SLEEP DISORDERS  A physician will diagnose sleep disorders, medication side-

 Sleep disorders (or sleep-wake disorders) involve problems effects, substance misuse, depression, and other physical and
with the quality, timing, and amount of sleep, which result in mental illnesses, as certain medications and medical
daytime distress and impairment in functioning. conditions can impact sleep.
 Sleep-wake disorders often occur along with medical  May involve a patient history, a physical exam, a sleep diary
conditions or other mental health conditions, such as and clinical testing (a sleep study).
depression, anxiety, or cognitive disorders.  Sleep problems can occur at any age but most commonly start
 Insomnia is the most common. Other sleep-wake disorders in young adulthood. The type of insomnia often varies with
include obstructive sleep apnea, parasomnias, narcolepsy, and age. Problems getting to sleep are more common among
restless leg syndrome. young adults. Problems staying asleep are more common
 Sleep difficulties are linked to both physical and emotional among middle-age and older adults.
problems. Sleep problems can both contribute to or  Symptoms of insomnia can be:
exacerbate mental health conditions and can be a symptom of - Episodic (episode of symptoms lasting 1 month)
other mental health conditions. - Persistent (symptoms lasting 3 months)
- Recurrent (2 or more episodes within a year)
IMPORTANCE OF SLEEP  Symptoms of insomnia can also be brought on by a specific life
 Sleep is a basic human need and is critical to both physical and event or situation.
mental health. There are two types of sleep that generally
occur in a pattern of three-to-five cycles per night:  Treatment & Self-Help
 Rapid Eye Movement: when most dreaming occurs  Regular sleep habits can improve sleep problems, but if they
 Non-REM: has three phases, including the deepest sleep persist or interfere with daily functioning, it's recommended to
 The body typically works on a 24-hour cycle (circadian rhythm) seek physician evaluation and treatment.
that helps you know when to sleep.  Chronic insomnia= cognitive behavior therapy
 How much sleep we need varies depending on age and varies  Antidepressants
from person to person. According to the National Sleep  Antihistamines
Foundation most adults need about seven to nine hours of  Complementary Health Approaches: many people turn into
restful sleep each night. this to help with sleep problems.
- Relaxation techniques
CONSEQUENCES OF LACK OF SLEEP AND COEXISTING - Melatonin supplements
CONDITIONS - Mind and body approaches
 The most obvious concerns are fatigue and decreased energy, - Herbs and dietary supplements
irritability and problems focusing. Note: Let your health care provider know about any
 The ability to make decisions and your mood can also be alternative medicines or supplements you are taking.
affected.
 Sleep problems often coexist with symptoms of depression or  Sleep Hygiene: Healthy sleep tips to address sleep problems
anxiety. Sleep problems can exacerbate depression or anxiety,  Stick to a sleep schedule – same bed time and wake up time
and depression or anxiety can lead to sleep problems. even on the weekends
 Lack of sleep and too much sleep are linked to many chronic  Allow your body to wind down with a calming activity, such as
health problems, such as heart disease and diabetes. reading away from bright lights; avoid electronic devices
 Sleep disturbances can also be a warning sign for medical and  Avoid naps especially in the afternoon
neurological problems, such as congestive heart failure,  Exercise daily
osteoarthritis and Parkinson’s disease.  Pay attention to bedroom environment (quiet, cool and dark is
best) and your mattress and pillow (should be comfortable and
SLEEP DISORDERS supportive)
 INSOMNIA DISORDER:  Avoid alcohol, caffeine and heavy meals in the evening
- the most common sleep disorder, involves problems getting to
sleep or staying asleep.  SLEEP APNEA
- About 1/3 of adults report some insomnia symptoms, 10-15% - Obstructive Sleep Apnea: involves breathing interruptions
report problems with functioning during the daytime and 6-10 during sleep.
% have symptoms severe enough to meet criteria for insomnia - will have repeated episodes of airway obstruction during sleep
disorder. An estimated 40-50% of individuals with insomnia causing snoring, snorting/gasping or breathing pauses (causes
also have another mental disorder. daytime sleepiness and fatigue).
- Diagnosed with a clinical sleep study. The sleep study
 Symptoms & Diagnosis (polysomnography) involves monitoring the number of
 the sleep difficulties must occur at least 3 nights a week for at obstructive apneas (absence of airflow) or hypopneas
least 3 months and cause significant distress or problems at (reduction in airflow) during sleep.
work, school or other important areas of a person's daily - affects an estimated 2 to 15% of middle-age adults and more
functioning. than 20% of older adults.
- Major risk factors: obesity, male gender and family history.
 - Lifestyle changes: such as losing weight if needed or sleeping months about 20% experience them. Only about 2% of adults
on your side, can improve sleep apnea. experience night terrors.
- In some cases, a custom-fit plastic mouthpiece can help keep
airways open during sleep. The mouthpiece can be made by a  NIGHTMARE DISORDER
dentist or orthodontist. -involves repeated occurrences of lengthy, distressing, and
- CPAP (continuous positive airway pressure) Device: Doctors well-remembered dreams that usually involve efforts to avoid
prescribe a device to maintain airway openness, using a tube threats or danger.
and face mask to blow air through the mouth and nose. -generally occur in the second half of a major sleep episode.
-nightmares are typically lengthy, elaborate, story-like
 Central Sleep Apnea sequences of dream imagery that seem real and cause anxiety,
 the brain does not properly control breathing during sleep, fear or distress.
causing breathing to start and stop. -After waking up, people experiencing nightmares are quickly
 diagnosed when a sleep study identifies five or more central alert and generally remember the dream and can describe it in
apneas (pauses in breathing) per hour of sleep. detail.
 rare and less prevalent than obstructive sleep apnea -The nightmares cause significant distress or problems
 more common in older adults, in people with heart disorders functioning.
or stroke, and in people using opioid pain medications. -Nightmares often begin between ages 3 and 6 years but are
 It can be treated using a CPAP or other device during sleep. most prevalent and severe in late adolescence or early
adulthood.
 Sleep-Related Hypoventilation
 have episodes of shallow breathing, elevated blood carbon  RAPID EYE MOVEMENT SLEEP BEHAVIOR DISORDER
dioxide levels, and low oxygen levels during sleep. -involves episodes of arousal during sleep associated with
 frequently occurs along with medical conditions, such as speaking and/or movement.
chronic obstructive pulmonary disease (COPD), or medication -The person’s actions are often responses to events in the
or substance use dream, such as being attacked or trying to escape a
 have trouble with insomnia or excessive daytime sleepiness threatening situation. Speech is often loud, emotion-filled, and
 Risk factors include medical conditions, such as obesity and profane.
hypothyroidism, and use of certain medications, such as - These behaviors may be a significant problem for the
benzodiazepines and opiates. individual and their bed partner and may result in significant
injury (such as falling, jumping, or flying out of bed; running,
 OTHER SLEEP DISORDERS hitting, or kicking).
 NON-RAPID EYE MOVEMENT SLEEP AROUSAL DISORDERS -Upon awakening, the person is immediately alert and can
-involve episodes of incomplete awakening from sleep, usually often recall the dream.
occurring during the first third of a major sleep episode, and -These behaviors arise during REM sleep and usually occur
are accompanied by either sleepwalking or sleep terrors; more than 90 minutes after falling asleep.
cause significant distress or problems functioning. -cause significant distress and problems functioning and may
-most common among children and become less common with include injury to self or the bed partner.
increasing age. -Embarrassment about the episodes can cause problems in
 Sleepwalking social relationships and can lead to social isolation or work-
-involves repeated episodes of rising from bed and walking related problems.
around during sleep. -The prevalence of REM sleep behavior disorder is less than 1%
-the individual has a blank, staring face; is relatively in the general population and it overwhelmingly affects males
unresponsive to others; and is difficult to wake up. older than 50.
-Nearly 30% of people have experienced sleepwalking at some
time in their lives.  HYPERSOMNOLENCE DISORDER
-Sleepwalking disorder, with repeated episodes and distress or -excessively sleepy even when getting at least 7 hours sleep.
problems functioning, affects an estimated 1% to 5% of They have at least one of the following symptoms:
people.  Recurrent periods of sleep or lapses into sleep within the
 Sleep Terrors same day
-episodes of waking abruptly from sleep, usually beginning with  Sleeping more than nine hours per day and not feeling
a panicky scream. rested
- During each episode, the person experiences intense fear and  Difficulty being fully awake after abruptly waking up
associated physical signs such as rapid breathing, accelerated -extreme sleepiness occurs at least 3x per week, for at least 3
heart rate and sweating. months.
-The person typically does not remember much of the dream -may have difficulty waking up in the morning, sometimes
and is unresponsive to efforts of others to comfort them. appearing groggy, confused or combative (often referred to as
-common among very young children—at 18 months of age sleep inertia).
about 37% of children experience night terrors and at 30
 -The sleepiness causes significant distress and can lead to
problems with functioning, such as issues with concentration
and memory.
-The condition typically begins in late teens or 20s but may not
diagnosed until many years later.
-Among individuals who consult in sleep disorders clinics for
complaints of daytime sleepiness, approximately 5%–10%
diagnosed with this disorder.

 NARCOLEPSY
-experience periods of an irrepressible need to sleep or lapsing
into sleep multiple times within the same day.
-Sleepiness typically occurs daily but must occur at least 3x a
week for at least 3 months.
-have episodes of cataplexy, brief sudden loss of muscle tone
triggered by laughter or joking. This can result in head
bobbing, jaw dropping, or falls. Individuals are awake and
aware during cataplexy
-nearly always results from the loss of hypothalamic hypocretin
(orexin)-producing cells.
-This deficiency in hypocretin can be tested through
cerebrospinal fluid via a lumbar puncture (spinal tap).
-rare, affecting and estimated 0.02%–0.04% of the general
population. It typically begins in childhood, adolescence or
young adulthood.

 RESTLESS LEGS SYNDROME

-involves an urge to move one’s legs, usually accompanied by
uncomfortable sensations in the legs, typically described as
creeping, crawling, tingling, burning, or itching.
-The urge to move the legs:
-symptoms occur at least 3 per week, continue for at least 3
months, and cause significant distress or problems in daily
functioning.
-can cause difficulty getting to sleep and can frequently awaken
the individual from sleep, leading, in turn, to daytime
sleepiness.
-typically begins in a person’s teens or twenties and it affects an
estimated 2% to 7.2% of the population.

 CIRCADIAN RHYTHM SLEEP-WAKE DISORDERS

-person’s sleep-wake rhythms (body clock) and the external
light-darkness cycle become misaligned.
-This misalignment causes significant ongoing sleep problems
and extreme sleepiness during the day leading to significant
distress or problems with functioning.
-can be caused by internal factors (a person’s body clock is
different than the light-dark cycle) or external factors (such as
shift work or jet lag).
-Prevalence of delayed sleep phase type (staying up late and
getting up late) in the general population is approximately
0.17% but estimated to be greater than 7% in adolescents.
-The estimated prevalence of advanced sleep phase type (going
to sleep early and waking early) is approximately 1% in middle-
age adults and it is more common in older adults.