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1. YyOoUuRr GgUuIiDdEe TtOo SLEEP   DISORDERS     2. Insomnia Secondary Insomnia is where there is a single, underlying medical, psychiatric disorder or environmental…
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  • 1. YyOoUuRr GgUuIiDdEe TtOo SLEEP   DISORDERS    
  • 2. Insomnia Secondary Insomnia is where there is a single, underlying medical, psychiatric disorder or environmental cause. Insomnia is a characteristic symptom disorder i.e. it is secondary. E.g.  Psychological disorders; depression, anxiety states.  Medical conditions; heart disease, Parkinson’s, asthma.  Drugs; stimulants like amphetamines, alcohol. What is it?  Phase delay syndrome (circadian rhythm disorder from Shift  Trouble falling asleep (initial insomnia) Work)  Trouble remaining asleep (middle insomnia)  Parasomnias; sleep apnoea, sleepwalking.  Waking up too early (terminal insomnia)  Environmental causes like too much caffeine. Morin et al (1999) estimated 40% of patients seeking treatment for Diagnostic criteria insomnia have a an associated psychiatric disorder.  Sleep onset latency (time taken to fall asleep) 30mins +  Sleep efficiency (time asleep in bed) 85% Risk factors  Increased number of night time awakenings Age and Gender – Older people are more likely to get insomnia due to  Symptoms occurring 3+ times a week problems such as arthritis or diabetes. Women are more likely to experience it in older years due to hormone fluctuations like in the Classifications menopause.  Transient/Short Term (lasts less than a week e.g. after jet Other sleep disorders - sleep apnoea, sleepwalking, snoring or teeth lag/short term stresses like exams) grinding can lead to insomnia.  Intermittent/Occasional (1-4 weeks) Personality – Kales et al (1976) found that insomniacs were more likely  Chronic/Long Term (1 month+) to internalise psychological disturbance rather than acting out problems of being aggressive. They suggested that internalisation leads to higher The Causes levels of emotional arousal and anxiety are risk factors of insomnia. Psychologists believe Insomnia may caused by another disorder (secondary) or a disorder in it’s own right (primary.) Why is it important to distinguish the cause? The DSM describes Primary Insomnia as cases where insomnia occurs The correct cause is needed to be diagnosed for treatments, if it is on its own, with no known causes, more than a month. The individual secondary insomnia where it is a symptom of another disorder the may be stressed or depressed but psychological states are not the main disorder needs to be treated first. problem. It may be developed from bad sleep habits (staying up late, well lit room) but insomnia is the only problem resulting from these Treatments of insomnia habits. Sometimes insomnia which had an identifiable cause which has Drugs are only used in secondary insomnia cases to treat depression or now disappeared, continues due to the expectation of sleep difficulty. anxiety; antidepressants or anti-anxiety drugs such as benzodiazepines. The most severe case of insomnia is idiopathic insomnia which begins in Sleeping pills may increase sleep time but evidence shows they reduce early childhood and is effectively lifelong, in severest cases it is not sleep quality, disrupting the normal ultradian pattern of REM and NREM affected by anxiety or arousal however can be associated with high sleep. And when the drugs are stopped increased insomnia can be levels of depression. Primary insomnia is thought to be caused by a induced. malfunction of our sleep control systems or anxiety or OCD.
  • 3. Stimulus Control Therapy – this is based on the idea that insomnia is a a conditioned (learned behaviour) response to cues such as night-time and - Only going to bed when sleepy - Bedroom only used for sleeping or sex - Keeping to routine of waking and sleeping times - No naps in daytime CBT - used to treat anxiety experienced around bedtime. CBT aims to correct faulty cognitions, causes of insomnia are discussed and some elements of sct used. Relaxation techniques and improvement of ‘sleep hygiene’ are encouraged, such as cutting down on caffeine, sleeping in a darker room, cutting down on naps and increasing exercise. Bright light therapy can be used for circadian rhythm disruption.
  • 4. Sleep walking What is it? Why children?  Children have more SWS.  Olivieo (2008) suggested that the system that normally inhibits sufficiently developed in some children and it may be Sleep walking (SW) is an example of a parasomnia, an event occurring undeveloped in some adults. during sleep that does not result in severe insomnia or daytime sleepiness. It occurs during NREM/SWS sleep and is related to night terrors which occur during NREM sleep. Activities carried out during sleep are routine but can be quite complicated such as making a cup of tea. Sleep walking is not a conscious activity and a person will have no memory of the events that occurred during sleep walking. Hublin et al (1997) found that the disorder is most common in childhood, affecting about 20% of children and 3% of adults. In severe cases it can have considerable affects on a person’s life and may be a risk of injury. It is only classified as a sleep disorder when it becomes distressing to the individual. Possible Causes the environment. Sleep control therapy aims to create new associations with the cues. Morin et al (1999) suggested Incomplete Arousal- Sleep walking is a disorder of arousal. EEG recordings during SW show a mixture of the delta waves which are typical of SWS, plus the beta waves which are characteristic of awake state. Therefore it appears that SW occurs when a person in SWS is awakened, but the arousal of the brain is incomplete. This abnormality is thought to be genetic. Various Factors - Plazzi et al (2005) found that various factors appear to increase the likelihood of SW. E.g. sleep deprivation, alcohol, having a fever, stress. Hormonal changes during puberty and menstruation can also be triggers Psychodynamic- It has been suggested that SW represents a desire to sleep where the individual slept as a child. However this does not explain the activities carried out. An explanation based of Freud’s work suggests that we are working through unconscious anxieties. Moving from REM to NREM prevents this so energy is channeled into motor activities; sleep walking.
  • 5. Sleep Apnoea , NnAaRrCcOoLlEePpSsYy What is it? WwHhAaTt IiSs IiTt? Sleep Apnoea is where a person experiences repeated episodes of  Extreme daytime sleepiness breathing failure during sleep. These typically last between 20-40  Episodes of cataplexy (loss of muscular control) during the day, seconds, in rare cases can last minutes. For clinical diagnosis there they can last between a few seconds and a few minutes. needs to be at least 5 episodes a night. The person may or may not be Episodes appear to be triggered by emotional arousal e.g. anger, fully conscious during an episode. Either way the experiences will lead to fear, amusement or stress. insomnia and daytime sleepiness.  Hypnagogic hallucinations; dream like experiences during wakefulness.  Sleep paralysis, an inability to move, when falling asleep or other features: waking up  Snoring  Interruption of night-time sleep by waking  Morning Headaches *Only 50% of sufferers show all four symptoms  Dry mouth in the morning CcOoUuRrSsEe OoFf TtHhEe DdIiSsOoRrDdEeRr Types of Sleep Apnoea: Usually begins in early adulthood and continues through life. Estimated 1 Obstructive Sleep Apnoea (OSA) –The upper airways are obstructed in 2000 people are sufferers (Blacks et al, 2004.) Though this may an and breathing is inefficient. It is due to a narrowing of the airways, underestimate as minor symptoms can go unnoticed therefore never enlargement of the tissue at the back of the mouth or enlargement of lead to a diagnosis. the tonsils. OSA is highly correlated with obesity, typically patients are middle aged and overweight. 4% men and 2% women. PpOoSsSsIiBbLlEe CcAaUuSsEeSs Central Sleep Apnoea (CSA) – No problems with upper airways, CSA RrEeMm In the 1960s it was thought that Narcolepsy was linked to a linked to heart problems and blood supply to the brain resulting in malfunction in the system that regulates REM sleep, explaining malfunctions in the brain’s control of respiration and cardiac function. It symptoms of muscle tone (cataplexy) and hallucinations. results in several episodes of breathing failure in the night associated HhLlAa In the 1980s research linked Narcolepsy to a mutation in the with a chocking sensation. Can lead to insomnia and daytime immune system. Honda et al (1983) found frequency of one HLA (human sleepiness. leukocyte antigen) in narcoleptic patients. HLA molecules are found on the surface of white blood cells and coordinate the immune response. Treatments Surgery can be used for OSA to widen upper airways, whilst weight loss HhYyPpOoCcRrEeTtIiNnSs Lit et al (1999) uncovered a link between the is also effective. A night cap can also be used. Treatment of CSA is neurotransmitter hypocretin (or orexin) and narcolepsy. Lit et al found limited, drugs can help the underlying condition. narcoleptic dogs who had a mutation in a gene chromosome 12 which is responsible for regulating brain receptors. It is thought that lack of hypocretin or receptors is the cause of narcolepsy in humans
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