1

SLEEP WAKE DISORDERS

GROUP 4

BUENSALIDA, JESUFIDES R.

DELA CRUZ, KEVIN ANGELO

ELIZAN, JANN EARL HEINRICH S.

GENTOLIZO, MARIA ROMA BIANCA V.

GO, GENE LOROSE P.

GRAN, PAULA ANGELICA T.

LAYA, ANGELICA SHYR

NOJARA, DANNICA V.

OHARA, HEBER JUSTIN P.

RIVERA, CARMELA TERESA C.

SAN GABRIEL, BRYLLE ALLAN P.

VILLANUEVA, MA SOCCORRO G.

3BES1

ARREVILLAGA, MILAGROS C.

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INSOMNIA DISORDER

I. DESCRIPTION

It is the difficulty of falling asleep (onset) or staying asleep

(maintenance), even though the person had the opportunity to

get a full night of sleep. One or more things of the following are

experienced by people with Insomnia: fatigue, low energy,

difficulty concentrating, mood disturbances, and decreased

performance in work or at school.

Insomnia may be characterized depending on its duration.

Acute Insomnia and Chronic Insomnia.

Acute Insomnia: Often happens because of life circumstances,

many people may have experienced this passing sleep type of

disruption, and can be resolved without any treatment.

Chronic Insomnia: Changes in the environment, unhealthy

sleep habits, shift work, other clinical disorders, and certain

medications could lead to a long-term pattern of insufficient

sleep may cause this, as this is a disrupted sleep that occurs at

least three nights per week and lasts at least three months.

They may need treatment to be able to get back in their healthy

sleep pattern.

II. SYMPTOMS

Symptoms and causes of insomnia are different for every

patient. Insomnia symptoms may include:

Fatigue

Problems with attention, concentration or memory

(cognitive impairment)

Poor performance at school or work

Moodiness or irritability

Daytime sleepiness

Impulsiveness or aggression

Lack of energy or motivation

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Errors or accidents

Concern or frustration about your sleep

III. TREATMENT

A. SLEEP HYGIENE

In many chronic insomnia cases, by practicing good hygiene

and changing your sleep habits you can improve your sleep.

Sleep hygiene is a set of bedtime habits and rituals you can

do every night to improve how you sleep.

Sleep as much as you need to feel rested; do not

oversleep.

Exercise regularly at least 20 minutes daily, ideally 4-5

hours before your bedtime.

Avoid forcing yourself to sleep.

Keep a regular sleep and awakening schedule.

Do not drink caffeinated beverages later than the

afternoon (tea, coffee, soft drinks etc.) Avoid "night

caps," (alcoholic drinks prior to going to bed).

Do not smoke, especially in the evening.

Do not go to bed hungry.

Adjust the environment in the room (lights,

temperature, noise, etc.)

Do not go to bed with your worries; try to resolve them

before going to bed.

Go to bed when you feel sleepy.

Do not watch TV, read, eat, or worry in bed. Your bed

should be used only for sleep and sexual activity.

If you do not fall asleep 30 minutes after going to bed,

get up and go to another room and resume your

relaxation techniques.

Set your alarm clock to get up at a certain time each

morning, even on weekends. Do not oversleep.

Avoid taking long naps in the daytime.

B. MEDICAL TREATMENT

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A number of medication can possibly treat Insomnia, so this

should not be used as the only therapy to treat Insomnia.

Benzodiazepine sedatives: These include temazepam

(Restoril), flurazepam (Dalmane), triazolam (Halcion),

estazolam (ProSom, Eurodin), lorazepam (Ativan), and

clonazepam (Klonopin).

Nonbenzodiazepine sedatives: These include

eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem

(Ambien).

Antihistamines

C. COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA

Cognitive behavioral therapy for insomnia, or CBT-I,

addresses the thoughts and behaviors that keep you from

sleeping well. It also helps you learn new strategies to sleep

better. CBT-I can include techniques for stress reduction,

relaxation and sleep schedule management.

IV. FAMOUS PERSONALITIES

1. Jimi Hendrix

2. Michael Jackson

3. Madonna

4. Miley Cyrus

5. Bill Clinton

6. Sandra Bullock

7. George Clooney

8. Eminem

9. Jessica Simpson

10. Lady Gaga

V. FACTS / TRIVIAS

Pills might not help

Many people with sleeping problems might turn to sleeping

pills. However, these pills are not always the answer, especially

if the sleep problems are chronic. Instead, people should try to

make their bedrooms optimal for sleeping.

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Paying attention can worsen symptoms

Some people might put a lot of attention on their sleeping patterns and habits, preventing them from being able to relax

and actually fall asleep.

HYPERSOMNOLENCE DISORDER

I. HISTORY

In the year 1966, William Dement suggested that patients with

excessive daytime sleepiness, but without cataplexy, sleep

paralysis, or sleep-onset rapid eye movement (REM), should not

be considered narcoleptic. In 1972, Roth et al described a type

of hypersomnia with sleep drunkenness that consists of

difficulty coming to complete wakefulness, confusion,

disorientation, poor motor coordination, and slowness,

accompanied by deep and prolonged sleep. The abrupt sleep

attacks seen in classic narcolepsy are not present in this

disorder. (WEBMD, 2015)

II. DESCRIPTION

Also known as HYPERINSOMIA

Described as having excessive DAY-TIME NAPS despite the

night sleep.

Excessive INVOLOUNTARY DAY TIME SLEEPINESS.

Even if the person takes a nap for more than an hour, he or

she would still feel tired and unalert.

People diagnosed with hypersomnolence are compelled to nap

during inappropriate times of the day. (during a meal,

gatherings, comverstaions, etc)

Fully manifests in late adolescence to early adulthood.

III. SYMPTOMS

A. Self-reported excessive sleepiness (hypersomnolence)

DESPITE a main sleep period lasting at least 7 hours, with

at least one of the following symptoms:

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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 non-restorative (i.e., unrefreshing). 3. Difficulty being fully awake after abrupt awakening.

B. Occurs at least THREE TIMES PER WEEK, for at least

THREE MONTHS.

C. The hypersomnolence is accompanied by significant distress

or impairment in cognitive, social, occupational, and 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.

Other Symptoms:

Anxiety

Increased Irritability

Decreased energy despite the excessive amount of

sleep

Slow thinking or response

Slow speech

Loss of appetite

Hallucinations

Memory difficulty

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Diagnosis:

By Duration:

Acute: Duration of less than 1 month.

Subacute: Duration of 1-3 months.

Persistent: Duration of more than 3 months.

By Severity:

Mild: Difficulty maintaining daytime alertness 1-2

days/week.

Moderate: Difficulty maintaining daytime alertness 3-4

days/week.

Severe: Difficulty maintaining daytime alertness 5-7

days/week.

IV. TREATMENT

The treatment for this disorder is based on the patients

environment. An example could be a change in behavior,

avoiding late night work.

Medication is also prescribed to some patients

Stimulants such as the following may be prescribed:

amphetamine,methylphenidate (Concerta, Metadate CD,

Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin LA,

Ritalin-SR), and modafinil (Provigil).

Other drugs used to treat hypersomnia include:

clonidine (Catapres),

levodopa (Larodopa),

bromocriptine (Parlodel),

antidepressants, and

monoamine oxidase inhibitors

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NARCOLEPSY

I. HISTORY

Narcolepsy, a neurological disorder that causes overwhelming

daytime drowsiness and sleep attacks was first recognized as a

clinical disorder in 1880.

Narcolepsy is the English form of the French word narcolepsie,

and was first used in 1880 by the French physician Jean-

Baptiste-Edouard Glineau (1828-1906). The origin is from the

Greek, narke (numbness, stupor) and lepsis (attack, to seize).

Early descriptions of narcolepsy were in case reports from the

German physicians Westphal (1877) and Fisher (1878). Both

authors noted the associations between sleep episodes and

attacks of muscle weakness triggered by emotion.

Thomas Willis (1621-1675) described patients with a sleepy

disposition who suddenly fall fast asleep, which may represent

the earliest account of narcolepsy.

Vogel in 1960 first recorded REM sleep at the onset of an attack

in a patient with narcolepsy

II. DESCRIPTION

Narcolepsy is a neurological disorder that affects the control of

sleep and wakefulness. People with narcolepsy experience

excessive daytime sleepiness and intermittent, uncontrollable

episodes of falling asleep during the daytime. These sudden

sleep attacks may occur during any type of activity at any time

of the day.

In a typical sleep cycle, we initially enter the early stages of

sleep followed by deeper sleep stages and ultimately (after about

90 minutes) rapid eye movement (REM) sleep. For people

suffering from narcolepsy, REM sleep occurs almost

immediately in the sleep cycle, as well as periodically during the

waking hours. It is in REM sleep that we can experience dreams

and muscle paralysis -- which explains some of the symptoms

of narcolepsy.

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Narcolepsy usually begins between the ages of 15 and 25, but it

can become apparent at any age. In many cases, narcolepsy is

undiagnosed and, therefore, untreated.

III. SYMPTOMS

Narcolepsy is typically characterized by the following symptoms

with varying degrees of frequencies, include:

Excessive daytime sleepiness

Cataplexy

Hypnagogic hallucinations

Sleep paralysis

Disturbed nocturnal sleep

Automatic behavior

Other complaints such as blurred vision, double vision,

or droopy eyelids

IV. TREATMENT

Currently, narcolepsy cannot be cured, and intensive research

to find a cure continues. The loss of hypocretin is believed to be

irreversible and lifelong. But the condition can be controlled in

most individuals with drug treatment. The leading medications

are Xyrem, Provigil and Nuvigil.

Drug therapy should accompany various behavioral strategies

according to the needs of the affected individual, such as:

Take short, regularly scheduled naps at times when

sufferers tend to feel sleepiest.

Maintain a regular sleep schedule.

Avoid alcohol and caffeine-containing beverages for

several hours before bedtime.

Avoid smoking, especially at night.

Maintain a comfortable, adequately warmed bedroom.

Engage in relaxing activities such as a warm bath before

bedtime.

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Exercising for at least 20 minutes per day no closer than

four to five hours before bedtime.

V. FAMOUS PERSONALITIES

1. Kurt Cobain (Musician)

2. Arthur Lowe (Actor)

3. Franck Bouyer (French Cyclist)

4. Jimmy Kimmel (Talk Show Host)

5. Thomas Edison (Inventor of the Light Bulb)

6. Winston Churchill (Former British Prime Minister)

7. Nastassja Kinski (Actress)

8. Harriet Tubman (Abolitionist who helped many slaves to

freedom)

VI. FACTS/TRIVIAS

Humans spend approximately 1/3 of their lives asleep.

Narcolepsy is a lifelong disorder that affects approximately

1 in every 2000 people in the US.

Many people with narcolepsy go through their lives

undiagnosed.

Symptoms of narcolepsy are usually first seen during the

adolescent years.

Narcolepsy has been observed in humans and a few other

species of animals, including dogs.

Narcolepsy has both genetic and sporadic forms.

The severity of the disorder varies from person to person.

Narcoleptics have 10 times the rate of automobile accidents

as non-narcoleptics.

A description of narcolepsy in a mother and a son dates

back to 1887.

BREATHING RELATED SLEEP DISORDERS

1. OBSTRUCTIVE SLEEP APNEA

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I. DESCRIPTION

OSA occurs when there are repeated episodes of partial or total

blockage in the upper airway during sleep. These blockages

cause the diaphragm and the chest muscles to work harder so

when breathing resumes, it is often accompanied with a loud

snort, jerk, or gasp.

It is more common to men more than women. For women it

usually occurs after the menopausal stage. Other risk factors

include: being overweight, having a large or thick neck.

It may also be caused by other diseases especially those that

affect the lungs and those which may cause blockage in the

nose or throat.

II. SYMPTOMS

Signs and symptoms of obstructive sleep apnea include:

Excessive daytime sleepiness

Loud snoring

Observed episodes of breathing cessation during sleep

Abrupt

Awakenings accompanied by shortness of breath

Awakening with a dry mouth or sore throat

Awakening with chest pain

Morning headache

Difficulty concentrating during the day

Experiencing mood changes, such as depression or

irritability

Difficulty staying asleep (insomnia)

Having high blood pressure

Consult a medical professional if you experience, or if your

partner observes, the following:

Snoring loud enough to disturb your sleep or that of

others

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Shortness of breath that awakens you from sleep

Intermittent pauses in your breathing during sleep

Excessive daytime drowsiness, which may cause you to

fall asleep while you're working, watching television or

even driving a vehicle

III. TREATMENT

The treatment for obstructive sleep apnea will depend on the

factors causing the obstruction. There are several possible

treatments for obstructive sleep apnea

Conservative treatments -- In mild cases of sleep apnea,

conservative therapy may be all that is needed. These

treatments include the following:

Overweight individuals can benefit from losing weight.

Even a 10% weight loss can reduce the number of sleep

apnea events for most patients.

Individuals with sleep apnea should avoid the use of

alcohol and sleeping pills, which make the airway more

likely to collapse during sleep and prolong the apneic

periods.

In some patients who have mild sleep apnea, breathing

pauses occur only when they sleep on their backs. In

such cases, using pillows and other devices that help

them sleep in a side position may be helpful.

People with sinus problems or nasal congestion, who are

more likely to experience sleep apnea, can try nasal

sprays to reduce snoring and improve airflow for more

comfortable nighttime breathing.

Avoiding sleep deprivation is important for all patients

with sleep disorders.

1. Mechanical therapy -- Continuous positive airway

pressure (CPAP) is the preferred initial treatment for

most people with obstructive sleep apnea. With CPAP,

patients wear a mask over their nose and/or mouth.

An air blower forces constant and continuous air

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through the nose and/or mouth. The air pressure is

adjusted so that it is just enough to prevent the upper

airway tissues from collapsing during sleep. Other

types of positive airway pressure devices are also

available, including the BPAP, which has two levels of

air flow that vary with breathing in and out.

2. Mandibular advancement devices -- For patients with

mild sleep apnea, dental appliances or oral mandibular

advancement devices that prevent the tongue from

blocking the throat and/or advance the lower jaw

forward can be made. These devices help keep the

airway open during sleep. A sleep specialist and

prosthodontist -- a person with expertise in these types

of oral appliances -- should jointly determine if this

treatment is best for you.

3. Surgery -- Surgical procedures may help people with

sleep apnea. There are many types of surgical

procedures, often performed on an outpatient basis.

Surgery is reserved for people who have excessive or

malformed tissue that is obstructing airflow through

the nose or throat. For example, a person with a

deviated nasal septum, markedly enlarged tonsils, or

small lower jaw and a large tongue that causes the

throat to be abnormally narrow might benefit from

surgery. These procedures are typically performed after

sleep apnea has failed to respond to conservative

measures and a trial of CPAP.

Types of Surgery include:

1. Upper airway stimulator -- This device, called Inspire,

consists of a small pulse generator placed under the skin

in the upper chest. A wire leading to the lung detects the

person's natural breathing pattern. Another wire, leading

up to the neck, delivers mild stimulation to nerves that

control airway muscles, keeping them open. A doctor can

program the device from an external remote. Also, those

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who have Inspire use a remote to turn it on before bed and

turn off upon waking in the morning.

2. Somnoplasty -- a minimally invasive procedure that uses

radiofrequency energy to tighten the soft palate at the back

of the throat.

3. UPPP, or UP3, (which stands for

uvulopalatopharyngoplasty) -- a procedure that removes

soft tissue in the back of the throat and palate, increasing

the width of the airway at the throat opening.

4. Mandibular/maxillary advancement surgery -- surgically

moving the jaw bone and face bones forward to make more

room in the back of the throat -- an intricate procedure

that is reserved for patients with severe sleep apnea and

head-face abnormalities.

5. Nasal surgery-- correction of nasal obstructions, such as a

deviated septum.

IV. FAMOUS PERSONALITIES

1. Shaquille ONeal

2. Quincy Jones

3. Randy Jackson

4. Rosie oDonnell

2. CENTRAL SLEEP APNEA

I. HISTORY

(most historical background of central sleep apnea involves sleep-

apnea in general)

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II. DESCRIPTION

Central sleep apnea is when you repeatedly stop breathing

during sleep because the brain temporarily stops sending

signals to the muscles that control breathing.

Central sleep apnea often occurs in people who have certain

medical conditions. For example, it can develop in persons who

have life-threatening problems with the brainstem. The

brainstem controls breathing. As a result, any disease or injury

affecting this area may result in problems with normal

breathing during sleep or when awake.

III. SYMPTOMS

Common signs and symptoms of central sleep apnea include:

Observed episodes of stopped breathing or abnormal

breathing patterns during sleep

Abrupt awakenings accompanied by shortness of breath

Shortness of breath that's relieved by sitting up

Difficulty staying asleep (insomnia)

Excessive daytime sleepiness (hypersomnia)

Difficulty concentrating

Mood changes

Morning headaches

Snoring

Although snoring indicates some degree of increased

obstruction to airflow, snoring also may be heard in the

presence of central sleep apnea. However, snoring may not be

as prominent with central sleep apnea as it is with obstructive

sleep apnea.

IV. TREATMENT

Oxygen supplementation and the regulation of air pressure

during sleep are effective treatments for many people with

central sleep apnea. These include:

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CPAP, or continuous positive air pressure, provides a

steady source of pressure in your airways as you sleep.

You wear a mask over your nose and mouth that delivers

pressurized air throughout the night. CPAP is used to

treat obstructive sleep apnea, but can also be beneficial

for people with central sleep apnea.

BPAP, or bi-level positive air pressure, adjusts the air

pressure to a higher level when you inhale and a lower

level when you exhale. BPAP is also delivered through a

facemask.

ASV, or adaptive servo-ventilation, monitors your

breathing as you sleep. The computerized system

remembers your breathing pattern. The pressurized

system regulates the breathing pattern to prevent apnea

episodes.

V. FACTS / TRIVIAS

In general, the main risk factors for sleep apnea are male

gender, being overweight, and being over 40 years of age.

However, anyone can have any of the types of sleep apnea.

Central sleep apnea is often associated with other conditions.

One form of central sleep apnea, however, has no known cause

and is not associated with any other disease. In addition,

central sleep apnea can occur with obstructive sleep apnea, or

it can occur alone.

Conditions that may be associated with central sleep apnea

include the following:

Congestive heart failure

Hypothyroid Disease

Kidney failure

Neurological diseases, such as Parkinson's

disease, Alzheimer'sdisease, and amyotrophic lateral

sclerosis (ALS or Lou Gehrig's disease)

Damage to the brainstem caused by encephalitis, stroke,

injury, or other factors

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3. SLEEP RELATED HYPOVENTILATION

I. DESCRIPTION

Trait of abnormal gas exchange that significantly worsens or

may only be present during sleep. Such abnormalities are

usually caused by hypoventilation and result in hypercapnea

and hypoxemia Even during normal sleep mild

hypoventilation occurs, as documented by a rise in PaCO2

of about ~5 mm Hg.1,2 But in people with respiratory,

neurologic or neuromuscular disease, such hypoventilation

can compound existing deficiencies and have clinical

consequences, such as headaches, insomnia, and

pulmonary hemodynamic complications.

Can present with sleep-related complaints of insomnia or

sleepiness

Caused By:

Ventilatory insufficiency

Pulmonary hypertension

Right heart failure

Polycythemia

Neuorocognitive Dysfunction

TYPES:

1. IDIOPATHIC SLEEP-RELATED HYPOVENTILATION

Very uncommon

Slowly progressive disorder of respiratory

impairments

Can manifest during infancy, childhood and

adulthood because of variable penetrance of

PHOX2B

Associated with reduced ventilator drive due to a

blunted chemoresponsivess to CO2

Complications:

Pulmonary hypertension

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Cor pulmonale

Cardiac dysrhythmias

Polycythemia

Neurocognitive dysfunction

Worsening respiratory failure can develop with

increasing severity of blood gas abnormalities

2. COMORBID SLEEP-RELATED HYPOVENTILATION

Chronic obstructive pulmonary disease

Nueormuscular disorders

Obesity

II. SYMPTOMS

Excessive daytime sleepiness

Frequent arousals and awakening during sleep

Morning headaches

Insomnia complaints

Episodes of shallow breathing may be observed

Obstrusive sleep apnea hypopnea

4. CIRCADIAN RHYTHM SLEEP DISORDER

I. HISTORY

The earliest recorded account of circadian process is during

the 4th century when a ship captain serving under Alexander

the Great described the diurnal movements of a tamarind

tree leaves.

In 1896, it was observed that during prolonged period of

sleep deprivations, sleepiness decreases and increases with

approximately 24 hour period.

The term circadian was termed by Franz Halberg during

1950s

Circadian comes from the Latin words circa, meaning

around, and diem, meaning day.

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II. DESCRIPTION

Circadian rhythm disorder is a disruption in a persons

circadian rhythm or bodys internal body clock.

The key feature of CRD is the continuous or occasional

disruption of sleep patterns.

There is a malfunction of the internal body clock or there is a

mismatch between the internal body clock and d the external

environment regarding the timing and duration of sleep.

III. SYMPTOMS

Difficulty initiating sleep

Difficulty maintaining sleep

Nonrestorative sleep

Daytime sleepiness

Poor concentration

Impaired performance, including decrease in cognitive skills

Poor psychomotor coordination

Headaches

Gastrointestinal distress

When poor sleep for more than one month is accompanied by

one or more of the ff:

Poor concentration

Forgetfulness

Decreased motivation

Excessive daytime sleepiness

Difficulty falling asleep

Nonrefreshing sleep

Habitual snoring

TYPES OF CIRCADIAN RHYTHM SLEEP DISORDER

1. Delayed Sleep Phase Disorder

Occurs when a person regularly goes to sleep and

wakes up more than two hours later than is

considered normal.

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People tend to be evening types and stays up until

1am or later and wake up in the late morning or

afternoon.

More common among adolescents and young adults

2. Advance Sleep Phase Disorder

Occurs when a person regularly goes to sleep and

wakes up several hours earlier than most people.

People tend to be morning types who typically

wake up at 2am to 5am and go to sleep between

6pm and 9pm.

Affects approximately 1% of middle-aged and older

adults and increases with age.

3. Jetlag Disorder

Occurs when long travel by airplane quickly puts a

person in another time zone.

In this new location the person must sleep and

wake at times that are misaligned with his or her

body clock.

The severity of the problem increases with the

number of time zones that are crossed. The body

tends to have more trouble adjusting to eastward

travel than to westward travel.

Jet lag affects all age groups. However, in the

elderly, symptoms may be more pronounced and

the rate of recovery may be more prolonged than in

younger adults.

Sleep deprivation, prolonged uncomfortable sitting

positions, air quality and pressure, stress and

excessive caffeine and alcohol use may increase the

severity of insomnia and impaired alertness and

function associated with transmeridian travel.

Jet lag is a temporary condition with symptoms

that begin approximately one to two days after air

travel across at least two time zones. Exposure to

light at inappropriate times may prolong the time of

adjustment by shifting the circadian rhythms in

the opposite direction.

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4. Shift Work Disorder

Occurs when a persons work hours are scheduled

during the normal sleep period.

Sleepiness during the work shift is common, and

trying to sleep during the time of day when most

others are awake can be a struggle.

Depending on the type of shift, diurnal or circadian

preferences may influence the ability to adjust to

shift work.

Persons with comorbid medical, psychiatric and

other sleep disorders such as sleep apnea and

individuals with a strong need for stable hours of

sleep may be at particular risk.

5. Irregular Sleep-Wake Rhythm

Occurs when a person has a sleep-wake cycle that

is undefined.

The persons sleep is fragmented into a series of

naps that occur throughout a 24-hour period.

Sufferers complain of chronic insomnia, excessive

sleepiness or both.

A low-amplitude or irregular circadian rhythm of

sleep-wake pattern may be seen in association with

neurological disorders such as dementia and in

children with mental retardation.

6. Free-running

Occurs when a person has a variable sleep-wake

cycle that shifts later every day.

It results most often when the brain receives no

lighting cues from the surrounding environment.

Occasionally, the disorder is associated with mental

retardation or dementia. It has also been suggested

that there may be an overlap between circadian

rhythm sleep disorder, delayed sleep phase type,

and circadian rhythm sleep disorder, free-running

type.

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IV. TREATMENT

1. Lifestyle changes - People may cope better with certain

circadian rhythm sleep disorders by doing such things as

adjusting their exposure to daylight, making changes in the

timing of their daily routines, and strategically scheduling

naps.

2. Sleep hygiene - These instructions help patients develop

healthy sleep habits and teach them to avoid making the

problem worse by attempting to self-medicate with drugs or

alcohol.

3. Bright light therapy - This therapy synchronizes the body

clock by exposing the eyes to safe levels of intense, bright

light for brief durations at strategic times of day.

4. Medications - A hypnotic may be prescribed to promote

sleep or a stimulant may be used to promote wakefulness.

5. Melatonin - This hormone is produced by the brain at night

and seems to play a role in maintaining the sleep-wake cycle.

Taking melatonin at precise times and doses may alleviate

the symptoms of some circadian rhythm sleep disorders.

PARASOMNIAS

NON RAPID EYE MOVEMENT SLEEP AROUSAL

DISORDER

A. SLEEPWALKING

I. DESCRIPTION

Repeated occurrence of incomplete arousals, usually

beginning during the first third of the major sleep episode

(Criterion A) that typically are brief, lasting 1 10 minutes,

but may be protracted, lasting up to 1 hour.

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Slow-wave sleep

The eyes of the individual are typically open during these

events.

Varying degrees of simultaneous occurrence of wakefulness

Complex behaviors arising from sleep with varying degrees of

conscious awareness, motor activity and autonomic

activation

II. SYMPTOMS

Recurrent episodes of incomplete awakening from sleep,

usually occurring during the first third of the major sleep

episode, accompanied by either one of the following:

1. Sleepwalking: Repeated episodes of rising from the

bed during sleep and walking about. While

sleepwalking, the individual has a blank, staring face;

is relatively unresponsive to the efforts of others to

communicate with him or her; and can be awakened

only with great difficulty.

2. Sleep terrors: Recurrent episodes of abrupt terror

arousals from sleep, usually beginning with a panicky

scream. The individual has intense fear and show

signs of autonomic arousal (mydriasis, tachycardia,

rapid breathing and sweating) during each episode.

There is also relative unresponsiveness to efforts of

others to comfort the individual during the episodes.

No or little (e.g., only a single visual scene) dream imagery is

recalled.

Amnesia for the episodes present.

The episodes cause clinically significant distress or

impairment in social, occupational, or other important areas

of functioning.

The disturbance is not attributable to the physiological

effects of a substance (e.g., a drug of abuse, a medication)

Coexisting mental and medical disorders do not explain the

episodes of sleepwalking or sleep terrors.

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III. TREATMENT

1. Improving sleep conditions

setting a regular bedtime

practicing relaxation

limiting food and drink before sleeping

establishing a bedtime routine

2. Medication

Levodopa/carbidopa, gabapentin and clonidine are

sometimes used but there is little systematic evidence of

benefit.

Benzodiazepines anti-anxiety drugs such as

diazepam (Valium) or alprazolam (Xanax) can be used to

help relax muscles, although these may not result in

fewer episodes of sleepwalking.

3. Stress management

4. Biofeedback training

5. Relaxation techniques

6. Hypnosis - Has been used help sleepwalkers awaken once

their feet touch the floor.

7. Psychotherapy - May help individuals who have underlying

psychological issues that could be contributing to sleep

problems.

IV. FAMOUS PERSONAITIES

Sleepwalking

1. Jennifer Aniston

2. Bobby Brown

3. Park Ha Sun

Sleep Terrors

1. Florence Welch

2. Gerard Way

3. H.R. Giger

4. H.P. Lovecraft

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5. Travis Pastrana

V. FACTS AND TRIVIAS

30% of children will experience at least once sleepwalking

episode.

40% of children will experience at least once sleep terror

episode.

Only 2-3% of children and adults sleepwalk often.

Only about 2% of adults experience sleep terror.

More than half of adults who sleep walk also experience

sleep terror and nearly three quarters of adults who

experience sleep terrors also sleepwalk (Reite, Weissberg &

Ruddy, 2008).

80% of individuals who experience a sleep walking or sleep

terror episode have a family history of similar occurrences.

Use of medications or sedatives is a common cause in adults.

In children and adults, episodes often occur during a period

of stress or sleep deprivation.

Boys are more likely to sleepwalk than girls.

The highest prevelance of sleepwalking was 16.7% at age 11

to 12 years of age.

Sleepwalking can have a genetic tendency. If a child begins

to sleepwalk at the age of 9, it often lasts into adulthood.

Night terrors are most common in boys ages 5 to 7

(Kaneshiro, 2011).

There is some evidence that night terrors run in families.

It is rare for night terrors to persist beyond the age of 12.

Sleep terrors differ from nightmares. The dreamer of a

nightmare wakes up from the dream and may remember

details, but a person who has a sleep terror episode remains

asleep.

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SLEEP TERRORS

I. DESCRIPTION

Also known as: Night Terrors, or Pavor Nocturnus

The sudden arousal of the individual usually begins with a

horrified scream or cry

A typical sleep terror episode involves a sense of intense anxiety

or apprehension and a pressing urge to escape

During the episode, the individual is not completely awake and

returns to sleep after the episode

The episode lasts for 1-10 minutes, but it may last longer and

may go on for an hour, especially in children

Generally, only 1 episode occurs on any night, but there are

instances wherein several episodes occur at intervals

throughout the night

Sleep terrors during daytime naps are rare

Causes:

Sleep deprivation

Fatigue

Fever

Physical and/or emotional stress

Hereditary Factors

Complications include:

Regular disruption of sleep, which may lead to excessive

sleepiness during

Daytime and difficulty to accomplish daily tasks

Embarrassment over sleep terrors

Possibility to injure self and others

II. SYMPTOMS

During an episode:

1. The individual abruptly sits up in bed screaming or

crying

2. Abnormal increase in heart rate

3. Rapid breathing

4. Sweating

5. Dilation of the pupils

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6. The individual is difficult to awaken, therefore

inconsolable and unresponsive to

7. Others attempt to comfort him/her

After an episode:

1. The individual returns to sleep

2. If not none, only fragmentary vivid images are recalled

from dreams

3. The individual has amnesia for the episode on

awakening the next morning

III. TREATMENT

Treating an underlying condition such as a medical or mental

condition, or another sleep disorder

Improving sleeping habits

Counseling or simply comforting (for children)

Relaxation techniques (for adults)

Talk therapy or psychotherapy to help the individual cope with

the stress causing the sleep terrors (for adults)

Hypnotics such as Diazepam (a sleep-inducing medication),

which can prevent sleep terror episodes by calming the nerves

(for adults)

IV. FAMOUSE PERSONALITIES

1. Florence Welch (Florence and the Machine)

2. Gerard Way (My Chemical Romance)

3. H.R. Giger (Sci-fi Surrealist who creates alien visions)

4. H.P. Lovecraft (Author - Horror Fiction)

5. Travis Pastrana (Motorsports Competitor and Stunt

Performer)

V. FACTS / TRIVIAS

Sleep Terrors are more common in children, than in adults

Sleep Terrors are more common in young boys, than young girls

For adults, males and females have an equal tendency to suffer

from sleep terrors

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Children are more likely to have complete amnesia and provide

vague reports regarding episodes

Individuals (children or adults) who experience sleep terrors are

likely to have elevated scores for depression and anxiety on

personality inventories

NIGHTMARE DISORDER

I. DESCRIPTION

Nightmare disorder, also known as 'dream anxiety disorder'

and is referred to by doctors as parasomnia, is a sleep disorder

characterized by unwanted experiences that take place while

you're falling asleep, during sleep or when you're waking up.

The nightmares, which often depict the individual in a situation

that jeopardizes their life or personal safety, usually occur

during the second half of the sleeping process, called the rapid

eye movement (REM) stage. Though such nightmares occur

within many people, those with nightmare disorder experience

them with a greater frequency.

Nightmares can be caused by extreme pressure or irritation if

no other mental disorder is discovered. The death of a loved one

or a stressful life event can be enough to cause a nightmare but

mental conditions like post-traumatic stress disorder and other

psychiatric disorders have been known to cause nightmares as

well.

If the individual is on medication, the nightmares may be

attributed to some side effects of the drug. Amphetamines,

antidepressants, and stimulants like cocaine can cause

nightmares. Blood pressure medication, levodopa and

medications for Parkinson's disease have also been known to

cause nightmares

Diagnosis according to its duration:

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Acute: Duration of period of nightmares is 1 month or

less.

Subacute: Duration of period of nightmares is greater

than 1 month but less than 6 months.

Persistent: Duration of period of nightmares is 6 months

or greater.

Severity is rated by the frequency with which the nightmares

occur:

Mild: Less than one episode per week on average.

Moderate: One or more episodes per week but less than

nightly.

Severe: Episodes nightly.

II. SYMPTOMS

The sleeper may scream and yell out things during the

nightmare

Victim is often awakened by these threatening and frightening

dreams and can often vividly remember their experience

Upon awakening, the sleeper is unusually alert and oriented

within their surroundings

Increased heart rate and symptoms of anxiety, like sweating.

Have trouble falling back to sleep for fear they will experience

another nightmare

Have trouble going through everyday tasks; the anxiety and

lack of sleep caused by the fearful dreams would hinder the

individual from completing everyday jobs efficiently and

correctly

III. TREATMENT

Medical condition treatment - If the nightmares are

associated with an underlying medical or mental health

condition, treatment is aimed at the underlying problem.

Stress or anxiety treatment - If stress or anxiety seems to be

contributing to the nightmares, your doctor may suggest

stress-reduction techniques, counseling or therapy.

30

Medication - Medication is rarely used to treat nightmares.

However, medications that reduce REM sleep or reduce

awakenings during sleep may be recommended if you have

severe sleep disturbance.

Imagery rehearsal therapy - Often used with people who have

nightmares as a result of PTSD, imagery rehearsal therapy

involves changing the ending to your remembered nightmare

while awake so that it's no longer threatening. You then

rehearse the new ending in your mind. This approach may

decrease the frequency of nightmares.

IV. FACTS AND TRIVIAS

Fear is not the main emotion in nightmares. Research

published in the journal Sleep has found that fear is not the

prominent emotion in nightmares. Rather, researchers found

that it's more often feelings of sadness, confusion and guilt.

They said these are the nightmares more likely to stick with a

person after they wake up.

Bad dreams and nightmares are different. Researchers asked

572 volunteers to record their dreams over a period of two to

five weeks and then analyzed the 9,796 dreams that were

reported. Death, health concerns and threats are common to

nightmares. But, bad dreams, according to the researchers, are

more about interpersonal conflicts.

RAPID EYE MOVEMENT SLEEP BEHAVIOR DISORDER

I. HISTORY

Mark Mahowald, MD and Carlos Schenck, MD from the

University of Minnesota were the first to describe the first cases

of REM Behavior disorder in 1985.

In Principles and Practice of Sleep Medicine (W.B. Saunders

Company, 2000), they outlined several case histories of people

with RBD:

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A 77-year old minister had been behaving violently in his

sleep for 20 years, sometimes even injuring his wife.

A 60-year old surgeon would jump out of bed during

nightmares of being attacked by "criminals, terrorists and

monsters."

A 62-year old industrial plant manager who was a war

veteran dreamt of being attacked by enemy soldiers

and fights back in his sleep, sometimes injuring himself.

A 57-year old retired school principal was inadvertently

punching and kicking his wife for two years during vivid

nightmares of protecting himself and family from aggressive

people and snakes.

"Past history and current neurological and psychiatric

evaluations were unremarkable, apart from the findings

reported," the authors noted. "All four men were known by day

to be calm and friendly individuals."

Mahowald and Schenck also found out that males compromise

90% of RBD patients and age ranges from 50 to older.

Furthermore, the doctors noted that most RBD patients are

placid and good-natured when awake; however, many of them

display rhythmic movements in their legs during non-REM and

slow-wave sleep.

II. DESCRIPTION

REM sleep begins with signals from an area at the base of the

brain called the pons. These signals travel to a brain region

called the thalamus, which relays them to the cerebral cortex

the outer layer of the brain that is responsible for learning,

thinking, and organizing information.

The pons also sends signals that shut off neurons in the spinal

cord, causing temporary paralysis of the limb muscles. If

something interferes with this paralysis, people will begin to

32

physically act out their dreams a rare, dangerous problem

called REM sleep behavior disorder.

REM sleep behavior disorder associated with neurodegenerative

disorders

May improve as the underlying neurodegenerative disorder

progresses most notably one of the synucleinopathies

(Parkinson's disease, multiple system atrophy, or major or mild

neurocognitive disorder with Lewy bodies), the neurological

status of individuals with REM sleep behavior disorder should

be closely monitored.

III. SYMPTOMS

1. Repeated episodes of arousal during sleep, associated with

vocalization and/or complex motor behaviors.

2. These behaviors arise during rapid eye movement (REM) sleep

and therefore usually occur more than 90 minutes after sleep

onset. They are more frequent during the later portions of

the sleep period. While they may occur during daytime

naps, it is uncommon.

3. Upon awakening from these episodes, the individual is

completely awake, alert and not confused or disoriented.

4. Either of the following:

REM sleep without atonia on polysomnographic

recording.

A history suggestive of REM sleep behavior disorder and

an established synucleinopathy diagnosis (e.g.,

Parkinsons disease, multiple system atrophy).

The behaviors cause clinically significant distress or

impairment in social, occupational or other

important areas of functioning (which may include injury

to self or the bed partner).

5. The disturbance is not attributable to the physiological effects

of a substance or another medical condition.

6. Co-existing mental and medical disorders do not explain the

episodes.

IV. TREATMENT

33

1. MEDICATION

Clonazepam has proven to be a highly successful

treatment for RBD. It is effective in nearly 90% of

patients (complete benefit in 79% of patients and partial

benefit in another 11% of patients), with little evidence of

tolerance or abuse. The response usually begins within

the first week, often on the first night. 0.5 mg initial dose.

Melatonin restores RBD-related desynchronization of the

circadian rhythms.[35]Polysomnographic studies showed

possible direct restoration of the mechanisms producing

REM sleep muscle atonia. 3-6mg initial dose.

Levodopa may be very effective in patients in whom RBD

is the harbinger of Parkinson disease. In addition,

anecdotal reports exist of responses to carbamazepine,

clonidine, and L-tryptophan in patients with RBD.

2. LONG-TERM MONITORING

Since RBD has strong relationships with many

neurodegenerative disorders, such as Parkinson disease,

multiple system atrophy, and dementia, the neurologist

always should explore the possibility of RBD in these

conditions. RBD symptoms may be the first

manifestations of these disorders and may precede the

onset of other typical symptoms and signs by several

years. Therefore, careful follow-up is needed to assess the

risk of neurodegenerative disorder development, for

patient counseling, and to plan for potential

neuroprotective trials.

V. FAMOUS PERSONALITY

Mike Birbiglia - His sleep disorder has been the basis for a

book and one-man show. Now the comedians REM sleep

behavior disorder is featured in film. Sleepwalk with Me made

its premiere at the 2012 Sundance Film Festival in Park City,

Utah.

34

VI. FACTS/TRIVIAS

REM sleep stimulates the brain regions used in learning. This

may be important for normal brain development during

infancy, which would explain why infants spend much more

time in REM sleep than adults.

Like deep sleep, REM sleep is associated with increased

production of proteins. One study found that REM sleep affects

learning of certain mental skills. People taught a skill and then

deprived of non-REM sleep could recall what they had learned

after sleeping, while people deprived of REM sleep could not.

RESTLESS LEGS SYNDROME (RLS)

I. HISTORY

The term Restless Leg Syndrome was coined by Professor Karl-

Axel Ekbom in 1944 and is therefore also known as "Ekbom's

disease". Ekbom studied medicine at the Karolinska Institute

and later became the first Professor and head of the

department of neurology at Uppsala university hospital. In his

1945 publication entitled "Restless Legs", Ekbom described the

disease and presented eight cases.

Ekbom was not the first to describe the disease. The earliest

documentation was appears to be by Thomas Willis, a 17th

century English physician of Charles II. Willis studied at the

private school of Edward Sylvester in Oxford and is probably

most famous for his publication Cerebri anatome, published in

1664, a foundational text on the anatomy of the cerebral

system. This book was the first to describe the term reflex

action and the Circle of Willis was outlined and understood.

In 1672 described what may have been RLS. Willis wrote in a

chapter entitled "Instructions for curing the Watching evil":

.......Wherefore to some, when being in bed they betake

themselves to sleep, presently in the arms and legs. Leaping and

contractions of the tendons and so great a restlessness and

tossing of the members ensure, that the diseased are no more

35

able to sleep, than if they were in the place of the greatest

torture!....

Willis went on to think that the diseases originated in the

spinal cord and was a product of spinal irritation and used

opiates as his therapy of choice.

Sometimes since I was advised with for a lady of quality, who in

the night was hindered from sleep by reason of these spasmodic

effects which came upon her only twice a week; she took

afterward daily for almost three months, receiving no injury

thereby, either on the brain or about any other function, and

when while by the use of other remedies; the dyscrasia of the

blood and nervous juice being corrected, the animal spirits

became more benign and mild. She afterward leaving wholly the

opium was able to sleep indifferently well!!

II. DESCRIPTION

Restless legs syndrome (RLS) is a neurological disorder with

unpleasant sensations in the legs and an uncontrollable urge

to move when at rest to try to relieve these feelings. RLS

sensations are often described by people as burning, creeping,

tugging, or like insects crawling inside the legs, and a wide

variety of descriptions is included in diagnostic criteria. Often

called paresthesias (abnormal sensations) or dysesthesias

(unpleasant abnormal sensations), the sensations range in

severity from uncomfortable to irritating to painful. Lying down

and trying to relax activates the symptoms or makes them

worse.

III. SYMPTOMS

People with RLS feel uncomfortable sensations in their legs,

especially when sitting or lying down, often more in the evening

than the day, with an irresistible urge to move about. Although

the sensations can occur on just one side of the body, most

often they affect both sides. Many people with RLS find it

difficult to describe the feeling that they get in their legs. It may

36

be like a crawling sensation, or like an electric feeling, or like

toothache, or like water running down your leg, or like itchy

bones or just fidgety, jumpy or twitchy legs, or just

uncomfortable. Some people describe a deep painful feeling in

their legs. The unpleasant feelings make you have an urge to

move. Typically, when the unpleasant feelings occur they occur

every 10-60 seconds and so you become quite restless.

Typically, the symptoms:

1. Develop when you are resting - particularly when you are

sitting down or lying in bed. They tend to be worse if you are

in a confined space such as in a cinema seat.

2. Are usually worse in the evening. In many people they only

occur in the evening, especially when trying to get to sleep.

The symptoms can make it difficult to get to sleep. This can

have a knock-on effect of causing poor sleep, and tiredness

the next day.

3. Are usually eased briefly by moving, walking, massaging or

stretching the legs. However, the symptoms tend to return

shortly after resting again.

4. Usually affect both legs. Occasionally, the arms are affected

too.

5. About 3 in 4 people with RLS also have sudden jerks

(involuntary movements) of their legs when they are asleep.

This is called periodic limb movements of sleep (PLMS).

These movements can wake you up (and/or your partner).

Some jerks may also occur when you are awake but resting.

6. About 3 in 4 people with RLS also have sudden jerks

(involuntary movements) of their legs when they are asleep.

A more common condition known as periodic limb

movement disorder (PLMD). PLMD is involuntary leg

twitching or jerking movements during sleep that typically

occur every 10 to 60 seconds, in periods or throughout the

night. Unlike RLS, the movements caused by PLMD are

involuntary-people have no control over them. Although

many patients with RLS also develop PLMD, most people

with PLMD do not experience RLS. Like RLS, the cause of

PLMD is unknown.

37

The cause is not known in most cases.

This is called primary or idiopathic RLS. (Idiopathic means of

unknown cause.) This most commonly first develops in younger

adults (under 45 years old). Symptoms tend to become slowly

worse over the years. It is thought that the cause may be a slight

lack of, or imbalance of, some brain chemicals

(neurotransmitters), especially one called dopamine. It is not

known why this should occur. There may be some genetic factor,

as primary RLS runs in some families.

Secondary causes

Symptoms of RLS can develop as a complication of certain other

conditions. For example:

Pregnancy. About 1 in 5 pregnant women develop RLS

during pregnancy (especially in the later part of

pregnancy). Symptoms often go after giving birth.

Lack of iron (iron deficiency) - which can cause anaemia.

If this is the cause, then the symptoms of RLS usually go

if you take iron tablets.

As a side-effect of some medicines. For example, it occurs

in some people who take: antidepressants, antipsychotics,

dopamine antagonists, antihistamines, calcium-channel

blockers, phenytoin, or steroids.

As a symptom of some other conditions - for example, kidney

failure, Parkinson's disease, diabetes, and underactive thyroid.

IV. TREATMENT

Relief on movement is generally only temporary. However, RLS

can be controlled by finding any possible underlying disorder.

Often, treating the associated medical condition, like anaemia,

peripheral neuropathy or diabetes, will alleviate many

symptoms. For patients with idiopathic RLS, treatment is

directed toward relieving symptoms.

For those with mild to moderate symptoms, prevention is key,

and many physicians suggest certain lifestyle changes and

38

activities to reduce or eliminate symptoms. Decreased use of

caffeine, alcohol, and tobacco may provide some relief. Doctors

may suggest the use of supplements to correct deficiencies in

iron, folate, and magnesium. Studies also have shown that

maintaining a regular sleep pattern can reduce symptoms.

Some individuals, finding that RLS symptoms are lower in the

early morning, change their sleep patterns. Others have found

that a program of regular moderate exercise helps them sleep

better. Taking a hot bath, massaging the legs, or using a

heating pad or ice pack can help relieve symptoms in some

patients. Although many patients find some relief with such

measures, rarely do these efforts completely eliminate

symptoms, and for many of these measures there is only

anecdotal evidence that they work.

V. FAMOUS PERSONALITIES

Keith Olbermann: Restless Legs Syndrome - Former MSNBC

talk-show host and outspoken pundit Keith Olbermann has

been diagnosed with restless legs syndrome, a condition that

causes people to feel such discomfort in their legs that they

have an urge to move or stretch even when they are trying to

settle down for sleep. His sleep problem was mentioned in a

New Yorker profile that also detailed Olbermann's intense work

schedule. Staying active may reduce symptoms.

VI. FACTS / TRIVIAS

RLS occurs in women and men, probably slightly more often in

women. Although the syndrome may begin at any age, even as

early as infancy, most patients who are severely affected are

middle-aged or older. In addition, severity appears to increase

with age. Older patients experience symptoms more frequently

and for longer.

Other triggering situations are periods of inactivity such as

long car trips, sitting in a movie theater, long-distance

flights, immobilization in a cast, or relaxation exercises.

39

Studies have also linked RLS to high blood pressure and

erectile dysfunction, possibly due to chronically interrupted

sleep or factors involving dopamine in the brain.

That RLS often runs in families and appears to be most

prevalent among people of Western European descent has

long hinted at a genetic component of the condition.

40

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