Tiêu đề 14 AbPsy - Sleep and Wake Disorders.pdf ✅

14 – Sleep and Wake Disorders ABPSY | 2024 - 2025 | NOT FOR SALE OUTLINE 1. Insomnia Disorder 2. Hypersomnolence Disorder 3. Narcolepsy 4. Breathing-Related Sleep Disorders 5. Circadian Rhythm Sleep-Wake Disorders 6. Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders 7. Nightmare Disorder 8. Rapid Eye Movement (REM) Sleep Behavior Disorder 9. Restless Legs Syndrome SLEEP-WAKE DISORDERS AN OVERVIEW Sleep and Wake Disorders – sleep-wake complaints of dissatisfaction regarding the quality, timing, and amount of sleep ● Resulting daytime distress and impairment are core features shared by all sleep-wake disorders ● Sleep disorders are often accompanied by depression, anxiety, and cognitive changes ● Rapid Eye Movement (REM) Sleep ○ Also called dream sleep ○ Involves the brain circuit in the limbic system ○ This mutual neurobiological connection suggests that anxiety and sleep may be interrelated in important way ○ NREM Sleep Stage 1 (N1): transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults ○ NREM Sleep Stage 2 (N2): characterized by specific electroencephalographic waveforms (sleep spindles and K complexes), occupies about 50% of time spent sleep ○ NREM Sleep Stage 3 (N3): slow wave sleep; deepest level of sleep ● Sleep Continuity: overall balance of sleep and wakefulness during night of sleep ○ Sleep Latency: amount of time required to fall asleep ○ Wake After Asleep Onset: amount of awake time between initial sleep onset and final awakening ○ Number of awakenings ○ Sleep Efficiency: ratio of actual time spent asleep to time spent in bed ● Sleep abnormalities are preceding signs of serious clinical depression ● Major Categories ○ Dyssomnias: involve difficulties in getting enough sleep, problems with sleeping when you want to, and complaints about the quality of sleep ○ Parasomnias: characterized by abnormal behavioral or physiological events that occur during sleep ● Polysomnographic (PSG) Evaluation: determines the clearest and most comprehensive picture of sleep habits; usually shows impairments of sleep continuity ○ Electroencephalogram: measures brain wave activity ○ Electrooculogram: measures eye movements ○ Electromyogram: measures muscle movements ○ Electrocardiogram: measures heart activity ○ Actigraph: records the number of arm movements; alternative to PSG ● Sleep Efficiency (SE): percentage of time actually spent asleep ○ Calculated by dividing the amount of time sleeping by the amount of time in bed ○ SE of 100% would mean you fall asleep as soon as your head hits the pillow INSOMNIA DISORDER DEFINING INSOMNIA DISORDER Insomnia Disorder – difficulty initiating and maintaining sleep ● Situational, persistent, or recurrent, episodic ● One of the most common sleep–wake disorders ● Primary Insomnia: sleep problems that are not related to other medical or psychiatric problems ● Different manifestations of insomnia can occur at different times of the sleep period ○ Sleep Onset Insomnia (or initial insomnia): involves difficulty initiating sleep at bedtime ○ Sleep Maintenance Insomnia (or middle insomnia): involves frequent or prolonged awakenings throughout the night 1 | @studywithky
○ Late Insomnia: involves early-morning awakening with an inability to return to sleep ● Difficulty maintaining sleep is the most common single symptom of insomnia, followed by difficulty falling asleep ○ Nonrestorative Sleep: poor sleep quality that does not leave the individual rested upon awakening despite adequate duration ○ Microsleeps: sleep that last several seconds or longer; result of being awake for one or two nights ● Often associated with physiological and cognitive arousal and conditioning factors that interfere with sleep ● First episode is more common in young adulthood DIAGNOSTIC CRITERIA A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: 1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.) 2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.) 3. Early-morning awakening with inability to return to sleep. B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning. C. Sleep difficulty occurs at least 3 nights per week. D. The sleep difficulty is present for at least 3 months. E. Sleep difficulty occurs despite adequate opportunity for sleep. F. Insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia). G. Insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia. Specify if: With non-sleep disorder mental comorbidity, including substance use disorders With other medical comorbidity With other sleep disorder Specify if: Episodic: Symptoms last at least 1 month but less than 3 months. Persistent: Symptoms last 3 months or longer. Recurrent: Two (or more) episodes within the space of 1 year. CAUSES / RISK FACTORS Genetic and Physiological Risks ● Delayed temperature rhythm ○ Body temperature doesn’t drop ○ They don’t become drowsy until later at night ○ People with insomnia seem to have higher body temperatures than good sleepers ● Drug use Environmental Risks ● Changes in light, noise, or temperature Psychological Risks ● Psychological Stress ● Parent’s depression and negative thoughts about child sleep negatively influenced infant night waking ● Children learn to fall asleep only with a parent present Temperamental Risks ● Anxiety or worry-prone personality or cognitive styles, ● Increased arousal predisposition ● Tendency to repress emotions An Integrative Model ● Both biological and psychological factors are present in most cases ● Multiple factors are reciprocally related ● Personality characteristics, sleep difficulties, and parental reaction interact in a reciprocal manner to produce and maintain sleep problems ● People may be biologically vulnerable to disturbed sleep ○ Also referred to as predisposing conditions ○ This vulnerability differs from person to person and can range from mild to more severe disturbances ● Biological vulnerability may, in turn, interact with sleep stress ● Rebound Insomnia: sleep problems reappear, sometimes worse 2 | @studywithky
DIAGNOSTIC ISSUES Gender ● More prevalent complaint among females than among males ● First onset is often associated with the birth of a new child or with menopause DIFFERENTIAL DIAGNOSIS AND COMORBIDITY Situational/Acute Insomnia ● Usually lasts a few days to a few weeks ● Often associated with life events or with changes in sleep schedules ● When symptoms are frequent enough and meet all other criteria except for the 3-month duration, a diagnosis of other specified insomnia disorder or unspecified insomnia disorder is made Comorbidity ● Diabetes, coronary heart disease, chronic obstructive pulmonary disease, arthritis, fibromyalgia, and other chronic pain conditions ● Bipolar, depressive, and anxiety disorders ● Persistent insomnia represents a risk factor or an early symptom of subsequent bipolar, depressive, anxiety, and substance use disorders TREATMENT Medical Treatments ● Benzodiazepine ● Triazolam (Halcion) ● Zaleplon (Sonata) ● Zolpidem (Ambien) ● Flurazepam (Dalmane) Psychological Treatments ● Cognitive ○ Focuses on changing the sleepers’ unrealistic expectations and beliefs about sleep ○ Therapist attempts to alter beliefs and attitudes about sleeping by providing information on topics such as normal amounts of sleep and a person’s ability to compensate for lost sleep ● Guided Imagery Relaxation: uses meditation or imagery to help with relaxation at bedtime or after a night waking ● Graduated Extinction ○ Used for children who have tantrums at bedtime or wake up crying at night ○ Instructs the parent to check on the child after progressively longer periods until the child falls asleep on his or her own ● Paradoxical Intention: instructs poor sleepers to lie in bed and try to stay awake as long as they can ● Progressive Relaxation: involves relaxing the muscles of the body in an effort to introduce drowsiness HYPERSOMNOLENCE DISORDER DEFINING HYPERSOMNOLENCE DISORDER Hypersomnolence Disorder – excessive sleepiness despite having at least 7 hours of main sleep ● Hyper means “in great amount” or “abnormal excess” ● Take longer naps, have trouble waking from naps, and do not feel alert afterward ● Includes symptoms of excessive quantity of sleep, deteriorated quality of wakefulness, and sleep inertia ● Sleep Inertia: prolonged impairment of alertness at the sleep-wake transition ● They often snore loudly, pause between breaths, and wake in the morning with a dry mouth and headache ● Has a persistent course, with a progressive evolution in the severity of symptoms ● Has a progressive onset, with symptoms beginning between ages 15 and 25 years, with a gradual progression over weeks to months DIAGNOSTIC CRITERIA A. Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms: 1. Recurrent periods of sleep or lapses into sleep within the same day. 2. A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing). 3 | @studywithky
3. Difficulty being fully awake after abrupt awakening. B. The hypersomnolence occurs at least three times per week, for at least 3 months. C. The hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning. D. The hypersomnolence is not better explained by and does not occur exclusively during the course of another sleep disorder (e.g., narcolepsy, breathing-related sleep disorder, circadian rhythm sleep-wake disorder, or a parasomnia). E. The hypersomnolence is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). F. Coexisting mental and medical disorders do not adequately explain the predominant complaint of hypersomnolence. CAUSES / RISK FACTORS Genetic and Physiological Risks ● Presence of the gene HLA-Cw2 and HLA-DR11 ● Previous exposure to a viral infection such as mononucleosis, hepatitis, and viral pneumonia ● May also be familial, with an autosomal dominant mode of inheritance Environmental Risks ● Increased temporarily by psychological stress and alcohol use ● Guillain-Barré syndrome NARCOLEPSY DEFINING NARCOLEPSY Narcolepsy – irrepressible need to sleep ● Some people with narcolepsy experience cataplexy ○ Sudden loss of muscle tone ○ Occurs while the person is awake ○ Can range from slight weakness in the facial muscles to complete physical collapse ○ Appears to result from a sudden onset of REM sleep ● Evidence from polysomnography reveal that REM sleep latency is less than or equal to 15 mins DIAGNOSTIC CRITERIA A. Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three times per week over the past 3 months. B. The presence of at least one of the following: 1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month: a. In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness are precipitated by laughter or joking. b. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers. 2. Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less than or equal to one-third of values obtained in healthy subjects tested using the same assay, or less than or equal to 110 pg/mL). Low CSF levels of hypocretin-1 must not be observed in the context of acute brain injury, inflammation, or infection. 3. Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep latency less than or equal to 8 minutes and two or more sleep-onset REM periods CAUSES / RISK FACTORS Temperamental Risks ● Parasomnias, such as sleepwalking, bruxism, REM sleep behavior disorder, and enuresis ● Individuals commonly report that they need more sleep than other family members Environmental Risks ● Group A streptococcal throat infection, influenza), or other winter infections ● Head trauma and abrupt changes in sleep-wake patterns BREATHING-RELATED SLEEP DISORDERS DEFINING BREATHING-RELATED SLEEP DISORDERS Breathing-Related Sleep Disorders – problems with breathing while asleep ● Characteristics ○ Hypoventilation: constricted and labored breathing ○ Sleep Apnea: individual stop breathing altogether ○ Sleep Attacks: episodes of falling asleep during the day ● Types of Breathing-Related Sleep Disorders ○ Obstructive Sleep Apnea Hypopnea ■ Occurs when airflow stops despite continued activity by the respiratory system 4 | @studywithky