Physiology of sleep and disorders regarding sleep

This presentation deals with physiology of sleep. Disorders related to sleep

1. SLEEP DISORDERS

2. Common sleep disorders
•Insomnia
•Sleep apnea
•Restless legs syndrome
•Narcolepsy

3. Common Signs of a Sleep disorder
•More than 30 minutes to fall asleep at night.
•If awaken frequently in the night and then
have trouble falling back to sleep again.
•If awaken too early in the morning.
•Feel sleepy during the day and fall asleep
within 5minutes if have an opportunity to
nap, or fall asleep unexpectedly or at
inappropriate times during theday.

4. •Bed partner claims about snore loudly, snort,
gasp, or make choking sounds while you sleep,
or partner notices that our breathing stops
for short periods.
•Have creeping, tingling, or crawling feelings in
the legs that are relieved by moving or
massaging them, especially in the evening and
when we try to fall asleep.
•Legs or arms jerk often during sleep.

5. Insomnia
•Insomniaisdefinedashavingtroublefalling
asleeporstayingasleepandnotfeelingwell
rested

6. Types –based on duration
ACUTE (short term) CHRONIC (long term)
lasts from 1 night to a few
weeks
at least 3 nights a week for
3 months or more

7. Types –based on causes
PRIMARY SECONDARY
No specificcause can
be found
Physical pain, asthma,
arthritis, hyperthyroidism,
excessive use of caffeine,
hunger, use of certain drugs
and steroids
Depression, anxiety, mania,
dementia, withdrawal from
alcohol or drugs

8. •Sleep-onset insomnia:trouble getting to
sleep.
•Sleep-maintenance insomnia:trouble staying
asleep through the night or wake up too early.
•Mixed insomnia:trouble in both falling
asleep and staying asleep through the night.

9. Insomnia Risk Factors
•Insomnia affects women more than men
•Older people more than younger ones.
•Long-term illness
•Mental healthissues
•Working night shifts or shifts that rotate

10. Insomnia Symptoms
•Sleepiness during the day
•Fatigue
•Grumpiness
•Problems with concentration or memory

11. Insomnia Prevention
•Good sleep habits, also called sleep hygiene
•Go to sleep at the same time each night, and
get up at the same time each morning.
•Try not to take naps during the day
•Don’t use phones or e-books before bed.
•Avoidcaffeine, nicotine, and alcohol late in the
day.
•Get regularexercise.

12. •Make the bedroom comfortable: dark, quiet,
and not too warm or too cold.
•Follow a routine to relax before bed. Read a
book, listen tomusic
•If don’t fall asleep and not drowsy, get up and
do something calming, like reading until feel
sleepy.

13. SLEEP APNEA
•Sleep apnea is a common sleep disorder that
causes frequent pauses in breathing during
sleep.
•Most people with sleep apnea experience
symptoms such as loud snoring and daytime
sleepiness.

14. Types
Obstructive sleep apnea
(OSA)
Central sleep apnea (CSA)
A narrowing of the airway
during sleep leads to
breathing disruptions
Caused by a lack of
communication between
the brain and the muscles
involved in breathing

15. Obstructive sleep apnea
•Mostcommontypeofsleepapnea
•Occurswhentheairwayatthebackofthethroat
becomesconstrictedorblockedduringsleep
•Themusclesinthebackofthethroatrelaxduring
sleep,reducingspaceforairtopassthrough.
Snoringoccursastheairwaynarrows,andwhen
theairwayisobstructed,apersonfailstoget
enoughoxygen.
•Thelackofoxygencausespartialorcomplete
awakeningsinordertorestoreairflow.These
breathingdisruptionshappenrepeatedlyduring
sleep

16. Symptoms
•Excessive daytime sleepiness
•Loud snoring that is often punctuated by gasping
or choking sounds
•Headaches in the morning that may persist for
several hours after waking up
•Dry mouth upon awakening
•Restless sleep with periods of wakefulness during
the night
•Increased need to get up from bed to urinate
•Irritability or frustration
•Reduced focus

17. Risk Factors forOSA
Age increases with age until a person is in their 60s
and 70s.
Sex: Men
Head and neck
anatomy:
more frequently in people who have specific
anatomical features including a larger tongue and
a shorter lower jaw.
Body weight: higher BMI have an elevated risk of developing
obstructive sleep apnea.
Cigarette smoking
Hormone
abnormalities
underactive thyroid or excess production of
growth hormone
Sleeping positionworsened when peoplesleep on their backbecause of how
that sleeping position affects the shape and positioning of
the tissue around the airway

18. •Family history of sleep apnea
•Nasal congestion
•Using alcohol and some medications
•Certain medical conditions-several heart and
lung conditions

19. Lifestyle changes
•Reduce body weight
•Getting regular exercise, which may decrease
OSA symptoms even without weight loss
•Altering sleeping position(sleep on the side) to
avoid back sleeping
•Reducing alcohol consumption

20. Central sleep apnea(CSA)
•Involves disruption in the communication
between the brain and themuscles that
control breathing
•The brain stem fails to properly recognize
carbon dioxide levels in the body during sleep.
This leads to repeated episodes of breathing
that is slower and shallower than it should be.

21. Symptoms ofCentral Sleep Apnea
•Abnormal breathing patternssuch as breathing
that slows down, speeds up, and pauses during
sleep
•Excessive daytime sleepiness
•Nighttime awakenings
•Sudden shortness of breath or chest pains at
night
•Difficulty focusing
•Morning headaches

22. Risk Factors forCSA
•Central sleep apnea most often occurs as a
consequence of another medical problem, such as an
infection or injuryaffecting the brain stem,stroke, or
excess growth hormone production.
•Age:People who are over age 65
•Sex:Central sleep apnea is more common in men
•Use of certain drugs:Chronic use of opioiddrugs and
some prescription medications can affect breathing
and have been associated with a higher risk of CSA.
•Being at high altitude:Spending time at high-altitude
is associated with CSA because of thedecreased
availability of oxygenin high-altitude environments.

23. Restless legs syndrome
•Willis-Ekbomdisease
•Itisacommonconditionofthenervoussystem
thatcausesanoverwhelmingirresistibleurgeto
movethelegs.
•Oftencausesanunpleasantpricklingortinglingin
thelegs,especiallyinthecalves,thatisrelieved
bymovingormassagingthem
•Usuallyinterfereswithsleepandsleeppatterns
•Insomniaorsleepdisturbancesarethecommon
symptoms,soalsoconsideredasasleepdisorder

24. •Periodic limb movements in sleep(PLMS)-
•Many people who have RLS also have brief limb
movements during sleep, often with abrupt
onset, occurring every 5–90 seconds. This
condition, known as periodic limb movements in
sleep (PLMS), can repeatedly awaken people who
have RLS, reducing their total sleep time and
interrupting their sleep. Some people have PLMS
but have no abnormal sensations in their legs
while awake.

25. Causes
•Unknown
•Genetic involvement
•Low levels of iron in brain
•Dysfunction of brain’s basal gangleacircuit that
use dopamine
•Medical conditions –Renal failure, DM2,
Peripheral neuropathy
•Certain medications like antipsychotics,
antidepressants
•Pregnancy –last trimester

26. Clinical features
•Uncomfortable sensation in legs –sometimes in
arms also, can affect both sides
•Classical features-worse at night and distinct
symptoms free period in early morning. Sypmtoms
appear with inactivity and relieved by movement.
Mild RLS Disruption of sleep onset, minor interference in
day time
Moderate-
Severe
Once/twice a week, significant delay in sleep.
Onset with some disruption of daytime function
Severe > twice a week, burdensome interruption of
sleep, impairment of daytime function

27. Management
Pharmacological Nonpharmocological
•Iron supplements
•Dopaminergicagents
•Anticonvulsants
•Avoid caffeinated beverages
•Massaging the legs before
bedtime
•Taking a hot bath
•Moderateexercise
•Maintain regular sleep pattern

28. Narcolepsy
•Adisablingsleepdisordercharacterizedby
extremeandoverwhelmingdaytimesleepiness,
evenafteradequatenighttimesleepand
abnormalrapideyemovementsleep.
•Nighttimesleepmaybefragmentedbyfrequent
awakenings.
•Peoplewhohavenarcolepsyoftenfallasleepat
inappropriatetimesandplacesandexperience
daytime“sleepattacks”thatlastfromsecondsto
morethanone-halfhour,canoccurwithout
warning,andmaycauseinjury.

29. •Candevelopatanyage,butthesymptoms
tendtoappearfirstduringadolescenceor
earlyadulthood.
•Geneticpredispositionisthere
•Asubstanceinthebrain(hypothalamus)
calledhypocretinplaysakeyrolein
narcolepsy.Mostpeoplewhohavenarcolepsy
lackhypocretin,whichpromoteswakefulness.

30. Clinical features
•Firstsymptom–Daytimesleepness
•Othercommonlyassociatedsymptomsinclude
•Cataplexy–characterizedbysuddenlossofmuscletone,
oftenprecipitatedbysuddenemotionalreactions,such
asanger,surprise,fear,orlaughter.Theweaknessmay
showupaslimpnessattheneck,bucklingoftheknees,
orsaggingfacialmusclesaffectingspeech,oritmay
causeacompletebodycollapse.
•Sleepparalysis-theoccurrenceofinabilitytomovethe
limbsortheheadortospeakandbreathenormally
eitheratsleeponsetoronwakingup,asiftheywere
gluedtotheirbeds.
•Hypnagogichallucinations

31. Management
•No cure, symptomatic management.
•Treatment for narcolepsy includes that restores
hypocretinto normal levels.
•Medications include
•Dopaminergicstimulants –for daytime sleepness
and sleep attacks
•Atidepressantsfor cataplexy
•Hypnotics –for disturbed nighttime sleep Doctors
also

32. Lifestyle changes
•Avoiding caffeine,alcoholand nicotine.
•Follow a regularexerciseand meal schedule.
Eat smaller meals more often instead of heavy
meals.
•Controlling the sleep schedule. Try to go to
sleep and wake up at about the same time
every day.
•Schedule two to three daytime naps, each
lasting 10-15 minutes.