SLEEP DISORDERS

SLEEP DISORDERSGROUP MEMBERSElliot MatogaStanley Tepeka Symon NyondoThemba Luwe

OUTLINENormal physiology of sleep Classification of sleep disorders according to DSM IVDyssomniasParasomniasSleep disorders related to another mental disorderOther sleep disordersCLASSIFICATION OF SLEEP DISORDERS ACCORDING TO DSM IVDYSOMINIASPrimary insomniaPrimary hypersomniaNarcolepsyBreathing related sleep disorderCircardium rhythm sleep disorderDyssomnias NOSPARASOMNIASNightmare disorder(dream anxiety disorder)Sleep terror disorderSleep walking disorderParasomnias NOSSLEEP DISORDER RELATED TO ANOTHER MENTAL DISORDERInsomnia

hypersomniaOTHER SLEEP DISORDERSSecondary sleep disorder due to GMC

Substance induced sleep disorder1.PRIMARY INSOMNIADifficult in initiating & maintaining sleep or non restorative sleep that last for @ least 1 month(DCM IV)

Def excludes all insomnias due to external factors

CLINICAL FEATURESThe primary insomniac goes to bed & is unable to fall asleep due to conditioned arousal. This cause the patient to be increasingly alert which further inhibit the ability to fall asleep and therefore increases the anxiety

MANAGEMENT1. Pyschoeducation2. Sleep restrictionReduction of time spent on bedPrescription of bed time3. Sleep hygieneRemoving all entertainmentNo caffeine ,smokingReduction of day sleepSleep in familiar & comfortable environmentRetire @ the same time in a comfortable bed warm Mgt cont..Hypnotic drugsNon-benzodiazines e.g. zopicloneBenzodiazepines e.g. temazepam2.PRIMARY HYPERSOMNIADEFFeature is excessive sleepiness for @ least 1 month as evidenced either by prolonged sleep episodes, or by daytime sleep episodes occurring almost daily(DSM IV)This is a diagnosis of exclusion

CAUSESInsufficient night time sleepUnsatisfactory sleep routines or circumstancesCircadium rhythm sleep disorder Frequent parasomniasChronic physical illnessNarcolepsyDrug effectsMANAGEMENT As in narcolepsyNARCOLEPSYDEFFeatures of repeated irresistible attacks of refreshing sleep, cataplexy and recurrent intrusion of REM sleep into the transition period between sleep and wakefulness(DSM IV)ONSET AND CAUSESBetween 10 & 20 yrs

associated with genetic predisposition

Abnormalities in neurotransmitters eg hypocretin

CLINICAL FEATURES4 MAJOR SYMPTOMS1.Sleep attacks2.Sleep hallucinationshypnogogic hallucinations and hypnopompic hallucinations3. Sleep paralysisParalysis of the entire body on waking up from sleep episode4.cataplexy Sudden loss of muscle tone either throughout or isolated to the jaw muscles

MANAGEMENTStimulants e.g. pemolneScheduled naps to alleviate the sleepiness for a few hrsAntidepressants for cataplexy i.e. clomipramineNo treatment for sleep paralysis & hallucinations4.BREATHING - RELATED SLEEP DISORDERSDEFEssential feature is sleep disruption leading to excessive sleepiness or insomnia that is judged to be due to abnormalities of ventilation during sleep(DSM IV)

RISK FACTORSNasal obstruction/blockadeObesityAbnormality with the soft palate and tongueCLINICAL FEATURESSevere snoring GaspingApnoeaSweatingHeart burn @nightMANAGEMENTTreatment depends on severity of the apnoeaNasal continuous positive airway pressure(CPAP)Mild obstructionsWeight reduction Medical & nasal decongestantsSurgery on nasal passagesMouth guards5.CIRCARDIUM RHYTHM SLEEP DISORDEREssential feature is persistent & recurrent pattern of sleep disruption(DSM IV)

The body clock controlling sleep-wake cycle is usually synchronized to the 24hr light-dark cycleCAUSESJET LAGDisturbance is proportional to the number of time zones crossed eg on eastwards flights-the day is shortened while westwards its lengthenedMANAGEMENTJet lagSelf limitingBright lightMelatonin-hormoneHypnoticsShort acting BZ eg lorazepam/triazoramNon-BZ

6.DYSSOMNIAS NOSSleep disorders not fitting in the aboveManagement is according to the cinical presentation PARASOMNIASEssential feature is occurrence of repeated frightening dreams that lead to awakenings from sleep(DSM IV)Occurs during 2nd half of the night & are associated with REM sleepRecall of dream is typically intactThese sleep disorders are characterized by abnormal behaviour or physiological events occurring in association with sleep, specific sleep stages or sleep-wake transitions.ONSET AND CAUSESPeak frequency 5-6yrsIdiopathic but associated withPTSD,depression&medicatin withdrawalFrightening experiences during the dayMANAGEMENTAntidepressantsHypnoticsAlcoholPsychosocial stresssors must be addressedSLEEP TERROR DISORDERRepeated occurrence in the 1st half of the night of sudden awakenings from sleep with a scream and increased motor & autonomic activity as if terrified.Occurs in 3rd & 4th stage of NREM sleepONSET AND CAUSESCommon in children

Genetic predisposition-familiarMANAGEMENTImproved sleep hygieneBZAntidepressants eg imipraminehypnoticsSLEEP WALKING DISORDEREssential feature is repeated episode of complex motor behaviour initiated during sleep(DSM IV)It is an automatism occuring during deep non-REM sleep usually in the early part of the nightONSET AND CAUSESCommon in children 5-12 yrs

Genetic predisposition-familiarMANAGEMENTSafetyAvoidance of sleep deprivation & other circumstances that can make them sleep eg alcohol

PARASOMNIAS NOSThese are sleep disorders that does not fit in the explained categories

Treatment is based on the clinical judgementSLEEP DISORDERS RELATED TO ANOTHER METAL DISORDERINSOMNIA/HYPERSOMNIADisturbance of sleep is common in a range of psychiatric illnesses including:Depression AnxietypsychosisMANAGEMENTManagement is according to the causeOTHER SLEEP DISORDERSSecondary sleep disorder due to GMC and substance induced sleep disordersSECONDARY SLEEP DISORDER DUE TO GMCMedical conditions often cause sleep disturbance which may be either insomnia or hypersomniaEspecially GMC associated with painE.g. of GMC with sleep disorder;NeoplasmAnginaEpilepsy traumaMANAGEMENTManagement is usually according to the causeSUBSTANCE INDUCED SLEEP DISORDERSSleep disorder may follow the use or abuse of psychoactive substancesExamples are:Depressants leading to sedation & hypersomniaAlcoholBZThose which cause and lead to hypersomniaCocaineamphetamines

Thanks but dont sleep u will be diagnosed