lesson 6 sleep disorders

7/30/2019 Lesson 6 Sleep Disorders

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Sleep Disorders (Somnipathy)


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Sleep Disorders 1 - Insomnia

BATs

A01 Outline the classification of sleep disorders(E)

A01 Explain the differences between primary andsecondary insomnia (C/D)

A01Describe some of the explanations forinsomnia and the role of personality (C)

Synoptic points

research complications,

real world application attribution theory(cognitive approach)


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Sleep Disorders - Insomnia

Classification - Transient (short-term),Intermittent (occasional) or Chronic (constant andlong term - more than one month)

Causes

Secondary Insomnia - symptom of an underlyingdisorder e.g depression, heart disease or due to shift

work, caffeine or alcohol -

Commentary -2007 Dr Ancoli-Israel sleep disorders should beregarded as comorbid, and receive the same emphasis in

treatment.- Ohayon and Roth 2003 found that insomnia

can precede mood disorders


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Primary Insomnia - result from anendogenous disturbance in the sleepingmechanism, often complicated by learnedbehaviours and bad sleep habits (room too light,

staying up late e.t.c)

Insomnia is the only problem. Insomnia occurswith no cause for more than 1 month (DSM)

Sleep Disorders - Insomnia

Synoptic- Chronic Insomnia highlycomplex so cant be explained by one factor and lots

of causes for insomnia so difficult to draw conclusionsfrom research


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Major Classifications of

SomnipathylDyssomnias- a broad category includinginsomnia and hypersomnolence (too much

sleep)lParasomnias strange behaviours duringsleep

lMedical or psychiatric conditions that canproduce somnipathy


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l Dyssomnias- a broadcategory including insomnia

and hypersomnolenceuInsomnia

uNarcolepsy

uObstructive sleep apnea

uRestless legs syndrome

uKlein-Levin Syndrome*

uPost-traumatic hypersomnia*recurring periods of excessive amounts of sleeping and eating. At the onset of

an episode the patient becomes drowsy and sleeps for most of the day and

night (hypersomnolence), waking only to eat or go to the bathroom.


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Parasomnias strange

behaviours during sleepuNight terrors

uBruxism (tooth grinding)

uSleepwalking (somnambulism)

uSleeptalking (somniloquy)

uExploding head syndrome!


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Exploding head syndrome

is a conditionthat causes the sufferer occasionally to experience a tremendouslyloud noise as originating from within his or her own head, usually describedas the sound of an explosion, roar, waves crashing against rocks, loud voicesor screams, a ringing noise, or the sound of an electrical short circuit(buzzing).

This noise usually occurs within an hour or two of falling asleep, but is notnecessarily the result of a dream and can happen while awake as well.[1]Perceived as extremely loud, the sound is usually not accompanied by pain.

Attacks appear to change in number over time, with several attacks occurringin a space of days or weeks followed by months of remission. Sufferers oftenfeel a sense offearand anxiety after an attack, accompanied by elevatedheart rate. Attacks are also often accompanied by perceived flashes of light(when perceived on their own, known as a "visual sleep start") or difficulty inbreathing. The condition is also known as "auditory sleep starts." It is notthought to be dangerous,[1] although it is sometimes distressing toexperience.

Reference to the condition was made in an episode of the BBC TV drama "DocMartin", which was instrumental in many sufferers becoming aware that theproblem was in fact a known medical condition, and not one to be concernedabout.


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Medical or psychiatricconditions that can produce

somnipathy

uPsychoses

uAnxiety

uDepression

uPanic

uAlcoholism

uSleeping sickness


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Sleep Disorders - InsomniaRisk Factors -

Age - older people more likely to suffer(arthritis, diabetes)

Gender - women more likely to suffer

menopause (hormone fluctuations)

Sleep Apnoea and otherparasomnias (e.g bruxism, sleepwalking)- disrupt sleep and increaselikelihood of insomnia

Personality - linked to people with atendency to internalising problems ratherthan act them out - anxiety and higher levels

of emotional arousal.Kales et al 1976

Commentary - Watsonet al 2006 - 50% risk ofhaving insomnia due togenetics.

Diathesis-stress model -environmental stressorsmay trigger the disorder

Perpetuating factors -being tense before going

to bed because ofprevious sleep problems


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Research ComplicationsSynoptic point

Chronic insomnia highly complex

Lots of causes of insomnia stress,depression, poor sleep hygiene, age,gender e.t.c

Unlikely to be explained by one factor

Therefore - Difficult to drawconclusions


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Attribution TheorySynoptic Point (cognitive approach)

One cause of Primary Insomnia is apersons beliefthatthey are going to have difficulty sleeping.

Self fulfillingtense before sleep

Attribute sleep problems to insomnia

Treatment

Train them to be convinced the source of problem lieselsewhere

Storms and Nisbett 1970 insomniacsgiven apill

half told it would stimulate them and the other half itwould sedate them.

Those expecting arousal went to sleep faster becausethey attributed their arousal to the pill and actuallyrelaxed!!


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Now drink some caffeine!!

Wait 15mins and try again!!What do you predict will

happen?

Have a go at sleep dash!!

http://www.bbc.co.uk/science/humanbody/sleep/sheep/


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Treatment of Insomnia

Read p 17

Create a problem page to give advice

on why they may be suffering frominsomnia and how to help it.


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BATs

A01 Describe symptoms of sleep disorders sleep

apnoea, narcolepsy and sleepwalkingA02 Understand explanations for these sleep

disorders

Synoptic points

Real world application sleep walking diagnosisused in cases of murder

Sleep Disorders 2 Narcolepsy andSleep Walking

http://www.bbc.co.uk/news/health-12327436


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Sleep Disorders -

NarcolepsyDefinition - feeling sleepy all the time orepisodes of cataplexy - loss of muscle control- triggered by emotional arousal e.g. anger,fear, amusement or stress. Usually starts inadolescence/early adulthood and persiststhrough life. 1/2000 are sufferers, but may bemore prevalent.

http://www.youtube.com/watch?v=3MBCeKn0Oeo


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Sleep Disorders - Narcolepsy

Explanations -REM - linked to a malfunction in the mechanism that regulates REM -explains cataplexy!!

Vogel 1960 and Siegel 1999 - but support from research not convincing

HLA - linked to mutation of the immune system - more of one type of HLAfound in narcoleptic patients.

Not found in all narcoleptics and also common in general population socant be only explanation

Hypocretin - link between neurotransmitter hypocretin and narcolepsy.Hypocretin helps maintain wakefulness.

A promising lead research in dogs and humans show lower hypocretinlevels. Not thought to be inherited, more likely due to brain injury, infection,diet or stress or result of an auto-immune attack (bodys immune system turns onitself) Mignot 2001


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Sleep Disorders - Sleep Walking

Definition -Most common in childhood,affecting 20% children and less than 3%adults. Only occurs during NREM/SWS and

related to night terrors. Sleep walker notconscious and later has no memory ofevents during sleep walking


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Sleep Disorders - Sleep Walking

Explanations -Incomplete arousal - Person wakes during SWS but brainarousal incomplete. Likely that this is genetic. Diathesis - stressmodel fits.50% concordance in MZ twins, 10x more likely to SW iffirst degree relatives have disorder.

Sleep deprivation, alcohol, fever, stress and psychiatricconditions, hormonal changes during puberty and menstruation haveall been shown to increase likelihood of sleep walking - the stresspart of the Diathesis-stress model

More common in childhoodpossibly because they have moreSWS than adults. Oliviero (2008) suggests that the system thatinhibits motor activity in SWS is underdeveloped in some children

and adults - evident in sleep walkers.

Synoptic - SW accepted as defence insome crimes


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Your mission, should you choose toaccept it,


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In groups, you will choose one category ofdisorder to research.

You must produce a poster on the category, givingdetailed examples, explanations and treatments.

You must consider behavioural /

psychotherapeutic treatments, management anddrug treatments.

AS WELL AS A POSTER, YOU MUST ALSO

PREPARE AND PRESENT A 5 MINUTEPOWERPOINT FOR THE REST OF THE GROUP ONTHE CATEGORY YOU CHOSE


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Homework

Finish presentation and/or

Question 6 p19

600 word essay

Outline and evaluate explanations oftwo ormore

sleep disorders

The narcolepsy powerpoint on the blog isparticularly good for essay prep (not done by

me. Mores the pity!)Produce some revision materials for the sleep

topic e.g. cards, mind maps, notes, game, quiz -bring in on Friday


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Outline and evaluate explanations oftwo ormore sleep disorders

You will be divided into pairs/3s

Pair 1 will prepare an outline of Narcolepsy

Pair 2 will prepare an evaluation of Narcolepsy

Pair 3 will prepare an outline on sleep walking

Pair 4 will prepare an evaluation of sleep walking

Pair 5 will prepare synoptic points relating to sleep

disorders

Pair 6 will prepare an outline of another disordere.g. Obstructive Sleep Apnoea or Night Terrors23

We will then put these

paragraphs together to makea super essay!!!

lesson 6 sleep disorders

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