INSOMNIA
INSOMNIA
•A condition of unsatisfactory quantity and/or quality of sleep, which persists for a considerable period of time, including difficulty falling asleep, difficulty staying asleep, or early final wakening.
Stages of Sleep
Stage 1
•Stage 1 sleep, or drowsiness, is often described as first in the sequence
•The eyes are closed during Stage 1 sleep, but if aroused from it, a person may feel as if he or she has not slept. Stage 1 may last for five to 10 minutes.
•alpha rythm
Stage 2
•
•Stage 2 is a period of light sleep during which spontaneous periods of muscle tone mixed with periods of muscle relaxation occur. Muscle tone of this kind can be seen in other stages of sleep as a reaction to auditory stimuli.
•The heart rate slows, and body temperature decreases. At this point, the body prepares to enter deep sleep
•
Stages 3 and 4
•These are deep sleep stages, with Stage 4 being more intense than Stage 3. These stages are known as slow-wave, or delta sleep.
Non-REM Sleep
•The period of non-REM sleep (NREM) lasts from 90 to 120 minutes, each stage lasting anywhere from 5 to 15 minutes.
•A normal sleep cycle has this pattern: waking, stage 1, 2, 3, 4, 3, 2, REM.
Stage 5, REM
•REM sleep is distinguishable from NREM sleep by changes in physiological states, including its characteristic rapid eye movements.
•In normal REM sleep, heart rate and respiration speed up and become erratic, while the face, fingers, and legs may twitch.
•Intense dreaming occurs during REM sleep as a result of heightened cerebral activity, but paralysis occurs simultaneously in the major voluntary muscle groups, including the submental muscles (muscles of the chin and neck).
•It is sometimes called paradoxical sleep.
•The first period of REM typically lasts 10 minutes, with each recurring REM stage lengthening, and the final one lasting an hour.
•EEG shows increased activity
REM Sleep
Rapid Eye Movement Stage-
Brain waves increase to the awake level
Most dreams occur during this stage
¡If awoken in this stage, most people remember their dreams
Physical changes during REM
¡Increase in H.R., B.P., and breathing rate
¡Breathing more shallow and irregular
¡Eyes jerk rapidly
¡Limb muscles temporarily paralyzed
¡Some loss of temperature regulation
¡Men may experience erections
¡
Most people have 3-5 intervals of REM each night
Infants spend 50% of time in REM
Adults spend nearly half of time in Stage 2
¡20% in REM, other 30% divided among other stages
¡Progressively spend less time in REM as we age
Classified as the inability to get enough sleep despite adequate time.
Symptoms Include:
Delayed Sleep Onset
Early Morning Wake-Ups
Unrefreshing Sleep
Trouble Maintaining Sleep
Causes many problems in daytime functioning
Primary Insomnia-
Also referred to as Idiopathic
This is diagnosed when a patient has no other cause of insomnia other than the fact they cannot sleep
Also been known to be patient confusion and misconception around what is meant and understood to be sleep
Acute Insomnia-
This is when a patient suffers from insomnia fewer than 3 times a week for less than a month
Typically stems from changes in the environment and a short illness the patient might have had
We spend 1/3 of our lives asleep
Sleep is an active process
No organ or regulatory system “shuts down”
¡Slight decrease in metabolic rate
Some brain activity increases during sleep
¡Delta Waves
¡Many parts of the brain are as active as awake periods
¡At least 2 hours of dream state per night
Specific hormones increase during sleep
¡Growth hormone
¡Melatonin
Specific cues exist for regulation of sleep
How much sleep do we need?
Infants 16-20
Toddlers 12-14
Pre School 11-13
School Age 10-11
Teens 9.5-10
Most adults need 7 ½ -8 hours to function well
¡About 10% require more or less sleep
¡Pregnant women need more sleep
Causes of Insomnia-
Often caused by depression or other psychiatric problems
Also caused by excess, lasting stress or racing thoughts at bedtime
Symptoms of insomnia also could be cause by other sleeping disorders such as:
Restless Leg Syndrome
Sleep Apnea
Somnolence
Declared a public health problem by
Institutes of Medicine of the National Academies-
An estimated 50% of Americans are sleep deprived
30% average less than 6 hours per night
Estimated 70 million with insufficient sleep
7 out of 10 have trouble sleeping
40 million suffer from some long term disorder
20 million experience occasional problems
1/3 of Americans have symptoms of insomnia
The cumulative effects of sleep loss and sleep disorder represent an under recognized public health problem
Children-
2/3 of children have several sleep problems per week
25%-40% of children have sleep disorders
10-12% snore regularly
Contributors to Sleep Disorders-
Genetics
Aging
¡Menopause, hot flashes, hormone changes
¡1/3 of older adults have insomnia
¡More nocturnal awakenings, more fitful sleep
Overweight
¡40% have sleep apnea
Diabetes
¡½ of people with sleep apnea have diabetes
Pain/Illness
Arthritis, osteoporosis, dementias, heart disease, lung disease, cancers
digestive disorders
Medications
Stress
Common Sleep Disorders-
Snoring/Apnea
Insomnia 9-12%
Narcolepsy
Restless leg syndrome-5%
Over 80 different disorders
Common Disorders in Children-
Dyssomnias-disturbance in the amount, timing or quality of sleep
¡Insomnia
¡Sleep apnea, 1-3%
¡Restless leg syndrome
¡Narcolepsy-rare
¡Periodic limb movement
Parasomnias-disorders with abnormal behavior or physiological events, interference with sleep stage transition
¡Arousal disorders
÷Night terrors,4-8 yr old
÷Sleep walking, 6-12 yr olds
¢Up to 40% sleep walk
¡Sleep wake transition
÷Sleep talking
¡Nightmares, 3-5%
¡Teeth grinding or bruxism
¡Bedwetting, 15%, boys, age 3+
Obstructive Apnea in Children-
Most common sleep disorder
Occurs in 1-3% of children
Most common in preschool children
Symptoms During sleep
¡Snoring
¡Restless sleep
¡Interruption of breathing
¡Chronic mouth breathing
General Symptoms of a Sleep Problem-
¡Performance decrease: academic, physical, etc.
¡Behavioral difficulties
¡Irritable
¡Hyperactive
¡Frequent illness
¡Headaches, jaw pain, earaches
¡Depression, anxiety
Daytime sleepiness
In general-
4 out of 10 adults sleepiness interfere with activities a few days each month
20% adults sleepiness interferes a few days per week or more
Direct cost of sleep related problems 16 billion dollars
Indirect cost 50-100 billion
Poor Functioning-
Drowsy driving
¡Sleep deprived, 2-4 times greater risk of an accident
¡100,000 auto accidents
¡71, 000 injuries
¡1,550 deaths
¡20% of all drivers have dozed at least once behind the wheel
¡One night of sleep deprivation is equal to legal intoxication
Disasters
¡Chernobyl, Three Mile Island, Challenger, Exxon Valdez
¡Contributed to by errors in judgment from fatigue, sleepiness
More mistakes!-
¡Work Performance and accidents
¡Contributes to job absenteeism, lost productivity
¡Mistakes and work accidents increase
Medical errors- study with sleepy interns
¡36% more serious errors
÷Of which 31% caused a fatality
¡28% more intercepted errors
¡57% more non-intercepted errors
¡21% more medication errors
¡5.6 times as many serious diagnostic errors
Health Consequences -
Cardiovascular system-increase in heart disease
¡Increase in blood pressure
¡Increase risk for heart attacks, strokes, 5 or fewer hours have 45% greater risk
Endocrine
¡Affects appetite regulating hormone
¡Diabetes and impaired glucose tolerance
÷2.5 times more with 5 or less hours of sleep
÷1.7 times more with 6 or fewer hours of sleep
¡Obesity and weight management
¡Increase in stress hormones
¡Thyroid and growth hormones affected
Immune system-more susceptible to illness
Nervous system-memory and learning affected
¡Balance is affected, more falls, 2 to 4.5 greater chance of falling
¡Increased risk of tremors, seizures
¡Increase in pain, frequent headaches
Mental Health
¡Decreased neurotransmitters affecting mood
¡More distress, irritability, depression , alcohol use, suicide
¡Decreased quality of life
Early death
¡Less than 6 hours of sleep or less per night-
¡15%-30% greater risk of dying, regardless of cause
¡Protective factors of avoiding tobacco, alcohol, and unhealthy foods lost with sleep deprivation
Treatment of Disorders-
Good Sleep Hygiene
Medications
Psychotherapy, stress management
Relaxation techniques
OSA treatment
¡Mouth appliance
¡Surgery-tonsils and/or adenoids
¡Weight reduction if obese
CPAP-Continuous positive airway pressure
Sleep Hygiene
What contributes to good sleep?
¡Relaxing Routine
÷Warm bath/shower
÷Quiet activities
÷Lower lights
¡Regular sleep schedule
÷Go to bed and get up around the same time
÷Limit naps
¡Limit stimulating behaviors before bedtime
÷Limit caffeine after 2 pm
÷Limit alcohol after dinner
÷Limit large or spicy meals
÷Limit vigorous exercise 4-6 hours before bed
De-stress, learn relaxation techniques
¡Physical and mental
Maintain a regular physical activity routine
¡Physical activity helps with stress
¡Fitness reportedly helps with sleep quality
Do not go to bed hungry or full
¡Light snack of carbos and foods with tryptophan
Practice stimulus control
¡Bed for sleeping only, limit other activities (except sex!)
÷Eating, reading, watching television, studying, work, hobbies
¡Go to bed when you are drowsy
¡If you don’t fall asleep within 10-15 minutes
÷Get up, leave the bedroom
÷Read or watch something dull
¡Room and bed comfortable
÷Little clutter (Feng Shui the bedroom)
÷No pets on/in the bed
÷Temperature Cool
÷Lighting low, expose yourself to bright lights during day
÷Bed, sheets, PJ’s comfortable and not binding