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SLEEP DISORDERS
Andrzej Kokoszka
II Klinika Psychiatryczna AM w Warszawie
Dyssomnias – problems with the timing, quality or amount of sleep
Parasomnias - abnormalities in physiology or in behavior associated with sleep
General information
Sleep disorders
Insomnia - difficulty falling asleep or staying asleep
that - occurs three times per week for at least 1
month and leads to sleepiness during the day- or causes problems fulfilling social or
occupational obligations.
- is present in at least 30% of the population.
General information
Dyssomnias
Causes of insomnia: Major depressive disorder
- normal sleep onset
- repeated nighttime awakenings
- waking too early
General information
Dyssomnias
Causes of insomnia: Mania or hypomania - trouble falling
asleep and sleep fewer hours. Anxious patients trouble falling asleep
General information
Dyssomnias
Causes of insomnia: Use of CNS stimulants (e.g., caffeine) -
the most common cause of insomnia. Withdrawal of agents with sedating action
(e.g., alcohol, benzodiazepines, and opiates).
Medical conditions causing pain and endocrine and metabolic disorders.
General information
Dyssomnias
• Avoidance of caffeine, especially before bedtime
• Development of a series of behaviors associated with bedtime (i.e., "a sleep ritual" or "sleep hygiene")
• Maintaining a fixed sleeping and waking schedule
• Daily exercise (but not just before sleep)
General information
Dyssomnias – treatment of insomnia
• Relaxation techniques
• Psychoactive agents (i.e., limited use of sleep agents to establish an effective sleep pattern and antidepressants or antipsychotics if appropriate)
General information
Dyssomnias – treatment of insomnia
stop of breathing for brief intervals. low oxygen or high carbon dioxide level in
the blood awakens the patient repeatedly during the night, resulting in daytime sleepiness.
General information
Dyssomnias: breathing-related sleep disorder (sleep apnea)
central sleep apnea (more common in the elderly), little or no respiratory effort occurs, resulting in less air reaching the lungs.
obstructive sleep apnea, respiratory effort occurs, but an airway obstruction prevents air from reaching the lungs.
General information
Dyssomnias: breathing-related sleep disorder (sleep apnea)
obstructive sleep apnea occurs most often in people 40-60 years of age, and is more common in men (8x) and in the obese. Patients often snore.
Sleep apnea occurs in 1%-10% of the population and is related to depression, headaches, and pulmonary hypertension. It also may result in sudden death during sleep in the elderly and in infants.General information
Dyssomnias: breathing-related sleep disorder (sleep apnea)
Treatment:
• Weight loss (if overweight)
• Continuous positive airway pressure (CPAP), a device applied to the face at night to gently move air into the lungs
• Surgery to enlarge the airway, e.g.,
• Tracheostomy (as a last resort)
General information
Dyssomnias: breathing-related sleep disorder (sleep apnea)
sleep attacks (i.e., fall asleep suddenly during the day) despite having a normal amount of sleep at night.
-hypnagogic or hypnopompic hallucinations. These are strange perceptual experiences that occur just as the patient falls asleep or wakes up, respectively, and occur in 20- 40% of patients.
General information
Dyssomnias: narcolepsy
sleep paralysis - the inability to move the body for a few seconds after waking.
is uncommon decreased sleep latency, very short REM
latency (<10 minutes), less total REM, and interrupted REM (sleep fragmentation).
General information
Dyssomnias: narcolepsy
cataplexy - a sudden physical collapse caused by the loss of all muscle tone after a strong emotional stimulus (e.g., laughter, fear) and occurs in 30-70% of patients.
occurs most frequently in adolescents and young adults.
may have a genetic component.
General information
Dyssomnias: narcolepsy
Treatment: Stimulant agents (e.g., methylphenidate
[Ritalin], modafinil [Provigil] if cata plexy is present, antidepressants may be added)
Scheduled daytime naps
General information
Dyssomnias: narcolepsy
Circadian rhythm sleep disorder Inability to sleep at appropriate times Delayed sleep phase type involves falling
asleep and waking later than wanted Jet lag type last 2-7 days after a change in
time zones Shift work type (e.g., in physician training)
can result in physician errorGeneral information
Dyssomnias
Nocturnal myoclonus Repetitive, abrupt muscular contractions in
the legs from toes to hips Causes nighttime awakenings More common in the elderly
General information
Dyssomnias
Restless leg syndrome Uncomfortable sensation in the legs
necessitating frequent motion Repetitive limb jerking during sleep Causes difficulty falling asleep and
nighttime awakenings More common with aging, pregnancy, and
kidney disease
General information
Dyssomnias
Primary hypersomnias [Kleine-Levin syndrome and menstrual-associated syndrome (symptoms only in the premenstrum)]
Recurrent periods of excessive sleepiness occurring almost daily for at least 1 mont
Sleepiness is not relieved by daytime na Often accompanied by hyperphagia
(overeating) Kleine-Levin syndrome is more common in
adolescent malesGeneral information
Dyssomnias
Sleep drunkenness Difficulty awakening fully after adequate
sleep Rare, must be differentiated from
substance abuse or other sleep disorder Associated with genetic factors
General information
Dyssomnias
Bruxism Tooth grinding during sleep (stage 2) Can lead to tooth damage and jaw pain Treated with dental appliance worn at
night or corrective orthodontia
General information
Parasomnias
Sleepwalking disorder Repetitive walking around during sleep No memory of the episode on awakening Begins in childhood (usually 4-8 years of
age) Occurs during delta sleep
General information
Parasomnias
Sleep terror disorder Repetitive experiences of fright in which a person
(usually a child) screams in fear during sleep The person cannot be awakened The person has no memory of having a dream Occurs during delta sleep Onset in adolescence may indicate temporal lobe
epilepsy
General information
Parasomnias
Nightmare disorder Repetitive, frightening dreams that cause
nighttime awakenings The person usually can recall the
nightmare Occurs during REM sleep
General information
Parasomnias
REM sleep behavior disorder REM sleep without skeletal muscle
paralysis Patients can injure themselves or their
sleeping partners
General information
Parasomnias
