Sleep StatisticsSleep Statistics

We spend about 1/3 of our lives asleep.We spend about 1/3 of our lives asleep. Average 3,000 hours of sleep per year.Average 3,000 hours of sleep per year. Most people do not get enough sleep.Most people do not get enough sleep. Effects of sleep deprivation: Problems with Effects of sleep deprivation: Problems with

health, mood, concentration, memory, health, mood, concentration, memory, emotional stabilityemotional stability

Signs of Sleep DisordersSigns of Sleep Disorders Consistent failure to get enough sleep or restful sleepConsistent failure to get enough sleep or restful sleep Consistently feeling tired upon waking &/or waking with Consistently feeling tired upon waking &/or waking with

a headachea headache Chronic fatigue, tiredness, sleepiness during the dayChronic fatigue, tiredness, sleepiness during the day Struggling to stay awake while driving or doing Struggling to stay awake while driving or doing

something passive, e.g. watching TVsomething passive, e.g. watching TV Difficulty concentrating at work or schoolDifficulty concentrating at work or school Slowed or unusually delayed response to stimuli or Slowed or unusually delayed response to stimuli or

eventsevents Difficulty remembering things or controlling emotionsDifficulty remembering things or controlling emotions Frequent urge to nap during the dayFrequent urge to nap during the day Snoring or ceasing to breathe during sleepSnoring or ceasing to breathe during sleep

2 Categories of Sleep Disorders2 Categories of Sleep Disorders

DyssomniasDyssomnias

– Difficulty getting Difficulty getting enough sleepenough sleep

– Problems in the Problems in the timing of sleeptiming of sleep

– Complaints about Complaints about the quality of the quality of sleepsleep

ParasomniasParasomnias

– Abnormal Abnormal behavioral & behavioral & physiological physiological events during sleepevents during sleep

– e.g. nightmares, e.g. nightmares, sleep walking, sleep walking, sleep talkingsleep talking

Primary InsomniaPrimary Insomnia

Difficulty initiating sleep, maintaining sleep, Difficulty initiating sleep, maintaining sleep, &/or nonrestorative sleep for at least 1 &/or nonrestorative sleep for at least 1 monthmonth

Primary: insomnia is not related to other Primary: insomnia is not related to other medical or psychiatric problemsmedical or psychiatric problems

One of the most common sleep disorders: One of the most common sleep disorders: 1/3 of general population report Sx1/3 of general population report Sx

Women report insomnia 2x as often as menWomen report insomnia 2x as often as men

Primary InsomniaPrimary Insomnia

Contributing Factors:Contributing Factors:– Medical factors, such as pain & physical Medical factors, such as pain & physical

discomfort and respiratory problemsdiscomfort and respiratory problems– High body temperature High body temperature – Inactivity during the dayInactivity during the day– Psychological disordersPsychological disorders– StressStress– Unrealistic expectations regarding sleepUnrealistic expectations regarding sleep– Poor bedtime habits or sleep hygienePoor bedtime habits or sleep hygiene– Rebound insomnia (sleeping pills)Rebound insomnia (sleeping pills)

Primary InsomniaPrimary Insomnia

Treatments:Treatments:– Prescription drugs (benzodiazepines) & OTC Prescription drugs (benzodiazepines) & OTC

drugs drugs excessive sleepiness, dependence, excessive sleepiness, dependence, rebound insomniarebound insomnia

– Other drug options: antihistamines, Remeron, Other drug options: antihistamines, Remeron, TrazedoneTrazedone

– Relaxation trainingRelaxation training– Stimulus control proceduresStimulus control procedures– Setting regular bedtime routinesSetting regular bedtime routines– Sleep restrictionSleep restriction– Confronting unrealistic expectations about sleepConfronting unrealistic expectations about sleep

Primary HypersomniaPrimary Hypersomnia

Predominant complaint:Predominant complaint: excessive excessive sleepiness for at least a monthsleepiness for at least a month

Sleeping too much:Sleeping too much: prolonged sleep prolonged sleep episodes or daytime sleep episodes occur episodes or daytime sleep episodes occur almost dailyalmost daily

Treatments:Treatments: stimulants; provigil stimulants; provigil

NarcolepsyNarcolepsy Features:Features:

– Daytime sleepinessDaytime sleepiness– Irresistible attacks of refreshing sleep occur almost dailyIrresistible attacks of refreshing sleep occur almost daily– Cataplexy – sudden loss of muscle tone (associated Cataplexy – sudden loss of muscle tone (associated

with intense emotion & the sudden onset of REM sleep)with intense emotion & the sudden onset of REM sleep)– Sleep paralysisSleep paralysis– Hypnagogic & hypnopompic hallucinations Hypnagogic & hypnopompic hallucinations – Intrusions of REM sleep into the transition between Intrusions of REM sleep into the transition between

sleep and wakefulness (at sleep onset or awakening)sleep and wakefulness (at sleep onset or awakening) Treatments:Treatments:

– StimulantsStimulants– ProvigilProvigil– AntidepressantsAntidepressants

Breathing Related Sleep DisordersBreathing Related Sleep Disorders Sleep is disrupted by a sleep-related breathing Sleep is disrupted by a sleep-related breathing

condition condition Breathing is interrupted during sleep, producing Breathing is interrupted during sleep, producing

numerous brief arousals during the nightnumerous brief arousals during the night Leads to excessive sleepiness during the day Leads to excessive sleepiness during the day Treatments:Treatments:

– Weight lossWeight loss– Medications to stimulate breathing Medications to stimulate breathing

(medroxyprogesterone, tricyclics)(medroxyprogesterone, tricyclics)– Mechanical devices to reposition tongue or jawMechanical devices to reposition tongue or jaw

Sleep ApneaSleep Apnea

Symptoms:Symptoms: restricted airflow &/or brief periods (10-30 restricted airflow &/or brief periods (10-30 seconds) where breathing ceases completelyseconds) where breathing ceases completely

Signs:Signs: loud snoring, heavy sweating during the night, loud snoring, heavy sweating during the night, morning headaches, sleep attacks during the daymorning headaches, sleep attacks during the day

Obstructive Sleep Apnea:Obstructive Sleep Apnea: airflow stops despite continued airflow stops despite continued respiratory activity; airway is too narrow, damaged, respiratory activity; airway is too narrow, damaged, abnormalabnormal

Central Sleep Apnea:Central Sleep Apnea: complete cessation of respiratory complete cessation of respiratory activity; associated with certain CNS disorders, e.g. activity; associated with certain CNS disorders, e.g. degenerative disorders, cerebral vascular disease, head degenerative disorders, cerebral vascular disease, head traumatrauma

Contributing Factors:Contributing Factors: more common in males, the obese, more common in males, the obese, & middle to older age& middle to older age

Prevalence:Prevalence: occurs in 10-20% of population occurs in 10-20% of population

Circadian Rhythm Sleep DisordersCircadian Rhythm Sleep Disorders

Inability to synchronize one’s circadian sleep-wake Inability to synchronize one’s circadian sleep-wake pattern with the sleep-wake schedule of the pattern with the sleep-wake schedule of the surrounding environmentsurrounding environment

Results in disrupted sleep – either insomnia or Results in disrupted sleep – either insomnia or excessive sleepiness during the dayexcessive sleepiness during the day

2 types:2 types:– Jet lag typeJet lag type – sleep problems caused by – sleep problems caused by

rapidly crossing multiple time zonesrapidly crossing multiple time zones– Shift work typeShift work type – sleep problems associated – sleep problems associated

with night shift work or frequently changing shift with night shift work or frequently changing shift workwork

Circadian Rhythm Sleep DisordersCircadian Rhythm Sleep Disorders

Phase Shifts:Phase Shifts:– Delayed Sleep Phase TypeDelayed Sleep Phase Type – late sleep – late sleep

onset & late awakeningonset & late awakening– Advanced Sleep Phase TypeAdvanced Sleep Phase Type – early sleep – early sleep

onset & early awakeningonset & early awakening TreatmentsTreatments

– Phase delaysPhase delays – moving bedtime later – moving bedtime later– Phase advancesPhase advances – moving bedtime earlier – moving bedtime earlier– Use of a bright light (>2,500 lux)Use of a bright light (>2,500 lux)

ParasomniasParasomnias

Disturbances in arousal and sleep stage Disturbances in arousal and sleep stage transition that intrude into the sleep processtransition that intrude into the sleep process

2 types:2 types:

– Those that occur during rapid eye Those that occur during rapid eye movement (REM) sleepmovement (REM) sleep

– Those that occur during non-rapid eye Those that occur during non-rapid eye movement (NREM) sleepmovement (NREM) sleep

NightmaresNightmares

Occurs during REM (dream) sleepOccurs during REM (dream) sleep Extremely frightening dreams that interrupt Extremely frightening dreams that interrupt

sleep and interfere with daily functioning sleep and interfere with daily functioning Person readily awakens from dreams, has Person readily awakens from dreams, has

detailed recall, and rapidly becomes detailed recall, and rapidly becomes oriented and alertoriented and alert

Common in children (10-50%), but not Common in children (10-50%), but not adults (5-10%)adults (5-10%)

Sleep TerrorsSleep Terrors Symptoms:Symptoms:

– Occurs during NREM sleepOccurs during NREM sleep– Intense fear, panicky scream, autonomic Intense fear, panicky scream, autonomic

arousal (heart racing, rapid breathing, sweating)arousal (heart racing, rapid breathing, sweating)– Relatively unresponsive to efforts of others to Relatively unresponsive to efforts of others to

comfort or wake the person during the episodecomfort or wake the person during the episode– Abrupt awakening from sleepAbrupt awakening from sleep– Amnesia for the episode, no detailed dream Amnesia for the episode, no detailed dream

recallrecall Prevalence:Prevalence: more common in children (5%) than more common in children (5%) than

adultsadults (<1%)(<1%) Treatment:Treatment: antidepressants, benzodiazepines, antidepressants, benzodiazepines,

scheduled awakeningsscheduled awakenings

Sleep Walking (Somnambulism)Sleep Walking (Somnambulism)

Symptoms:Symptoms:– Occurs during NREM sleepOccurs during NREM sleep– Rising from bed and walking aboutRising from bed and walking about– Blank, staring faceBlank, staring face– Unresponsive to efforts of others to communicateUnresponsive to efforts of others to communicate– Can be awakened only with great difficultyCan be awakened only with great difficulty– Upon awakening, short period of confusion or Upon awakening, short period of confusion or

disorientationdisorientation– Upon awakening, amnesia for episodeUpon awakening, amnesia for episode

Prevalence:Prevalence: primarily a childhood problem (15-30%) primarily a childhood problem (15-30%) Course:Course: most will outgrow by age 15 most will outgrow by age 15 Causes:Causes: fatigue, sleep deprivation, use of sedative or fatigue, sleep deprivation, use of sedative or

hypnotic drugs, stress, heredityhypnotic drugs, stress, heredity

Other NREM ParasomniasOther NREM Parasomnias

Sleep TalkingSleep Talking Bruxism (teeth grinding)Bruxism (teeth grinding) Nocturnal Eating SyndromeNocturnal Eating Syndrome

Sleep HygieneSleep Hygiene Establish a set bedtime routineEstablish a set bedtime routine Set a regular sleep and wake timeSet a regular sleep and wake time Go to bed when tired & get out of bed if unable to sleep Go to bed when tired & get out of bed if unable to sleep

within 15 minuteswithin 15 minutes Reduce noise, light, stimulation, & temperature in bedroom Reduce noise, light, stimulation, & temperature in bedroom Restrict activities in bed to those that help induce sleepRestrict activities in bed to those that help induce sleep Avoid using caffeine & nicotine 6 hours before bedtimeAvoid using caffeine & nicotine 6 hours before bedtime Limit use of alcohol or tobaccoLimit use of alcohol or tobacco Do not exercise or participate in vigorous activities in the Do not exercise or participate in vigorous activities in the

eveningevening Exercise during the dayExercise during the day Eat a balanced dietEat a balanced diet Increase exposure to natural and bright light during the dayIncrease exposure to natural and bright light during the day Educate self about normal sleep and sleep behaviorEducate self about normal sleep and sleep behavior