Psychology Term 2 - 2013/2014

SLEEP DISORDERS
IMPROVING YOUR SLEEP
 Avoid caffeine, nicotine, and other stimulants before bed
 Don’t go to bed when you are full or hungry
 Develop a nightly ritual, particularly one that is relaxing
 Engage in regular aerobic exercise, but not late at night
 Take a warm bath 90 minutes before bed
 Avoid emotional stressors (e.g., balancing check book) right
before bed
 Limit activities in your sleeping area
 Avoid alcohol
 Designate a regular bedtime and waking time
 Minimize light and noises
TYPES OF SLEEP DISORDERS
 Dyssomnias: are a broad  Parasomnias: behavioral or
physiological abnormalities during
classification of Sleeping sleep; are a category of sleep disorders
disorders that make it that involve abnormal movements,
difficult to get to sleep, behaviors, emotions, perceptions, and
dreams that occur while falling asleep,
or to remain sleeping.
sleeping, between sleep stages, or
during arousal from sleep.
 Eg:
 E.g.:
 Insomnia  Sleepwalking & Sleep talking Disorder
 Sleep Apnea  Night terror & Nightmares Disorder
 Narcolepsy  REM Behavior Disorder
SLEEP DISORDERS
 Dyssomnias: are a broad classification of Sleeping disorders
that make it difficult to get to sleep, or to remain sleeping.
 There are over than 30 kinds of sleep disorders but the most
common and serious sleep disorders known are:
 Insomnia: is the inability to obtain an adequate amount or quality of
sleep. The difficulty can be in falling asleep, remaining asleep, or both.
 Sleep apnea: is a potentially serious sleep disorder in which breathing
repeatedly stops and starts
 Narcolepsy: is a chronic sleep disorder characterized by
overwhelming daytime drowsiness and sudden attacks of sleep
INSOMNIA
 Insomnia is a sleep disorder that is characterized by difficulty
falling and/or staying asleep.
People with insomnia have one or more of the following
symptoms:
 Difficulty falling asleep
 Waking up often during the night and having trouble going back to
sleep
 Waking up too early in the morning

 Feeling tired upon waking

INSOMNIA
Types of Insomnia Acute vs. Chronic Insomnia
 There are two types of insomnia: primary
 Insomnia also varies in how long it
insomnia and secondary insomnia. 2
classifications; lasts and how often it occurs.
 It can be short-term (acute insomnia)

1. Primary insomnia: Primary insomnia or can last a long time (chronic

means that a person is having sleep insomnia).
problems that are not directly associated
 It can also come and go, with periods
with any other health condition or problem.
2. Secondary insomnia: Secondary insomnia of time when a person has no sleep
means that a person is having sleep problems.
problems because of something else, such 1. Acute insomnia can last from one
as a health condition (like asthma,
depression, arthritis, cancer, or
night to a few weeks.
heartburn); pain; medication they are 2. Insomnia is called chronic when a
taking; or a substance they are using (like person has insomnia at least three
alcohol). nights a week for a month or longer.
CAUSES OF ACUTE INSOMNIA CAN CAUSES OF CHRONIC INSOMNIA
INCLUDE: INCLUDE:
Continue reading below...

 Depression and/or anxiety
 Significant life stress (job loss or change, death
of a loved one, divorce, moving)  Chronic stress
 Illness
 Emotional or physical discomfort
 Pain or discomfort at night
 Environmental factors like noise, light, or
extreme temperatures (hot or cold) that interfere
with sleep
 Some medications (for example those used to
treat colds, allergies, depression,
high blood pressure, and asthma) may interfere
with sleep
 Interferences in normal sleep schedule (jet lag or
switching from a day to night shift, for example)

CAUSES OF INSOMNIA
INSOMNIA
Symptoms of Insomnia Treatment for Insomnia:
 Sleepiness during the day 1. Acute insomnia may not require treatment.
 General tiredness 2. Mild insomnia often can be prevented or
 Irritability cured by practicing good sleep habits.
 Problems with concentration or memory 3. If your insomnia makes it hard for you to
function during the day because you are
Diagnosing Insomnia by a healthcare sleepy and tired, your health care provider
provider: may prescribe sleeping pills for a limited
time.
 An evaluation may include a physical
examination, a medical history, and a
sleep history. N.B.:
 Also as a method of monitoring 4. Avoid using over-the-counter sleeping pills

improvement or deterioration, patient for insomnia, because they may have

might be asked to keep a sleep diary. undesired side effects and tend to lose their
effectiveness over time.
 There are also specialized sleep centers
5. Rapid onset, short-acting drugs can help you
for diagnosing, monitoring and treating.
avoid effects such as drowsiness the
following day.
ASSIGNMENT
 Compare between the two types of sleep disorders , with
explanation of each type giving examples.
SLEEP APNEA
 Obstructive sleep apnea is a common and serious sleep disorder that causes you to stop
breathing during sleep.
Causes of Sleep Apnea:
 The airway repeatedly becomes blocked, limiting the amount of air that reaches your
lungs.
 When this happens, you may snore loudly or making choking noises as you try to breathe.

 Your brain and body becomes oxygen deprived and you may wake up.

 This may happen a few times a night, or in more severe cases, several hundred times a
night.

Further physiological explanation :

 It is caused by the tissue in the back of the throat collapsing.

 The muscles of the upper airway relax when you fall asleep.

 If you sleep on your back, gravity can cause the tongue to fall back.

 This narrows the airway, which reduces the amount of air that can reach your lungs.

 The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you

breathe
SLEEP APNEA
Major symptoms : Other symptoms of sleep apnea include:
 Sleep apnea can make you wake up in  Loud or frequent snoring

the morning feeling tired or  Choking or gasping while you sleep

unrefreshed even though you have  Pauses in breathing
had a full night of sleep.  Morning headaches

 Excessive daytime sleepiness

 During the day, you may feel fatigued,  Insomnia due to difficulty staying asleep
have difficulty concentrating or you  Waking up with dry mouth or a sore throat
may even unintentionally fall asleep.
 Frequent need to urinate during the night

 Trouble concentrating
 WHY? because your body is waking
 Memory or learning problems
up numerous times throughout the
 Moodiness, irritability or depression
night, even though you might not be
conscious of each awakening.
SLEEP APNEA
Diagnosis:
 In-lab overnight sleep study: You will sleep with sensors hooked up to
various parts of your body. These record your brain waves, heartbeat,
and breathing among other things.

 Home sleep test: The testing equipment differs in that it is less

complicated than what is used in an overnight sleep study. A staff
member will show you how to hook up the testing equipment yourself.
Once you are finished, you can take the device back to the sleep center
or send it by mail.

 Sleep Diary for recording your daily improvement or deterioration.

SLEEP APNEA RISK FACTORS
 Excess weight – An adult with a BMI of 25 or higher is considered to be
overweight. Your risk of sleep apnea increases with the amount of excess body
weight.
 Large neck size (>17 inches for men, > 16 inches for women) – A large neck
will have more fatty tissue that can block your airway.
 Older age (40+ for men, 50+ for women) – Sleep apnea occurs more often in
older adults, especially people older than 60.
 Being male – Men have twice the risk having sleep apnea compared to women
 Smoker – Smokers have a higher risk of sleep apnea
 Hypertensive – High blood pressure is very common in people with sleep apnea
 Family history – Sleep apnea can appear more often among family members.
This may be a result of either inherited traits or common lifestyles.
SLEEP APNEA –VE IMPACT

Very important info:

The lack of oxygen your body receives can have
negative long-term consequences for your health.
This includes:
1. High blood pressure
2. Heart disease
3. Stroke
4. Pre-diabetes and diabetes
5. Depression

http://www.sleepeducation.com/sleep-disorders/sleep-apnea/treatment
SLEEP APNEA TREATMENT
1. CPAP (Continuous Positive Airway Pressure): a machine that uses a steady stream
of air to gently keep your airway open throughout the night by a mask so you are able
to breathe.
2. Oral Appliance Therapy: It may resemble a sports mouth guard or an orthodontic
retainer. The device prevents the airway from collapsing by holding the tongue in
position or by sliding your jaw forward so that you can breathe when you are asleep
3. Surgery: reduce or eliminate the extra tissue in your throat that collapses and blocks
your airway during sleep. More complex procedures can adjust your bone structures
including the jaw, nose and facial bones. Weight loss surgery may also be an option
4. Weight Management: weight loss can help improve or eliminate your sleep apnea
symptoms if you are overweight or obese (not guaranteed to be effective but it helps).
5. Positional Therapy: it would help by improving or eliminating your symptoms by
changing your sleep position. Your airway may open if you sleep on your side instead
of your back. 
6. Lifestyle Changes: quitting smoking or not drinking alcohol may improve sleep
apnea symptoms. Alcohol relaxes your throat muscles which can cause you to snore
or for your airway to collapse.
NARCOLEPSY
 Narcolepsy is a sleep disorder that causes
overwhelming and severe daytime sleepiness.
 Pathologic sleepiness is characterized by the fact
that it occurs at inappropriate times and places.
 The daytime sleep attacks may occur with or without
warning, and can occur repeatedly in a single day.
 Persons with narcolepsy often have fragmented
nighttime sleep with frequent brief awakenings.
NARCOLEPSY
Symptoms:
1. Excessive daytime sleepiness (most common and obvious)

2. Cataplexy (sudden and temporary loss of muscle tone often triggered by

emotions such as laughter) (common)

3. Hallucinations (vivid dreamlike experiences that occur while falling asleep or

upon awakening) (less common)

4. Sleep paralysis (paralysis that occurs most often upon falling asleep or waking
up; the person is unable to move for a few minutes, least common symptom)
NARCOLEPSY
Causes:
 Narcolepsy is believed to result from a genetic

predisposition and abnormal neurotransmitter

(hypocretin) functioning and sensitivity.
Diagnosis:
 Questionnaires are used to measure excessive sleepiness.

 Sleep lab visits & monitoring.

 CSF (cerebrospinal fluid) hypocretin test

NARCOLEPSY
Treatment:
 Self-Care at Home

 Many people have an improvement in their symptoms if  Medical Treatment:

they maintain a regular sleep schedule, usually seven to
eight hours of sleep per night. The main focus of
 Scheduled naps during the day also help.
medical treatment is
symptomatic relief of
 Patient's with narcolepsy should also avoid heavy meals
and alcohol (as it can interfere with sleep).
excessive daytime
sleepiness and cataplexy
 Driving  should be restricted when the patient feels sleepy. with stimulants of the
 Children should be encouraged to participate in after-
central nervous system
school activities and sports.
and antidepressants.
 Parents should request school personnel to excuse the
child from activities if he or she appears drowsy.
SLEEP DISORDERS
 Parasomnias: behavioral or physiological abnormalities during
sleep; are a category of sleep disorders that involve abnormal
movements, behaviors, emotions, perceptions, and dreams that occur
while falling asleep, sleeping, between sleep stages, or during
arousal from sleep.

 Most parasomnias are dissociated sleep states which are partial

arousals during the transitions between wakefulness and NREM
sleep, or wakefulness and REM sleep:
 Sleepwalking & Sleep talking Disorder
 Night terror & Nightmares Disorder
 REM Behavior Disorder
SLEEP WALKING DISORDER
 Sleepwalking is a sleep disorder that causes people to get up and walk while sleeping.
 Episodes of sleepwalking typically occur when a person is in the deep stages of sleep.
 The sleepwalker is unable to respond during the event and does not remember sleepwalking.
 In some cases, sleepwalking is associated with incoherent talking.
 Sleepwalking occurs most commonly in childhood, typically between the ages of 4 and 8, but can last into adulthood.
 Sleepwalkers walk with their eyes opened with a glassy, staring appearance.

Symptoms of Sleepwalking
 Episodes of sleepwalking can range from quiet walking about the room to agitated running or attempts to "escape." Typically,

the eyes are open with a glassy, staring appearance as the person quietly roams the house. On questioning, responses are slow
or absent. If the person is returned to bed without awakening, they usually does not remember the event.
 Older children, who may awaken more easily at the end of an episode, often are embarrassed by the behavior (especially if it

was inappropriate).

What Causes a Person to Sleepwalk?

 Several different factors may be involved in the development of sleepwalking. These may include genetics (traits that run in

families), environment, and medical conditions.

 Sleepwalking is not associated with other sleep problems, sleeping alone in a room or with others, fear of the dark, or anger

outbursts.

Genetics
 Sleepwalking occurs more frequently in identical twins, and is 10 times more likely to occur if a first-degree relative has a

history of sleepwalking. Therefore, it is thought the condition can be inherited.

SLEEP WALKING DISORDER
Environmental Factors
 Certain factors may cause a person to sleepwalk, such as:

 Sleep deprivation

 Chaotic sleep schedules

 Stress

 Alcohol intoxication

 Drugs such as sedative/hypnotics (drugs that promote relaxation or sleep), neuroleptics (drugs used to treat

psychosis), stimulants (drugs that increase activity), and antihistamines (drugs used to treat symptoms of
allergy)

Medical conditions that have been linked to sleepwalking include:

 Arrhythmias (abnormal heart rhythms)

 Fever

 Gastroesophageal reflux (food or liquid regurgitating from the stomach up into the food pipe)

 Nighttime asthma

 Nighttime seizures (convulsions)

 Obstructive sleep apnea (condition in which breathing stops temporarily while sleeping)

 Psychiatric disorders, for example, posttraumatic stress disorder, panic attacks, or dissociative states, such as
http://www.webmd.com/sleep-disorders/guide/sleepwalking-causes
multiple personality disorder
SLEEP TALKING DISORDER
What causes sleep talking?
 Sleep talking usually occurs by itself and is most often harmless. However, in some cases,
it might be a sign of a more serious sleep disorder or health condition.
 REM sleep behavior disorder (RBD) and sleep terrors are two types of sleep disorders that
cause some people to shout during sleep. Sleep terrors, also called night terrors, usually
involve frightening screams, thrashing, and kicking. It's hard to wake someone having a
sleep terror. Children with sleep terrors usually sleep talk and sleepwalk.
 People with RBD yell, shout, grunt, and act out their dreams, often violently.

 Sleep talking can also occur with sleepwalking and nocturnal sleep-related eating disorder
(NS-RED), a condition in which a person eats while asleep.

Other things that can cause sleep talking include:

 Certain medications

 Emotional stress

 Fever
 Mental health disorder
http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/talking-in-your-sleep?page=2
 Substance abuse
SLEEP TALKING DISORDER
What is sleep talking?
 Sleep talking, or somniloquy, is the act of speaking during sleep. It's a type of parasomnia -- an
abnormal behavior that takes place during sleep. It's a very common occurrence and is not usually
considered a medical problem.
 The nighttime chatter may be harmless, or it could be graphic, even R rated. Sometimes, listeners find

the content offensive or vulgar. Sleep talkers normally speak for no more than 30 seconds per episode,
but some people sleep talk many times during a night.
 The late-night diatribes may be exceptionally eloquent, or the words may be mumbled and hard to
decipher. Sleep talking may involve simple sounds or long, involved speeches. Sleep talkers usually
seem to be talking to themselves. But sometimes, they appear to carry on conversations with others.
They may whisper, or they might shout. If you share a bedroom with someone who talks in his or her
sleep, you might not be getting enough shut-eye.
Who talks in their sleep?
 Many people talk in their sleep. Half of all kids between the ages of 3 and 10 years old carry on
conversations while asleep, and a small number of adults -- about 5% -- keep chit-chatting after they
go to bed. The utterances can take place occasionally or every night. Experts think that sleep talking
may run in families.
What are the symptoms of talking in your sleep?
 Usually, people will tell you they've heard you shout out during the night or while you were napping.
Or maybe someone might complain that your sleep talking is keeping him or her up all night.
NIGHT TERROR & NIGHTMARES DISORDER
Definition of Night terror & Nightmares Disorder : sleep disorders in which a person
abruptly awakens from sleep in a frightened or panicked state.
 The condition most often happens during the first third of the night and is sometimes

accompanied by sleepwalking.
 It usually run in families.

 It happens to adults , but more common in children, that usually outgrow after adolescence.

Causes:
 The condition may be triggered by a variety of Psychological factors including: anxiety,

stress, depression or conflict in the household, Fatigue, sleep deprivation

 Also, some underlying medical conditions such as: sleep apnea, a head injury, or

migraines.
 Certain medications including: antihistamines, sedatives, or sleeping pills may trigger an

episode as well.
 Addiction or dependency: Adults with an alcohol or other drug dependency are at a

greater risk for night terrors than others.

NIGHT TERROR & NIGHTMARES DISORDER
Symptoms:
 Sit up in bed

 Scream or shout

 Kick and thrash

 Sweat, breathe heavily and have a racing pulse

 Be hard to awaken

 Get out of bed and run around the house

 Engage in violent behavior (more common in adults)

 Stare wide-eyed

Treatment:
 Comfort to child if he or she has night terrors.

 Adults with night terrors may benefit from stress reduction, coping strategies, or psychotherapy.

 Complications of night terrors are rare and medication is rarely used.

REM BEHAVIOR DISORDER (RBD)
 In a person with REM sleep behavior disorder (RBD), the
paralysis that normally occurs during REM sleep is incomplete
or absent, allowing the person to "act out" his or her dreams.
 RBD is characterized by the acting out of dreams that are
vivid, intense, and violent.
 Dream-enacting behaviors include talking, yelling, punching,
kicking, sitting, jumping from bed, arm flailing, and grabbing.
 An acute form may occur during withdrawal from alcohol or
sedative-hypnotic drugs.
 RBD is usually seen in middle-aged to elderly people (more
often in men).
REM BEHAVIOR DISORDER (RBD)

Causes:
 55% has unknown cause, while the rest (45%) are
associated with:
 Alcohol
 Sedative-hypnotic withdrawal
 Some antidepressants

 RBD is highly associated with Parkinson’s Disease*,

however not all RBD patients have Parkinson’s.
*Parkinson’s disease involves the malfunction and death of vital nerve cells in the brain, called neurons. Some
of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls
movement and coordination.
REM BEHAVIOR DISORDER (RBD)

Treatment & Management:

 Treatment usually includes medication as Clonazepam (drug
having anxiolytic, anticonvulsant, muscle relaxant, sedative,
and hypnotic properties.

 Management includes removal of harmful objects from the

surrounding area of sleeping, locking patient and monitoring
and sometimes tying patient to bed.
ASSIGNMENT
1. Compare between the two types of sleep disorders , with
explanation of each type giving examples.
2. Define: Insomnia, Sleep Apnea, Narcolepsy, Sleep walking,
Sleep Talking, Night terrors & nightmares, RBD.
3. What are the different classifications of Insomnia explain each.
4. What are the causes of Insomnia?
5. What are the treatment or management ways of insomnia?
6. What is the dangers or risks of having sleep Apnea?
7. What are the major symptoms of a Narcolepsy?
8. What are the main causes of Night terrors & Nightmares?
9. What are the main steps for RBD Management?