essential for mental and physical health
What are the 3 ways to classify/ examine sleep disorders?
- International Classification of Diseases (ICD-11) (medical model)
- International Classification of Sleep Disorders (ICSD-3)
- The Diagnostic and Statistical Manual (DSM-5)
- -> Sleep-Wake Disorders
What brain region is implicated in wakefulness?
- Brain stem
- Forebrain/ cortex
What brain region is implicated in sleep?
- ventrolateral preoptic nucleus sends inhibitory signals to arousal centres promoting sleep state
- problems with these regions cause disorders. with wakefulness/sleep or on the cusp (Parasomnia)
Why do sleep disorders have their own classification system?
- There are 85+ sleep disorders according to the ICSD-3
- Sleep is critical for health (third pilar)
- Costs 66.3 Billion: healthcare costs & loss of productivity
Define Insomnia (Primary)
Predominant complaint of: initiation, maintenance or early morning awakening
What is the DSM-5 criteria for insomnia (primary)?
A) Predominant complaint of: initiation, maintenance or early morning awakening
B) clinically significant distress/ impairment
C) 3 times per week
D) Sleep difficulty presents for at least 3 months
E) Sleep difficulty occurs despite adequate opportunity for sleep
F) Disturbance not caused by another sleep disorder
G) Disorder not due to another mental/ substance or general medical disorder
Describe the characteristics of insomnia (primary)
Difficulties with sleep:
- initiation
- consolidation
- quality
- daytime impairment
Describe the causes of insomnia
- Circadian timing
- Sleep should be aligned with biological signal for sleep
Describe the prevalence of insomnia
- 10-30%
- 3rd cause of seeing physician
- Highly co-morbid with depression(60% in world) (1/2 patients)
How is insomnia diagnosed?
Sleep interview
- Narrative of bedtime
- Sleep perceptions
- Triggers
What are the types of primary sleep disorders according to the ICSD-3?
- Psychophysiological - heightened sense of arousal
- Sleep state misconception (paradoxical insomnia)– no evidence of objective disorder
- Idiopathic insomnia (childhood onset insomnia)
- Inadequate sleep hygiene (e.g. caffeine too late )
- Adjustment sleep disorder (triggered by stressor e.g. pain, anxiety, noise)
- Behavioural insomnia of childhood (refusal to go to bed, reliance of sleep onset cues)
What is Spielman’s (1987) Model of insomnia?
Predisposing - e.g. being female & anxiety makes one more vulnerable to insomnia [premorbid]
Precipitating - trigger symptoms e.g. divorce, noise, stress [acute]
Perpetuating - e.g. day time napping, excessive worry about sleep. exacerbate symptoms [chronic insomnia]
Outline the global changes in cognitive and mental health that occur as a consequence of insomnia
increased pain, emotional effects & mental health effects compared to heart failure
In terms of occupational risk ____ % more likely to have accident as a consequence of insomnia
2.5-4.5%
Describe the pre-2015 view of insomnia
Primary
- Insomnia only not associated with physical or psychological disorder
Secondary
- as a consequence of a co-morbidity with other conditions
What are the treatments for insomnia?
- Benzodiazepines or Z-drugs for sleep
CBT for insomnia
- Sleep restriction (cutting
time in bed to increase
sleep drive)
- Stimulus control (removing
clocks
- Relaxation. (progressive
muscle relaxation)
What are the treatments for insomnia?
- Benzodiazepines or Z-drugs for sleep
CBT for insomnia
- Sleep restriction (cutting
time in bed to increase
sleep drive)
- Stimulus control (removing
clocks
- Relaxation. (progressive
muscle relaxation)
- cognitive therapy -
challenging beliefs and
expectations
- slee hygiene
What are the treatments for insomnia?
- Benzodiazepines or Z-drugs for sleep
CBT for insomnia
- Sleep restriction (cutting
time in bed to increase
sleep drive)
- Stimulus control (removing
clocks
- Relaxation techniques. (progressive
muscle relaxation)
- cognitive therapy -
challenging beliefs and
expectations
- sleep hygiene
Define Narcolepsy
Characterised by the irrepressible urge to sleep or lapses into sleep
What is the DSM-5 criteria for Narcolepsy?
A. Characterised by the irrepressible urge to sleep or lapses into sleep
A.a 3 times per week, 3 months
B. one of the following:
a) Episodes of cataplexy
b) deficiency
c) REM sleep latency
<15minutes, OR MSLT
<8 minutes + two
SOREMPs
What is the prevalence of narcolepsy?
1 in 2000
can take 5-10 years to get diagnostic
What are the three defining symptoms of narcolepsy ?
A. Excessive daytime sleepiness
B. Hypocretin/orexin deficiency - system is implicated in wake signalling
C. Cataplexy - loss of muscle tone due to initiation of REM sleep
What are the causes of narcolepsy?
Genetic
- Human leukocyte antigen (HLA- DQB1)
Immune response
- most prevalent in late spring
- 2009/10 winter (Swine flue& vaccine ^ cases of narcolepsy)
Strong emotions
- can cause episode of cataplexy
