Sleep Disorders
Omoniyi Oluwarotimi
Popoola Daniel
Ikuborije Praise
Rabo Godiya
Seimiebo Ayibatarelayefa
Shaibu Mariam
Rufai Mudassira
Shior George
Outline
Introduction
Sleep is an essential process for proper brain functioning and serves a restorative, homeostatic function, and appears to be crucial for normal thermoregulation and energy conservation.
It is one of the most significant of human behaviors, occupying roughly one-third of human life.
Lack of sleep can lead to the inability to concentrate, memory complaints, deficits in neuropsychological testing, and decreased libido. Additionally, sleep disorders can have serious consequences, including fatal accidents related to sleepiness.
Disturbed sleep can be a primary diagnosis itself or a component of another medical or psychiatric disorder. Careful diagnosis and specific treatment are essential.
Epidemiology
Risk factors
Classification
The DSM-5 classifies sleep disorders on the basis of clinical diagnostic criteria and presumed etiology.
DSM-5 are only a fraction of the known sleep disorders; they provide a framework for clinical assessment. The current classification includes;
Primary sleep disorders
They are associated with difficulty initiating or maintaining the sleep or daytime sleepiness;
Abnormal behavioral or physiological events occurring during sleep.
Insomnia
DSM-5 defines insomnia disorder as dissatisfaction
with sleep quantity or quality associated with one or more of the
following symptoms: difficulty in initiating sleep, difficulty in
maintaining sleep with frequent awakenings or problems returning to
sleep, and early morning awakening with inability to return to sleep.
Insomnia can be categorized in terms of how it affects sleep (such as.,
sleep-onset insomnia, sleep-maintenance insomnia, or early-morning
awakening).
Insomnia can also be classified according to its duration
(e.g., transient, short term, and long term).
Primary insomnia is diagnosed by nonrestorative sleep or difficulty in initiating or maintaining sleep, and the complaint continues for at least a month (according to ICD-10, the disturbance must occur at least three times a week for a month).
Causes of insomnia
The causes of Insomnia can be split into 2 categories:
1. Conditions causing difficulty falling asleep
2. Conditions that make it hard to remain asleep
Symptoms
Diagnosis
The diagnosis of insomnia involves careful history looking to rule out any underlying medical conditions, also to find out any effects on personal life.
There aren’t any tests that can diagnose insomnia directly. Instead, tests help rule out other conditions with similar symptoms to insomnia. The most likely tests include:
It can detect sleep disorders or patterns in your sleep-wake cycle that affect your health. You may need to wear this device for up to two weeks.
Treatment
Strategies involved in this include:
2. Use of pharmacotherapeutics such as Temazepam (Restoril), Triazolam (Halcion).
Complications
Hypersomnia
This is a disorder characterized by excessive sleepiness
It is diagnosed when there is no other cause found for greater than 1 month of excessive somnolence (daytime sleepiness) or excessive amounts of daytime sleep. Usually begins in childhood. Can be a consequence of;
(2) basic neurologic dysfunction in brain systems regulating sleep
(3) disrupted sleep
(4) the phase of an individual’s circadian rhythm.
Types of hypersomnia
Rare condition consisting of recurrent periods of prolonged sleep (from which patients may be aroused) with intervening periods of normal sleep and alert waking.
b. Menstrual-related hypersomnia.
c. Idiopathic hypersomnia.
Disorder of excessive sleepiness in which patients do not have the ancillary symptoms associated with narcolepsy. It is associated with long nonrefreshing naps, difficulty awakening, sleep drunkenness, and automatic behaviors with amnesia. Other symptoms include migraine-like headaches, fainting spells, syncope, orthostatic hypotension, and Raynaud- type phenomena with cold hands and feet.
d. Other types include;
Treatment
Narcolepsy
Narcolepsy is a chronic neurological disorder that affects the brain's ability to control sleep-wake cycles. People with narcolepsy may feel rested after waking, but then feel very sleepy throughout much of the day.
Narcolepsy consists of the following characteristics:
b. Sleep paralysis
Temporary partial or complete paralysis in sleep–wake transitions. Conscious but unable to move or open eyes. Most commonly occurs on awakening. Generally described as an anxiety-provoking, “scary” event. Generally lasts less than 1 minute. Reported by 25% to 50% of the general population though for a much shorter duration.
.
c. Cataplexy
d. Hypnagogic and hypnopompic hallucinations; this refers to dreamlike experience during transition from wakefulness to sleep and vice versa. Usually associated with vivid auditory or visual hallucinations or illusions
Onset and clinical course
Typically, full syndrome emerges in late adolescence or early 20s. Once established, condition is chronic without major remissions.
A long delay may occur between the earliest symptoms (excessive somnolence) and the late appearance of cataplexy.
Causes
a. Plausibly caused by an abnormality of REM-inhibiting mechanisms.
b. Human leukocyte antigen (HLA)-DR2 and narcolepsy.
(1) Strong (>70%) association between narcolepsy and HLA-DR2, a type of human lymphocyte antigen.
(2) HLA-DR2 is also found in up to 30% of unaffected persons.
(3) Recent research involving hypocretin, a neurotransmitter, suggests that hypocretin is significantly reduced in narcolepsy patients.
Treatment
Breathing related sleep disorder
Characterized by sleep disruption that is caused by a sleep-related breathing disturbance, leading to excessive sleepiness, insomnia, or hypersomnia. Breathing disturbances include
Apnea
Caused by cessation of air flow through the nose or mouth in the presence of continuing thoracic breathing movements, resulting in decreases in arterial oxygen saturation and a transient arousal, after which respiration resumes normally.
Typically occurs in middle-aged, overweight men (Pickwickian syndrome).
Also occurs more frequently in patients with smaller jaws or micrognathia, acromegaly, and hypothyroidism.
Main symptoms include; loud snoring with intervals of apnea. Additional symptoms include extreme daytime sleepiness with long and unrefreshing daytime sleep attacks. Other symptoms include severe morning headaches, morning confusion, depression, and anxiety.
Circadian rhythm sleep disorders
Treatment of the circadian rhythm sleep disorder;
• Sleep hygiene
Parasomnia
Characterized by physiologic or behavioral phenomena that occur during or are potentiated by sleep. Wakefulness, NREM sleep, and REM sleep can be characterized as three basic states that differ in their neurologic organization.
1. NREM sleep arousal disorders
a. Sleepwalking disorder (somnambulism)
Complex activity—with brief episodes of leaving bed and walking about without full consciousness.
Usually begins between the ages of 4 and 8, with peak prevalence at about 12 years old; generally disappears spontaneously with age.
About 15% of children have an occasional episode and is more common in boys.
Patients often have familial history of other parasomnias.
Amnesia for the event—patient does not remember the episode.
b. Recurrent isolated sleep paralysis
It is usually an Isolated symptom characterized by Hypnagogic hallucinations
It usually last one to several minutes
Episode terminates with touch, noise (some external stimulus), or voluntary repetitive eye movements.
c. Nightmare disorder
Nightmares are vivid dreams in which one awakens frightened.
About 50% of the adult population may report occasional nightmares.
Almost always occur during REM sleep.
Can occur at any time of night, but usually after a long REM period late in the night.
Good recall (quite detailed).
Less anxiety, vocalization, motility, and autonomic discharge than in sleep terrors.
No harm results from awakening a person who is having a nightmare.
No specific treatment; benzodiazepines, tricyclics, and SSRIs may be of help.
d. Sleep terrors
Other parasomnias
a. Sleep enuresis
(1) Primary
One urinates during sleep while in be
Continuance of bed-wetting since infancy
Parental primary enuresisincreases the likelihood in children.
(2) Secondary
Relapse after toilet training is complete and there was a period during which the child remained dry.
Associated with nocturnal seizures, sleep deprivation, and urologic anomalies.
Treatment modalities include medicines (imipramine, oxybutynin chloride, and synthetic vasopressin), behavioral treatments (bladder training, using conditioning devices (bell and pad), and fluid restriction).
b. Sleep-related groaning (Catathrenia)
c. Sleep-related hallucinations
d. Sleep-related eating disorder
General Management of sleep disorders
Conclusion
One who complains of insomnia for greater than 1 year is 40 times more likely than the general population to have a diagnosable psychiatric disorder. In 35% of patients who present to sleep disorder centers with a complaint of insomnia, the underlying cause is a psychiatric disorder. Half of these patients have major depression. Roughly 80% of patients with major depression complain of insomnia. In patients with major depression, sleep involves relatively normal onset, but repeated awakenings in the second half of the night, premature morning awakening, decreased stages III and IV sleep, a short REM latency, and a long first REM period. Posttraumatic stress disorder patients typically describe insomnia and nightmares. Hypersomnia related to a mental disorder is usually found in a variety of conditions such as the early stages of mild depressive disorder, grief, personality disorders, dissociative disorders, and somatoform disorders.
References