Sleep disorders - a brief medical study

A sleep disorder is any condition that involves difficulty experienced when sleep , such disorders involve daytime fatigue causing severe distress and impairment to work.
SD also have an impact upon social and personal functioning
this is a brief study on all aspects of this ...............
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1. Sleep Disorders Prepared by Martin shaji Pharm d 4 th year 17G91T0023 1 [email protected]

2. Introduction Sleep is a state of unconsciousness in which the brain is relatively more responsive to internal than external stimuli . A sleep disorder is any condition that involves difficulty experienced when sleep , such disorders involve daytime fatigue causing severe distresss and impairment to work. SD also have an impact upon social and personal functioning [email protected]

3. sleep is divided into two different phases. 1)D-sleep(desynchronized or dreaming sleep) or REM sleep (rapid eye movement sleep) or active sleep or paradoxical sleep) 2)S-sleep(synchronized sleep) or NREM- sleep (non-REM sleep) or quiet sleep or orthodox sleep. S-sleep or NREM-sleep is further divided into 4 stages, from stage 1 to stage 4( deep sleep ) person first passes through these stages of NREM-sleep. Depending on the duration of total sleep,two extremes of normal sleeping patterns have been described [email protected]

4. Depending on the duration of total sleep,two extremes of normal sleeping patterns have been described. 1)long-sleepers = more than 9 hours/night 2)Short-sleepers = less than 6 hours/night Classification 1) Primary Sleep Disorder 2) Sleep disorder related to another mental disorder 3) Other sleep disorder, most notably those due to a general medical condition or substance-induced. [email protected]

5. Primary Sleep Disorders: - Dyssomnias( disorders of quality and timing of sleep) Insomnia Narcolepsy Breathing-Related Sleeping Disorders Circadian Rhythm Sleep Disorder -Parasomnias ( abnormal behaviour during sleep or the transition between sleep and wakefulness ) Nightmares Night Terrors Sleepwalking Sleep Paralysis [email protected]

6. Insomnia Insomnia means one or more of the following: 1)Difficulty in initiating sleep. 2)Difficulty in maintaining sleep This includes both: -frequent awakenings during the night, and -early morning awakening. 3)Non-restorative sleep,i.e.despite adequate duration of sleep, feeling of not having rested present(poor quality sleep) [email protected]

7. Chronic causes of insomnia Medications Drug or alcohol use Psychiatric disorders (e.g., depression, anxiety) Medical disorders Sleep apnoea Restless leg syndrome Poor sleep hygiene [email protected]

8. Insomnia treatment Lifestyle changes often can help relieve acute (short-term) insomnia. Sleep hygiene A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia. Anxiety tends to prolong insomnia. Stimulus control therapy Several medicines also can help relieve insomnia and re-establish a regular sleep schedule. [email protected]

9. Pharmacological treatment Dietary supplements melatonin l- tryptophan Short acting benzodiazepenes z – drugs Zolapedium Low dose sedative antidepressant Mitazepine Long acting medicines such as Flueazeporam Quazepam Other medications nefazodone Qutipine [email protected]

10. HYPERSOMNIA Excessive day time sleepiness or sometimes both Sleep attacks during day time(falling asleep unintentionally) Sleep drunkenness(person needs much more time to awaken and during this period is confused or disoriented) Causes / reason Insufficient night sleep Unsatisfactory sleep routine Circadian rhythm sleep disorders Chronic physical illness Psychiatric disorders …………………………………………………. [email protected]

11. Other pathological reasons are Narcolepsy Obstructive sleep apnea CNS diseases Drug effects Kleine -levin Syndrome Primary hypersomnia sleep disturbance occurs daily for at least 1 month or for recurrent periods of shorter duration, and that it causes either marked distress or interferes with social and occupational functioning. Treatment Stimulant drugs Non sedating SSRIs [email protected]

12. Sleep apnea Repeated stoppage in breathing during sleep Caused by lack of breathing drive (central) or by blockage (obstructive) Signs/Symptoms: Snoring, headaches, fatigue, poor sleep, chronic congestion, irritability, obesity, sexual dysfunction Treatment: Continual Positive Airway Pressure (CPAP), Lifestyle Changes, and Surgery. [email protected]

13. Medications Albuterol Attention Deficit Disorder Meds (e.g. Ritalin) Decongestants (Pseudoephedrine, Phenylephrine) Caffeine “Diet pills" Nicotine Thyroid medications Corticosteroids SSRIs (antidepressants) Phenytoin (seizure medication) Chemotherapy (cancer medications) Beta-blockers (high blood pressure meds) [email protected]

14. Narcolepsy Narcolepsy is a disorder that causes periods of extreme daytime sleepiness due to trouble sleeping at night and is sometimes accompanied by paralysis and hallucinations Diagnosis Polysomnography Multiple sleep latency test EEG MRI CT Possible factors include: Heredity. Some people may inherit a gene that affects hypocretin. Up to 10% of people who have narcolepsy report having a relative with the same symptoms. Infections Brain injuries caused by brain tumors, strokes, or trauma. Autoimmune disorders Low levels of histamine, a substance in the blood that promotes wakefulness [email protected]

15. Pathophysiology Specialized neurons Extend from lateral hypothalamus to RAS There it produce neuropeptides ( orexins A & B also called as hypocritin 1 & 2 ) responsible for maintaining sleep cycle in brain center Sleep disorders cause decreased levels of neuropeptides Result in decreased neuronal activity Nacrolepsy /hypersomnia and other SDs [email protected]

16. Narcoleptic Cataplexy This condition causes a sudden loss of muscle tone while you're awake. Muscle weakness can affect certain parts of your body or your whole body. For example, if cataplexy affects your hand, you may drop what you're holding. It may last seconds or minutes. [email protected]

17. Treatment A complete cure for narcolepsy is not possible by drugs The treatment consists of :- Stimulant medication ( eg:amphetamines )in some patients and/or Antidepressants( particularly when cataplexy is a prominent symptoms) Sedatives ( mild ) Hypnotics …………….Non- benzodiazepines [email protected]

18. Non –pharmacological treatment Reduce or stop caffeine ,alcohol or nicotine Exercise Meditation , yoga Counselling under a clinical psychologist Relaxation techniques Cognitive therapy Paradoxical intension [email protected]

19. KLEINE-LEVIN SYNDROME This is a rare syndrome characterized by:- Hypersomnia. Hyperphagia(usually present),with a varacious appetite. Hypersexuality [email protected]

20. Circadian Rhythm Sleep Disorder Persistent pattern of sleep disruption leading to excessive sleepiness or insomnia due to mismatch between sleep- wake schedule. Obvious distress/impairment in social and occupational settings. Delayed Sleep Phase Type An unnatural sleeping pattern created by falling asleep late and waking up late which eventually establishes an inability to fall asleep and awaken at a desired earlier time. [email protected]

21. parasomnias Nightmares Night Terrors Sleepwalking ( somanabulism ) Restless Leg Syndrome Sleep Paralysis [email protected]