1. Sleep Disorders

2. A Primer on Sleep
Sleep is an active, recuperative process. It is critical to survival.
Sleep deprivation = decreased functioning, hallucinations at extreme
Chronic sleep deprivation may precipitate disorders (diathesis-stress)

3. A Primer on Sleep Begin of 20th century avg. night sleep = 10 hours
Today adults sleep an avg. of 6.7 hours/night
It is highly unlikely our need for sleep has decreased 40% in less than a century
Mammals have entire brain involvement
Dreaming as a survival mechanism? As practice?

4. Stages of Sleep Stage 1 = between awake/asleep. Body relaxes
Stages 2 -4 = relaxing muscles, no eye movement. Increasing depth of sleep
REM = brain waves suggest light sleep, but wakening is difficult. Body is paralyzed, brain waves are complex & varied
Move through several stages several times in one night
Children/fetuses show higher rates of REM

5. Types of Sleep Disorders
Dyssomnias - difficulty initiating or maintaining sleep, excessive sleep. Affect sleep and functioning when awake
Parasomnias - abnormal behavior or physiology occurring during sleep or transitioning between stages of sleep
* Not in the context of another type of disorder (e.g., depression)

6. Dyssomnias Primary Insomnia Primary Hypersomnia Narcolepsy
Breathing-related sleep disorders
Circadian rhythm sleep disorders

7. Assessing Sleep Problems
Polysomnographic evaluation
Respiration, airflow
Leg movements
Brain waves
Eye movements, muscle movements
Heart activity
Actigraph
Sleep efficiency - % of time asleep in bed

8. Primary Insomnia Difficulty falling asleep or maintaining it
Person does not feel rested the next morning
33-50% of adults complain of insomnia
DSM estimate only 1-10% qualify for diagnosis
Common among elderly individuals

9. Causes of Insomnia Other disorders Biological clock/temperature
Higher, with less variation
Drug use
Environmental factors
Cognitions regarding sleep

10. Primary Hypersomnia Excessive sleep Prevalence is unknown
Sleeping for long periods of time
Taking frequent naps during the day
Prevalence is unknown
% of adults complain of sleepiness during day
Usually begins in late adolescence or early adulthood

11. Narcolepsy Repeated and irresistible attacks of sleep
Often in response to strongly emotional situations
May involve cataplexy (immediate muscle paralysis and REM)
1/3 experience hypnogogic hallucinations
Prevalence is low ( % population)

12. Narcolepsy Equal among men & women
First signs = intense daytime sleepiness
Often interferes with daily functioning
Driving
Jobs
Relationships

13. Breathing & Circadian Related Sleep Disorders
Disruptions in normal breathing can interrupt sleep (excessive sleepiness during day)
E.g. sleep apneas
Circadian characterized by a “mismatch” between person’s natural sleep-wake cycle and environmental demands
E.g. you are unable to sleep until 4am, but you work at 7am
Subtypes: Delayed sleep phase, Jet Lag, Shift Work

14. Parasomnias Nightmare Disorder Sleep Terror Disorder
Sleepwalking Disorder

15. Nightmare Disorder Frequent awakening due to frightening dreams
Involves detailed recall of content
Cause distress & sleep problems
Impair daytime functioning
Not diagnosed if another diagnosis accounts for the symptoms better (e.g, PTSD)
50% of children experience occasional nightmares; 1 in 30 young adults

16. Sleep Terror Disorder
Abrupt awakening from sleep, often with screaming
Unlike a nightmare, no quick orientation to where they are & feelings continue for several minutes
Difficult to comfort/reassure
Report no dream content & do not occur during REM
More common in children than adults

17. Sleepwalking Disorder
Complex motor behavior during sleep
Must cause distress for diagnosis
This makes prevalence rates low
2% of children frequently sleepwalk
1 in 200 adults frequently
Usually returns to bed with no recollection later
If awakened, will be confused (this is not dangerous as many people believe)

18. What Causes Parasomnias?
Less is known about prevalence or causes
Individuals often unaware of the experience
Other psychopathologies (PTSD)
Genetic risk for sleepwalking
Stress, mood/anxiety, sleep deprivation, medical conditions, shift work can all = sleepwalking

19. Biological Treatments for Sleep Disorders
May include sleep medication (hypnotics)
Ineffective for chronic insomnia - lose effectiveness after few nights + rebound insomnia

20. Environmental Changes
Change circadian rhythm (Phase delays or advances)
Dental devices, surgery
Continuous Positive Airway Pressure
Light treatment

21. Psychological Treatments
Many problems due to poor sleep hygiene
Stimulus control
E.g. getting out of bed if not asleep
Sleep reduction - do not go to bed until normal sleep time (e.g., 2am)
Progressive muscle relaxation, meditation

22. Preventing Sleep Disorders/Problems
Address sleep hygiene

23. Sleep Hygiene Avoid consuming caffeine during the evening
Avoid smoking just before falling asleep or when you wake up in the night; Nicotine is a stimulant
Do not use alcohol as a sleep aid. It may help you fall asleep, but it causes awakening during the night and decreases the restfulness of sleep

24. Sleep Hygiene
Sleep in a comfortable environment. Block noise with earplugs or a white noise machine. Maintain a cooler temperature & keep the room reasonably dark
Do not stay in bed if you are not tired! Trying to force yourself to sleep makes it less likely you will! Get up, read, watch TV and don’t go back to bed until you are tired

25. Sleep Hygiene
If you are having trouble sleeping, do not watch the clock, as it will increase anxiety. Turn it around so that you cannot see the time
Do not rely on sleep medications. They lose effectiveness if used over and over again. Only use them for occasional bouts of sleeplessness
Only use your bedroom for sleep & sex (e.g. do not do homework on your bed, you should not associate your bed with anything else)