1. Sleep Disorders (Somnipathy)

2. Objectives To be able to identify types (classifications) of somnipathy To work with other members of the class to start planning a half hour lesson on one sleep disorder.

3. Now drink some caffeine!! Wait 15mins and try again!! What do you predict will happen? Have a go at sleep dash!! http://www.bbc.co.uk/scie nce/humanbody/sleep/s heep/

4. Major Classifications of Somnipathy Dyssomnias- a broad category including insomnia and hypersomnolence (too much sleep) Parasomnias – strange behaviours during sleep Medical or psychiatric conditions that can produce somnipathy

5. Key question If some problems with sleep are caused by other disorders, which disorder should we treat? For example if depression causes insomnia - how do we know that insomnia is not the cause of the depression? Answer – if we don’t know for sure we should treat both disorders as being comorbid.

6. Dyssomnias- a broad category including insomnia and hypersomnolence  Insomnia (Primary and secondary)  Narcolepsy  Obstructive sleep apnea  Restless legs syndrome  Klein-Levin Syndrome (sleeping beauty syndrome)  Post-traumatic hypersomnia

7. Parasomnias – strange behaviours during sleep  Night terrors  Bruxism (tooth grinding)  Sleepwalking (somnambulism)  Sleeptalking (somniloquy)  Exploding head syndrome!

8. Medical or psychiatric conditions that can produce somnipathy  Psychoses  Anxiety  Depression  Panic  Alcoholism  Sleeping sickness  OTHER Causes  Might include shift work and jet travel

9. Traditionally, sleep disorders have been divided into primary and secondary disorders. Primary Insomnia - result from an endogenous disturbance in the sleeping mechanism, often complicated by learned behaviours and bad sleep habits. Insomnia the only problem. Insomnia occurs with no cause for more than 1 month (DSM) Secondary Insomnia - are said to be the result of another disorder –e.g. depression, pregnancy, respiratory problems or gastroesophageal reflux disease, shift work, too much caffeine or alcohol INSOMNIA

10. BUT In 2007 Dr Ancoli-Israel suggested that this is a false distinction and that all sleep disorders should be regarded as comorbid, and receive the same emphasis in treatment. Ohayon and Roth 2003 – Studied 15,000 Europeans – found that insomnia preceded cases of mood disorders. Therefore treat the insomnia whether it is primary or secondary

11. Check terms so far What are the three types of somnipathy (sleep disorders)? What is insomnia? What kind of somnipathy is insomnia? What is narcolepsy? What kind of somnipathy is narcolepsy? What is sleepwalking? What kind of somnipathy is sleepwalking?

12. Risk Factors Influencing Insomnia Age and Gender – older people and women more likely – illnesses (arthritis, diabetes) and menopause (hormone fluctuations) Parasomnias - increase likelihood of insomnia - -Sleep Apnoea -Sleep walking -Teeth grinding Personality – Kales et al 1976 – insomniacs more likely to internalise psychological disturbance than acting out problems or being aggressive

13. Research Complications Synoptic point Chronic insomnia highly complex Lots of causes of insomnia – stress, depression, poor sleep hygiene, age, gender e.t.c Unlikely to be explained by one factor Therefore - Difficult to draw conclusions

14. Attribution Theory Synoptic Point (cognitive approach) One cause of Primary Insomnia is a person’s belief that they are going to have difficulty sleeping. Self fulfilling – tense before sleep Attribute sleep problems to ‘insomnia’ Treatment – Train them to be convinced the source of problem lies elsewhere Storms and Nisbett 1970 – insomniacs given a pill – half told it would stimulate them and the other half it would sedate them. Those expecting arousal went to sleep faster because they attributed their arousal to the pill and actually relaxed!!

15. Narcolepsy http://www.youtube.com/watch?v=3MBCeKn0Oeo http://www.youtube.com/watch?v=3MBCeKn0Oeo narcolepsy 3 mins Cataplexy – loss of muscular control during the day Feeling sleepy all the time Triggered by anger, fear, amusement or stress 1/2000 suffer, starts in adolescence

16. Sleep Walking Most common in children – 20% children, 3% adults Only occurs during NREM/SWS sleep Related to Night Terrors Sleep walker not conscious and later has no knowledge of events during sleep walking

17. Your mission, should you choose to accept it,

18. Lecturer for a day In groups you are going to prepare a lesson on one sleep disorder The presentation must include a powerpoint and a handout with questions/notes to be completed during the lesson The presentation/lesson should last approx 10 minutes It should be as interactive as possible It must be ready by Thursday.

19. Critically consider explanations of disorders of sleep (25 marks) Introduction – Define ‘sleep disorder’ and outline classifications. Key question – should sleep problems caused by other disorders be treated? AO1 Define Insomnia and give explanations (Primary and secondary) AO2 Evaluate the explanations of insomnia with supporting/opposing evidence AO1 Define Narcolepsy and give explanations (REM,HLA and Hypocretin) AO2 Evaluate explanations of Narcolepsy with supporting/opposing evidence AO1 Define Sleep walking and give explanations (Incomplete arousal, GABA ) AO2 Evaluate explanations using supporting/opposing evidence Conclusion –Explanations for disorders are varied although biological causes are often focused on this could be reductionist as seen from attribution theory in insomnia.