Sleep Disorders (Somnipathy)

Sleep Disorders 1 - Insomnia

BATs A01 Outline the classification of sleep disorders (E) A01 Explain the differences between primary and secondary insomnia (C/D) A01Describe some of the explanations for insomnia and the role of personality (C) Synoptic points research complications, real world application attribution theory (cognitive approach)

Sleep Disorders - Insomnia

Classication - Transient (short-term),
Intermittent (occasional) or Chronic (constant and long term - more than one month)

Causes Secondary Insomnia - symptom of an underlying

disorder e.g depression, heart disease or due to shift work, caffeine or alcohol Commentary -2007 Dr Ancoli-Israel sleep disorders should be
regarded as comorbid, and receive the same emphasis in treatment. - Ohayon and Roth 2003 found that insomnia

can precede mood disorders

Sleep Disorders - Insomnia

Primary Insomnia - result from an
endogenous disturbance in the sleeping mechanism, often complicated by learned behaviours and bad sleep habits (room too light, staying up late e.t.c) Insomnia is the only problem. Insomnia occurs with no cause for more than 1 month (DSM)
Synoptic - Chronic Insomnia highly complex so cant be explained by one factor and lots of causes for insomnia so dicult to draw conclusions from research

Major Classifications of Somnipathy

Dyssomnias- a broad category including insomnia and hypersomnolence (too much sleep)
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Parasomnias strange behaviours during sleep

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Medical or psychiatric conditions that can produce somnipathy

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Dyssomnias- a broad category including insomnia and hypersomnolence

Insomnia Narcolepsy Obstructive sleep apnea Restless legs syndrome Klein-Levin Syndrome* Post-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.

Parasomnias strange behaviours during sleep

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Night terrors Bruxism (tooth grinding) Sleepwalking (somnambulism) Sleeptalking (somniloquy) Exploding head syndrome!

Exploding head syndrome

is a condition that causes the sufferer occasionally to experience a tremendously loud noise as originating from within his or her own head, usually described as the sound of an explosion, roar, waves crashing against rocks, loud voices or 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 not necessarily 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 occurring in a space of days or weeks followed by months of remission. Sufferers often feel a sense of fear and anxiety after an attack, accompanied by elevated heart rate. Attacks are also often accompanied by perceived flashes of light (when perceived on their own, known as a "visual sleep start") or difficulty in breathing. The condition is also known as "auditory sleep starts." It is not thought to be dangerous,[1] although it is sometimes distressing to experience. Reference to the condition was made in an episode of the BBC TV drama "Doc Martin", which was instrumental in many sufferers becoming aware that the problem was in fact a known medical condition, and not one to be concerned about.

Medical or psychiatric conditions that can produce somnipathy

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Psychoses Anxiety Depression Panic Alcoholism Sleeping sickness

Sleep Disorders - Insomnia

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

Commentary - Watson
et al 2006 - 50% risk of having insomnia due to genetics. Diathesis-stress model environmental stressors may trigger the disorder Perpetuating factors being tense before going to bed because of previous sleep problems

Gender - women more likely to suffer

menopause (hormone fluctuations)

Sleep Apnoea and other parasomnias (e.g bruxism, sleep walking)- disrupt sleep and increase
likelihood of insomnia

Personality - linked to people with a

tendency to internalising problems rather than act them out - anxiety and higher levels of emotional arousal. Kales et al 1976

Research Complications
Synoptic 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 - Difcult to draw conclusions

Synoptic Point (cognitive approach)

Attribution Theory

One cause of Primary Insomnia is a persons belief that they are going to have diculty sleeping. Self fulfilling tense before sleep Attribute sleep problems to insomnia Treatment Train them to be convinced the source of problem lies elsewhere Storms and Nisbett 1970 insomniacs given a pill half told it would stimulate them and the other half it would sedate them. Those expecting arousal went to sleep faster because they attributed their arousal to the pill and actually relaxed!!

Have a go at sleep dash!! http://www.bbc.co.uk/science/ humanbody/sleep/sheep/

Now drink some caffeine!! Wait 15mins and try again!! What do you predict will happen?

Treatment of Insomnia
Read p 17 Create a problem page to give advice on why they may be suffering from insomnia and how to help it.

Sleep Disorders 2 Narcolepsy and Sleep Walking

BATs A01 Describe symptoms of sleep disorders sleep apnoea, narcolepsy and sleepwalking A02 Understand explanations for these sleep disorders Synoptic points Real world application sleep walking diagnosis used in cases of murder
http://www.bbc.co.uk/news/health-12327436

Sleep Disorders Narcolepsy

Denition - feeling sleepy all the time or
episodes of cataplexy - loss of muscle control - triggered by emotional arousal e.g. anger, fear, amusement or stress. Usually starts in adolescence/early adulthood and persists through life. 1/2000 are sufferers, but may be more prevalent.
http://www.youtube.com/watch?v=3MBCeKn0Oeo

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 HLA
found in narcoleptic patients. Not found in all narcoleptics and also common in general population so cant be only explanation

Hypocretin - link between neurotransmitter hypocretin and narcolepsy.

Hypocretin helps maintain wakefulness. A promising lead research in dogs and humans show lower hypocretin levels. 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 on
itself) Mignot 2001

Sleep Disorders - Sleep Walking Denition - Most common in childhood,

affecting 20% children and less than 3% adults. Only occurs during NREM/SWS and related to night terrors. Sleep walker not conscious and later has no memory of events during sleep walking

Sleep Disorders - Sleep Walking

Explanations Synoptic - SW accepted as defence in some crimes

Incomplete arousal - Person wakes during SWS but brain

arousal incomplete. Likely that this is genetic. Diathesis - stress model ts. 50% concordance in MZ twins, 10x more likely to SW if rst degree relatives have disorder.

Sleep deprivation, alcohol, fever, stress and psychiatric

conditions, hormonal changes during puberty and menstruation have all been shown to increase likelihood of sleep walking - the stress part of the Diathesis-stress model

More common in childhood possibly because

they have more SWS than adults. Oliviero (2008) suggests that the system that inhibits motor activity in SWS is underdeveloped in some children and adults - evident in sleep walkers.

Your mission, should you choose to accept it,

In groups, you will choose one category of disorder to research. You must produce a poster on the category, giving detailed examples, explanations and treatments. You must consider behavioural / psychotherapeutic treatments, management and drug treatments. AS WELL AS A POSTER, YOU MUST ALSO PREPARE AND PRESENT A 5 MINUTE POWERPOINT FOR THE REST OF THE GROUP ON THE CATEGORY YOU CHOSE

Homework
Finish presentation and/or Question 6 p19 600 word essay Outline and evaluate explanations of two or more sleep disorders The narcolepsy powerpoint on the blog is particularly 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

Outline and evaluate explanations of two or more sleep disorders You will be divided into pairs/3s
We will then put these paragraphs together to make a super essay!!!

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 disorder 23 e.g. Obstructive Sleep Apnoea or Night Terrors