sleep disorders

my notes on sleep disorders

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  • Created on: 01-06-11 10:20
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Sleep Disorders
It is estimated that 2530% of the UK population will suffer from a sleep
disorder at some point in their lives.
Sleep difficulties are particularly common in women, children and those
over 65.
Sleep disorders can significantly affect an individual's quality of lifetime by
leading to daytime tiredness and possible problems with work and
relationships.
Sleep disorders can be divided into two categories:
Dyssomnias ­ problems with the amount, quality or timing with sleep. They
include disorders such as insomnia and narcolepsy, and often produce daytime
tiredness that affects daily activities.
Parasomnias ­ are behavioural or physiological events that occur during sleep.
e.g. sleepwalking and nights. Parasomnias are not usually associated with
daytime sleepiness.
Insomnia
Insomnia involves problems in falling asleep, maintaining sleep and
obtaining quality sleep. There are 2 types of insomnia, primary and
secondary.
Primary ­ no reason for it.
Secondary ­ reasons for it such as medicine, psychiatric/ physiological
disorder. There is a cause.
Insomnia can be transient (lasting less than a week, e.g. jet lag),
shortterm (lasting between 14 weeks) or chronic (lasting more than a
month).
Diagnostic criteria for primary insomnia:
Difficulty initiating or maintaining sleep, lasting for more than one month. This is
known as chronic insomnia.
The disturbance causes significant distress or impairment.
The disorder does not occur alongside any mental disorder.
The disorder is not due to any medical condition or substance use.
The most severe type of primary insomnia is idiopathic insomnia. This
begins in childhood and is usually a lifelong condition. It is not clear exactly
how it occurs, but it is thought to be related to an imbalance of
neurotransmitters associated with sleep (e.g. melatonin, serotonin). Only
around 1% of people suffer from idiopathic insomnia so it is quite rare.
Treatments might include:
Cognitive Behavioural Therapy ­ to change sleeping habits and perceptions of
sleep ­ indicating that it could be an interaction between thoughts and behaviour.
Sleeping pills/ aids ­ to try and balance neurotransmitters ­ indicating a
biological basis.
Sleep 'hygiene' ­ good habits to improve sleep e.g. avoiding caffeine ­ indicating
that it could have a behavioural explanation.

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Psychopathological insomnia is a form of behavioural insomnia usually
associated with excessive worrying. It is a form of primary insomnia as it is
not associated with any other mental/physical disorder.
The reason for psychopathological insomnia is stress related to not
sleeping, which in turn results in poor sleep and generates maladaptive
behaviours. These include:
A vicious cycle of trying harder to sleep and becoming tenser, expressed by
patients as 'trying too hard to get to sleep'.
Bedroom habits and routines and other sleeprelated activities (e.g.…read more

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Psychiatric conditions: secondary insomnia is associated with depression,
anxiety disorders, posttraumatic stress disorder etc. Treatment involving drugs
and psychotherapy can help to improve a person's sleep.
The use of stimulants: e.g. caffeine in coffee. It can trigger awakenings during
the night. Nicotine smokers take longer to get to sleep.
Use of alcohol: glass of wine may help sleep onset but usually interrupts
nighttime sleep.
Shift work: hard to maintain regular sleep patterns.
Environmental factors: e.g.…read more

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Dement 1999.
Dement believes that insomnia is not a sleep disorder at all! More a
symptom that occurs as a result of other disorders and treatment should
focus on the causes.
Factors that affect insomnia
Apnoea
There are two types of sleep apnoea ­ obstructive sleep apnoea and central
sleep apnoea.
Obstructive sleep apnoea (OSA) is defined as the cessation of airflow
during sleep, preventing air from entering the lungs, caused by an
obstruction.…read more

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­ heart rate and blood oxygen level monitoring
electrocardiography (ECG) ­ heart monitoring
sound and video recording
Causes of sleep apnoea make the throat narrow more than usual during
sleep. These factors are:
enlarged adenoids or tonsils
setback lower jaw
partially blocked nose e.g.…read more

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This is
supported by the effectiveness of therapies such as muscle relaxation and
CBT which aim to reduce arousal and anxiety levels and thus combat
insomnia. It is also supported by twin studies showing that high levels sleep
disturbance were associated with high levels of neuroticism (Heath et al
1998). Neuroticism is a personality trait that is significantly correlated with
anxiety.…read more

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This explained some of the symptoms of the disorder, such as the loss of
muscle tone (found in REM sleep) and the hallucinations (seen as REMtype
sleep and dreams intruding into the day).
However, this is reductionist as it ignores other biological variables as well
as environmental ones. Studies have shown that other theories e.g. orexin
levels have validity and so we cannot ignore other factors.
Also deterministic.
Narcolepsy can occur due to low levels of orexin (a neurotransmitter).
Without receptors orexin cannot function.…read more

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Sleepwalking affects approximately 117% of children and is more frequent
in boys. The incidence of sleepwalking decreases with age. Sleepwalking
usually occurs during deep, nonREM sleep early in the night. If it occurs
during REM sleep, it is defined as a REM behaviour disorder & tends to
happen near morning.
Sleepwalking in an individual is 10 times more likely if a firstdegree relative
has had a history of sleepwalking and it is more frequent in identical twins
sleepwalking can be inherited.…read more

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This shows that sleep deprivation had increased the amount of
sleepwalking.
Some of the conditions that can cause sleepwalking are fever, arrhythmia,
asthma during the nighttime, seizures during the nighttime and sleep
apnoea. It can also be caused by some psychiatric disorders like multiple
personality disorder, panic attack and stress disorder.
Discussion
Genetic research support ­ Bassetti's (2002) study adopts a classic
epidemiological procedure for showing a family association between sleep
disorders.…read more

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