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Sleep-Wake Disorders

The document discusses various sleep disorders and conditions. It describes normal sleep cycles including non-REM and REM sleep. Several sleep disorders are then outlined, including insomnia disorder characterized by difficulty initiating or maintaining sleep, hypersomnolence disorder involving excessive daytime sleepiness, and narcolepsy defined by irresistible daytime sleep attacks. Breathing-related sleep disorders and circadian rhythm disorders are also summarized. Treatment options are provided for some conditions.

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116 views23 pages

Sleep-Wake Disorders

The document discusses various sleep disorders and conditions. It describes normal sleep cycles including non-REM and REM sleep. Several sleep disorders are then outlined, including insomnia disorder characterized by difficulty initiating or maintaining sleep, hypersomnolence disorder involving excessive daytime sleepiness, and narcolepsy defined by irresistible daytime sleep attacks. Breathing-related sleep disorders and circadian rhythm disorders are also summarized. Treatment options are provided for some conditions.

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FAMED RESIDENTS CESMED
Copyright
© © All Rights Reserved
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SLEEP-WAKE DISORDERS

SLEEP
• serves a restorative, homeostatic
function

• essential to the restoration and


recovery of vital bodily and
mental functions
SLEEP CYCLE

NON-REM SLEEP REM SLEEP

• composed of stages 1 to 4 • high level of brain activity

• most physiological functions • physiological activity levels


are markedly lower than in similar to those in wakefulness
wakefulness
• occurs about every 90 to 100
minutes during the nights
NON- STAGE • EEG: alpha and theta
waves
REM 1 • Easily awoken
SLEEP
STAGE • EEG: spindles
2

STAGE • enuresis, somnambulism


3

STAGE • Dreams are lucid and


purposeful
4 • enuresis, somnambulism
• Nightmares

REM SLEEP • EEG: sawtooth waves


• Dreams are abstract and
surreal
SLEEP REGULATION
• S E R OTO N I N

• Re d u c e s s l e e p l a t e n c y a n d n o c t u r n a l
a wa k e n i n g s

• NOREPINEPHRINE

• Increase wakefulness

• ACETYLCHOLINE

• S h i f t f r o m wa k e f u l n e s s t o R E M s l e e p

• M E L ATO N I N

• entrainment of the brain to a 24-hour


s l e e p - wa k e c y c l e

• D O PA M I N E

• A l e r t i n g e ff e c t – a r o u s a l a n d
wa k e f u l n e s s
SLEEP
DISORDERS

This Photo by Unknown Author is licensed under CC BY-SA-NC


SLEEP DISORDER
CLASSIFICATION
• Insomnia Disorder

• Hypersomnolence Disorder

• Narcolepsy

• Breathing-Related Sleep
Disorders This Photo by Unknown Author is licensed under CC BY
INSOMNIA DISORDER
• dissatisfaction with sleep quantity or
quality with 1 of the following:

• Diffi culty initiating sleep

• Diffi culty maintaining sleep

• Early-morning awakening with


inability to return to sleep

• causes clinically signifi cant distress or


impairment

• occurs at least 3 nights per week

• present for at least 3 months

This Photo by Unknown Author is licensed under CC BY-NC-ND


INSOMNIA DISORDER

This Photo by Unknown Author is licensed under CC BY-NC-ND


INSOMNIA DISORDER
• Pharmacological treatment

• Sedative-hyptotic drugs

• Hypnotic drugs

• Sedating antidepressants

• OTC sleep aids

• Melatonin

• Sedating antihistamines

This Photo by Unknown Author is licensed under CC BY-SA-NC


INSOMNIA DISORDER
• Cognitive-Behavior Therapy

• Universal sleep hygiene

• Stimulus control therapy

• Sleep restriction therapy,

• Relaxation therapies
This Photo by Unknown Author is licensed under CC BY-SA

• Biof eedback

• Cognitive training

This Photo by Unknown Author is licensed under CC BY-SA


HYPERSOMNOLENCE
DISORDER
• Sleepiness can be a consequence of

(1) insuffi cient sleep

(2) basic neurologic dysfunction in


brain systems regulating sleep

(3) disrupted sleep

(4) the phase of an individual's


circadian rhythm
HYPERSOMNOLENCE DISORDER
• treated by extending and regularizing the sleep
period

• wake-promoting substance modafi nil (Provigil;


fi rst-line treatment)

• traditional psychostimulants such as


amphetamines and their derivatives

This Photo by Unknown Author is licensed under CC BY-SA

This Photo by Unknown Author is licensed under CC BY-NC-ND


NARCOLEPSY
• sleep attacks - episodes of irresistible sleepiness,
leading to perhaps 10 to 20 minutes of sleep, occurring
any time

• appearance of REM sleep within 10 minutes of sleep


onset

• hypocretin dysf unction and defi cit


NARCOLEPSY

• tetrad of symptoms: • N o c u r e e x i s t s f o r n a r c o l e p s y, b u t
s y m p t o m m a n a g e m en t i s po s s i bl e
(1) excessive daytime
• f o r c e d na p s a t a r e g u l a r ti m e
sleepiness,
o f d ay
(2) cataplexy,
• s t i mu l a n t s

(3) sleep paralysis, and • M o da fi ni l , a n a 1 - a dr e n e r g i c


r ec e p t o r a g o n i s t
(4) hypnagogic
hallucinations • t r i c yc l i c dr ug s o r SS R i s t o
r ed u c e c a t a p l e x y
BREATHING-RELATED DISORDERS
• OBSTRUCTIVE SLEEP APNEA HYPOPNEA

• weight loss, surgical intervention, positive airway pressure, and oral


appliances

• CENTRAL SLEEP APNEA

• SLEEP-RELATED HYPOVENTILATION
CIRCADIAN RHYTHM SLEEP DISORDERS

CHRONOTHERAPY

• D e l a y e d S l e e p P h a s e Ty p e • to r ese t th e biolog i c al c lock

• A d v a n c e d S l e e p P h a s e Ty p e
• prog r ess iv ely ph ase d el ay i ng a

• I r r e g u l a r S l e e p -Wa k e Ty p e per son un ti l t he c ir ca dia n


os ci ll at or i s sy n ch ron iz ed with
• N o n - 2 4 - H o u r S l e e p -Wa k e Ty p e ( F r e e
the de si re d s lee p-wa ke sc he dul e
Running)

• S h i f t Wo r k Ty p e

• J e t L a g Ty p e
PARASOMNIA
• disorders of partial arousal • NREM SLEEP AROUSAL DISORDERS

• a diverse collection of sleep • Sleep walking


disorders characterized by
• Sleep terrors
physiological or behavioral
phenomena that occur during or are • PARASOMNIAS ASSOCIATED WITH
potentiated by sleep REM SLEEP

• REM Sleep Behavior Disorder

• Recurrent Isolated Sleep


Paralysis

• Nightmare Disorder
SLEEP-RELATED MOVEMENT DISORDERS
• Re st le ss L eg Sy nd rom e

• Per iodi c L im b M ovem e nt Di sor der

• Sle ep- Rel at ed L eg C ram p s

• Sle ep- Rel at ed B ru xi sm

• Sle ep- Rel at ed Rhy t hm i c Move m ent D is orde r

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