1. Sleep DisordersSleep Disorders
BY
ARUN.M
KVM COLLEGE

2. SleepSleep
--SleepSleep isis unconsciousnessunconsciousness from which thefrom which the
person can beperson can be arousedaroused by sensory or otherby sensory or other
stimulistimuli
--ComaComa is unconsciousness from which the personis unconsciousness from which the person
cannot be arousedcannot be aroused

3. SleepSleep
11..Slow-wave sleepSlow-wave sleep (non REM sleep(non REM sleep((
22..Rapid eye movement sleepRapid eye movement sleep (REM sleep(REM sleep((

4. Slow-wave deep (non-REMSlow-wave deep (non-REM((
--Most sleep during night (75%Most sleep during night (75%(.(.
--Exceedingly restfulExceedingly restful..
--Dec. peripheral vascular toneDec. peripheral vascular tone..
--10-30%10-30%dec. in blood pressure, resp. rate anddec. in blood pressure, resp. rate and
basal metabolic ratebasal metabolic rate..
--dreams are usually not remembereddreams are usually not remembered..

5. Rapid Eye Movement (REMRapid Eye Movement (REM((
--Occurs in normal night sleepsOccurs in normal night sleeps..
--Last for 5-30 min. and occur every 90 minLast for 5-30 min. and occur every 90 min..
--Rapid movement of the eyesRapid movement of the eyes..
--Usually ass. With active dreaming and activeUsually ass. With active dreaming and active
bodily muscle movementbodily muscle movement..
--The heart rate and resp. rate become irregularThe heart rate and resp. rate become irregular
(dream(dream(.(.
--The brain is highly activeThe brain is highly active..

6. Theories of sleepTheories of sleep
passive theory of slepassive theory of sleep:ep: excitatory areas of (RAS) inexcitatory areas of (RAS) in
the upper brain stem fatigued and became inactivethe upper brain stem fatigued and became inactive..
active inhibitory processactive inhibitory process::
Stimulation of center located below theStimulation of center located below the midpontilemidpontile
levellevel of the brain stem inhibiting excitatory areas ofof the brain stem inhibiting excitatory areas of
(RAS) in the upper brain stem leading to sleep(RAS) in the upper brain stem leading to sleep..

7. Sleep DisordersSleep Disorders
--1/31/3of U.S. people suffer from sleep disordersof U.S. people suffer from sleep disorders..
--It is classified intoIt is classified into::
11..PrimaryPrimary ((DyssomniasDyssomnias andand ParasomniasParasomnias((
22..SecondarySecondary

8. Causes of 2ry sleep disordersCauses of 2ry sleep disorders
--Medical conditions (pain, met dis, endo disMedical conditions (pain, met dis, endo dis((
--Physical conditions (obesityPhysical conditions (obesity((
--Sedative withdrawalSedative withdrawal
--Use of stimulantsUse of stimulants
--Major depressionMajor depression
--Mania or anxietyMania or anxiety
--Neurotransmitter abnormalities ( dopamine orNeurotransmitter abnormalities ( dopamine or
norepinephrine, ACH, serotoninnorepinephrine, ACH, serotonin(.(.

9. Dyssomnias (1ry sleep dis.)Dyssomnias (1ry sleep dis.)
It is disturbance in theIt is disturbance in the amountamount,, qualityquality oror timingtiming
of sleep. It is subdivided intoof sleep. It is subdivided into::
11..Primary InsomniaPrimary Insomnia
22..Primary hypersomniaPrimary hypersomnia
33..NarcolepsyNarcolepsy
44..Breathing-Related DisorderBreathing-Related Disorder
55..Circadian Rhythm Sleep DisorderCircadian Rhythm Sleep Disorder

10. 11..Primary InsomniaPrimary Insomnia
--Difficulty in initiating or maintaining sleepDifficulty in initiating or maintaining sleep..
--Occurs 3x or more per week for at least 1 monthOccurs 3x or more per week for at least 1 month..
--Affects 30% of the populationAffects 30% of the population..
--Often exacerbated by anxiety and preoccupationOften exacerbated by anxiety and preoccupation
with getting enough sleepwith getting enough sleep..

11. Primary Insomnia (contPrimary Insomnia (cont.(.(
TreatmentTreatment::
11..Sleep hygiene measures (1Sleep hygiene measures (1stst
lineline((
22..Pharmacotherapy (for short term usePharmacotherapy (for short term use(:(:
--BenadrylBenadryl
--Ambien (zolpidemAmbien (zolpidem((
--Sonata (zaleplonSonata (zaleplon((
--Desyrel (trazodoneDesyrel (trazodone((

12. 22..Primary HypersomniaPrimary Hypersomnia
--At leastAt least 1 month1 month of excessiveof excessive daytime sleepinessdaytime sleepiness notnot
due to any medical or other conditiondue to any medical or other condition..
--TreatmentTreatment::
11..Stimulant drugs as amphetamine (1Stimulant drugs as amphetamine (1stst
lineline((
22..SSRI may be useful in some patientsSSRI may be useful in some patients..

13. 33..NarcolepsyNarcolepsy
--Repeated, sudden attacks of sleep during the dayRepeated, sudden attacks of sleep during the day
for at leastfor at least 3 months3 months, ass. With, ass. With::
11..Cataplexy (collapse due to sudden loss ofCataplexy (collapse due to sudden loss of
muscle tonemuscle tone(.(.
22..Short REM latencyShort REM latency..
33..Sleep paralysis ( brief paralysis uponSleep paralysis ( brief paralysis upon
awakeningawakening(.(.
44..Hypnagogic, hypnopompic hallucinationsHypnagogic, hypnopompic hallucinations..

14. Narcolepsy (contNarcolepsy (cont.(.(
--Occur in 0.02-0.16% of populationOccur in 0.02-0.16% of population..
--EqualEqual incidence in males and femalesincidence in males and females..
--Onset most commonly inOnset most commonly in childhoodchildhood andand
adolescenceadolescence..
--May have genetic componentMay have genetic component..
--Patients usually have poor nighttime sleepPatients usually have poor nighttime sleep..

15. Narcolepsy (contNarcolepsy (cont.(.(
--TreatmentTreatment::
11..Timed daily napsTimed daily naps..
22..Stimulant drugs (amphetamines andStimulant drugs (amphetamines and
methylphenidatemethylphenidate(.(.
33..SSRI or oxalate for patients withSSRI or oxalate for patients with cataplexycataplexy..

16. 44..Breathing-Related disBreathing-Related dis..
--Sleep disruption and excessive daytime sleepinessSleep disruption and excessive daytime sleepiness
caused by abnormal sleep ventilation fromcaused by abnormal sleep ventilation from
eithereither::
11..Obstructive Sleep ApneaObstructive Sleep Apnea [OSA] which is[OSA] which is
correlated tocorrelated to snoringsnoring oror
22..Central Sleep ApneaCentral Sleep Apnea [SPA] which is correlated[SPA] which is correlated
toto heart failureheart failure..

17. OSA risk factorsOSA risk factors::
-Male gender.-Male gender.
-Obesity-Obesity
-male shirt collar size >17-male shirt collar size >17
-Previous upper airway surgeries.-Previous upper airway surgeries.
-Deviated nasal septum.-Deviated nasal septum.
- retrognathia- retrognathia
Large uvulaLarge uvula

18. Breathing-Related dis. (contBreathing-Related dis. (cont.(.(
--TreatmentTreatment::
11..OSAOSA::
Nasal continuous positive airway pressureNasal continuous positive airway pressure
(nCPAP), weight loss, nasal surgery or(nCPAP), weight loss, nasal surgery or
uvulopalatoplastyuvulopalatoplasty..
22..CSACSA::
Mechanical ventillation with a backup rateMechanical ventillation with a backup rate..

19. ParasomniasParasomnias
--Abnormal events inAbnormal events in behaviorbehavior oror physiologyphysiology
during sleep. It is subdivided intoduring sleep. It is subdivided into::
11..Nightmare disorderNightmare disorder..
22..Night Terror disorderNight Terror disorder..
33..Sleep Walking disorder (somnambulismSleep Walking disorder (somnambulism(.(.

20. 11..Nightmare disNightmare dis..
--RepeatedRepeated awakeningsawakenings with recall of extremelywith recall of extremely
frightening dreamsfrightening dreams..
--Occurs duringOccurs during REMREM sleepsleep..
--Onset most often starts atOnset most often starts at childhoodchildhood..
--Occur more frequently during time of stressOccur more frequently during time of stress..
--NONO SPECIFICSPECIFIC TREATMENTTREATMENT butbut tricyclicstricyclics
could be usedcould be used..

21. 22..Night Terror disorderNight Terror disorder
--Repeated episodes of fearfulness during sleepRepeated episodes of fearfulness during sleep..
--Episodes usually occur during theEpisodes usually occur during the slow-waveslow-wave
deep stage of sleepdeep stage of sleep..
--Patients usually donPatients usually don’’t remember the episodest remember the episodes..
--It usually begins with a scream and ass. WithIt usually begins with a scream and ass. With
intense anxietyintense anxiety..

22. Night Terror dis. (contNight Terror dis. (cont.(.(
--Usually occur inUsually occur in childrenchildren..
--More common inMore common in boysboys..
--Tend to run in familiesTend to run in families..
--High ass. WithHigh ass. With comorbid sleepwalking discomorbid sleepwalking dis..
--NoNo specificspecific treatmenttreatment but givingbut giving diazepamdiazepam beforebefore
bedtime might be effectivebedtime might be effective..

23. 33..Sleepwalking dis. (SomnambulismSleepwalking dis. (Somnambulism((
--Repeated episodes of getting out of bed andRepeated episodes of getting out of bed and
walkingwalking..
--Ass. WithAss. With blank stareblank stare andand difficulty in beingdifficulty in being
awakenedawakened..
--Onset bet. Age 4-8 yrsOnset bet. Age 4-8 yrs..
run in familyrun in family toto tendstends boyboy - More common in- More common in
--The best treatment is to prevent injury inThe best treatment is to prevent injury in
surrounding environmentsurrounding environment..

24. Thank youThank you