1. Sleep Disorders-NREM NREM is 75% of all sleep time (>=slower)
Stage 1-5% of the night
Stage 2-48% of the night
Stage 3 (delta)-7% of the night
Stage 4-15% of the night
Muscles mover during NREM, metabolic functions slow down & 20% of dreams*

2. Sleep Disorders-REM
During REM, you have muscle paralysis, erections and much more vivid dreams
Newborns dream 80% of time
By age 2, REM sleep is 33% of total sleep time, approaching adolescent levels

3. Sleep Disorders Insomnias (> 30’ to fall or return to sleep, 3+/wk)
Insomnia (middle and late in elderly)
Dysomnias (or less than satisfying sleep)
Psysiological causes
Sleep Apnea (obstructive or central)
Narcolepsy (“REM on a rampage”)
Periodic limb movement/restless leg syndrome

4. Assessment Measures Epworth Sleepiness Scale Pittsburgh Quality Index
Duration, at least 1 month, but usually 6
Assess routine (including a 2 week sleep diary* )and meds.
Ex. Recent study found that people who sleep with TV or noise have poorer QOS….even “white noise”
Ex. Acetimiophen has caffiene where Iboprfen does not

5. How to Become an Insomniac
Keep unrealistic sleep goal
Catastrophize about not meeting this goal
Nap in daytime/spend more time in bed
Spend all of the desperate hours fighting to get to sleep in bed (stimulus for upset)
Make bed center for activity
Start taking sleep medications (REM reb.)

6. Sleep Hygiene-Avoid Excessive noise
“Stress” (activities of bedtime)
Uncomfortable bed
Caffeine (< 2 hours of bedtime)
Cigarettes (< 2 hours of bedtime)
Alcohol
Napping (longer awake, faster/deeper sleep)
Extra wink in morning
Variable bedtimes or morning wake-up times

7. Sleep Hygiene-Maintain
60-65 degrees Fahrenheit in bedroom
Early afternoon or evening exercise
Satisfying (safe) sex
Light snacks (hunger aggravates sleep)
Warm milk or Ovaltine
Awake same time/go to bed only when sleepy
Imagine a tranquil place and calming sounds
If repeatedly awake 20 minutes after retiring, relax in another room and return to bed only when tired

8. Treatment

9. Treatment
Most treatments are initially behavioral conditioning-stimulus control
Cognitive Arousal/Refocusing
Exs. Paradoxical or focus on the sensation in body part
Physiological
PMR
Imaging
Biofeedback