Miss Sameera Shafiq

Muzamil Kousar 011 Sunila Saif 012 Saba Saleem 014
BS (Hons) Psychology 6th Sem

Date: 05 June 2009 UOG

SLEEP DISORDER
Sleep is absolutely essential for normal, healthy function. Scientists and medical professionals still have much to learn about this complicated physiological phenomenon. According to the National Institute of Neurological Disorders and Stroke, about 40 million people in the United States suffer from chronic long-term sleep disorders each year and an additional 20 million people experience occasional sleep problems. Sleep disorder is defined as any difficulties related to sleeping, including: Falling asleep at inappropriate times, Difficulty falling or staying asleep, Abnormal behaviors associated with sleep, or Excessive total sleep time.

Why Does the Body Need Sleep?
It is not clear exactly why the body requires sleep, although inadequate sleep can have severe detrimental effects on health. Studies have shown that sleep is essential for normal immune system function and to maintain the ability to fight disease and sickness. Sleep also is essential for normal nervous system function and the ability to function both physically and mentally. In addition, sleep is essential for learning and for normal, healthy cell growth.

Types of Sleep Disorders Lack of Sleep
Everyone has suffered from a lack of sleep at one time or another. But some people have medical disorders that cause poor sleep on a regular basis. There are many types of sleep disorders and, in many cases, a combination of factors may cause sleep problems.

Primary Sleep Disorders
1. Insomnia² the inability to fall asleep or stay asleep.
Almost everyone will be affected by insomnia at some point during life. Insomnia ± a short term or chronic inability to get high quality sleep. Short-term (situational) insomnia may be related to stressful situations such as illness, work/school demands or emotionally upsetting events in a person¶s life. Situational insomnia is the most common reason for poor sleep. Chronic Insomnia ² at least three months of poor sleep most nights ² may be related to another unrecognized sleep disorder such as sleep apnea or restless legs syndrome. In many cases, more than one factor may cause insomnia.

2. Sleep Apnea ² a temporary suspension of breathing (10 or more seconds)
Sleep apnea refers to a temporary cessation of breathing during sleep that usually repeats in a cycle. In children, common causes include tonsillitis and adenoiditis. In adults, the condition is often related to obesity, but it can also be caused by other disorders or structural defects in the throat. There are two main types of sleep apnea: Obstructive Sleep Apnea, in which the airway becomes obstructed and prevents the flow of air. And it is also called snoring.

Central Sleep Apnea, in which the brain does not send the signal to the muscles to take a breath. A person also may have mixed sleep apnea (both obstructive sleep apnea and central sleep apnea).

3. Narcolepsy
Unexplained sleepiness at inappropriate times despite adequate nighttime sleep. Narcolepsy is a syndrome that involves vivid dreams, sleep paralysis and cataplexy (a condition in which a person suddenly feels weak and collapses at moments of strong emotion). Symptoms may occur all at once or gradually over many years.

4. Restless Legs Syndrome
A chronic neurological disorder characterized by unpleasant sensations in the legs and an irrepressible urge to move the legs when resting to relieve these feelings. Symptoms worsen in the evening and at rest, preventing sleep. Symptoms are relieved by moving the legs. Suffers describe the sensation as energy, creepy-crawly, electric shock, or pain. One-third of people with this disorder have had symptoms since childhood. The symptoms tend to become more severe with aging.

5. Periodic Limb Movement Disorder (PLMD)
A disorder characterized by periodic, involuntary leg twitching or jerking movements that occur during sleep. More than 80 percent of people with restless legs syndrome also experience PLMD. The movements caused by PLMD are involuntary, unlike RLS. Although most people with RLS develop PLMD, most people with PLMD do not experience RLS.

6. Inadequate Sleep Hygiene (bad sleep habits)
A sleep disorder caused by the performance of daily living activities that are inconsistent with the maintenance of good quality sleep and full daytime alertness. This may involve lifestyle practices that keep a person awake and/or practices that bring disorder to a person¶s sleep schedule.

7. Jet Lag
A temporary disorder that causes fatigue, insomnia and other symptoms as a result of air travel across time zones.

8. Shift Work
People who work second or third shifts may have difficulty sleeping during the day and trouble staying awake during their shift at night. Workers who are most affected work between 11:00 pm and 7:00 am and those who do rotating shifts. Night shift workers are likely working during the time in their circadian rhythm (the body¶s internal regulator of sleep and wake) when their brain is most sleepy.

9. Sleepwalking
A disorder characterized by walking or other activity while seemingly still asleep. Sleep walking may occur at any age, but most often occurs in children ages 6 to 12. A common misconception is that sleepwalking is acting out the physical movements within a dream, but in fact, sleepwalking occurs earlier on in the night when rapid eye movement (REM), or the "dream stage" of sleep, has not yet occurred. According to a Finnish study published in 1997, children sleepwalk more frequently than adults. Sleepwalking was reported for 6.9% of female children and 5.7% of male children, compared to rates of 3.1% for adult women and 3.9% for adult men. Activities such as eating, bathing, urinating, talking, dressing, driving cars, painting, whistling, dancing, committing murder, or engaging in sexual intercourse have been reported or claimed to have occurred during sleepwalking. In December 2008, reports were published of a woman who sent semi-coherent emails while sleepwalking, including one inviting a friend round for dinner and drinks.

10. Night Terror (Sleep Terror)
A common sleep disorder among children involving abrupt awakening from sleep in a terrified state. A child may scream and shake, and the child is difficult to wake. Night terrors may be associated with emotional tension, stress or conflict. Night terror is similar to nightmares except that nightmares usually occur during REM sleep. The disorder usually ends around the time a child reaches grade school age.

Secondary Sleep Disorders
In addition to primary sleep disorders, more than 50 secondary sleep disorders have been identified, including eating disorders, bedwetting, circadian rhythm sleep disorder, hypersomnia, environmental sleep disorder, teeth grinding, delayed sleep phase and many other conditions.

Symptoms Of Sleep Problems And Disorders
The symptoms of sleep disorders include: Daytime napping almost every day Falling asleep while driving Having difficulty paying attention or concentrating at work, school, or home Having difficulty controlling your emotions Having difficulty in remembering Struggle to stay awake when inactive, such as when watching television or reading. Having slow responses.

Common Causes Of Sleep Disorders
Changes in life style, such as shift work change (SWC), can contribute to sleep disorders. Other problems that can affect sleep: Back pain Chronic pain Neck pain Environmental (for example, alcohol use) Medical (for example, asthma) Psychiatric (for example, depression and anxiety disorders) Physical (for example, ulcers) Incontinence

Withdrawal - Drug Withdrawal during the cold turkey actual withdrawal stage can lead to loss of ability to get to sleep and can last for several days through to several weeks. It is particularly a pervasive symptom for withdrawal from Opiods and in particular Heroin. Endocrine imbalance mainly due to Cortisol but not limited to this hormone. Hormone changes due to impending menstruation or during the menopause transition years. Chronobiological disorders, mainly Circadian rhythm disorders Other sleep disorder causes factors that can interfere with sleep include: Night Shift Work: People who work at night often experience sleep disorders because they cannot sleep when they start to feel drowsy. Their activities run contrary to their biological clocks. Medications: Many medications can interfere with sleep, such as certain antidepressants, blood pressure medication, and over-the-counter cold medicine. Aging: About half of all adults over the age of 65 have some sort of sleep disorder. It is not clear if it is a normal part of aging or a result of medications that older people commonly use. Genetics: Researchers have found a genetic basis for narcolepsy, a neurological disorder of sleep regulation that affects the control of sleep and wakefulness.

Sleep Disorder Diagnosis
Medical History
As with other neurological disorders, an accurate medical history is an essential part of diagnosing a sleep disorder. People with sleep disorders should keep a daily diary of activities and sleep²both when they try to go to sleep and when they actually do fall sleep. Behavior during sleep (e.g., snoring), as well as the use of alcohol, tobacco, and other drugs, should be reported to the physician.

Polysomnography
A polysomnogram is a sleep study that involves using electroencephalography (EEG) to monitor the brain and muscle activity, heart rhythm, and breathing during sleep. Patients are usually tested in a sleep center (sleep lab, sleep clinic) or are given portable equipment to take home. The EEG monitors the various stages of sleep, which is then interpreted by the clinician. For example, the EEG shows the degree of muscle activity during the various NREM and REM sleep stages. This information may provide clues about the type and cause of the sleep disorder.

Other Tests
In people with suspected obstructive sleep apnea (OSA), overnight oximetry (measuring the oxygen saturation in the blood) may be performed to determine the oxygen level during the apnea episodes.

In people with suspected narcolepsy, there are various tests that can be performed. The multiple sleep latency test (MSLT), for example, measures the time it takes for REM sleep to occur in patients who fall asleep suddenly and repeatedly. In people with narcolepsy, REM occurs immediately.

Sleep Disorders Treatments
Treatment for sleep disorders depends on the cause and may include improvements in sleep hygiene (e.g., going to bed at the same time each day) and lifestyle modifications (e.g., avoiding caffeine, exercising daily, weight loss), medications, and other treatments. Medication Treatments Behavior Treatments Alternative Therapy Supplements

Medication for Sleep Disorders
In some cases, doctors will prescribe medicines for the sleep disorders treatments. Medications should be used in combination with good sleep practices and/or behavioral treatments.

Types of Medications Used to Treat Sleep Disorders
Listed below are some of the types of drugs used for sleep disorders treatments. Your doctor can prescribe the appropriate medication for your particular sleep disorder. Anti-parkinsonian drugs (dopamine agonists), Benzodiazepines, Non-benzodiazepine hypnotics, Opiates Anticonvulsants

Behavior Treatments for sleep disorders:
Lifestyle/behavioral treatments for sleep disorders may include: Cognitive therapy Stimulus control (SC) Sleep hygiene Relaxation training Sleep restriction therapy (SRT)

Alternative Therapy for Sleep Disorders
Alternative therapy encompasses a variety of disciplines that include everything from diet and exercise to mental conditioning and lifestyle changes. Examples of alternative therapies for sleep disorders include acupuncture, guided imagery, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage and many others. Some complementary and alternative therapies used to treat insomnia include supplements, acupuncture, relaxation and meditation, and exercise.

Supplements for Sleep Disorders Treatment
1. 2. 3. 4. 5. 6. Herbs, Melatonin, Acupuncture, Relaxation, Meditation and Exercise

Understanding sleep disorders, treatments and alternative treatments by health psychologist
In the United States alone, over 60 million people suffer from sleep disorders. Problems sleeping at the night cause exhaustion and dysfunction throughout the day. Sufferers should do all they can to seek help and can find relief from symptoms in varied treatment options. This does not necessarily mean visiting the doctor; some people with common sleep disorders can find enough support online to get better. Others might need professional aid, all depending on the person and the sleep disorder. About 80 different sleep disorders are known to exist, the most common being insomnia, sleep apnea, and restless leg syndrome. For those who want to explore alternative treatments, also called alternative therapy there are a variety of ways to calm the mind/ nervous system and address the root of the problem. A therapist can assist you in finding the help you need which may encompass a variety of disciplines including everything from diet and exercise to mental conditioning and lifestyle changes. Examples of alternative therapies include Cognitive Behavioral Therapy, acupuncture, guided imagery, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage, and many others.

Insomnia
The most common sleep disorder in existence, insomnia can cause major exhaustion problems. Signs of insomnia include difficulty falling asleep, waking up often, trouble going back to sleep, waking up too early, and not getting restful sleep. People who often feel tired and moody throughout the day may have insomnia. Acute insomnia (short-term) may last one night and

disappear, while chronic insomnia (long-term) may last for years, coming and going at the most inconvenient times. Most people can cure insomnia at home by changing their lifestyle habits. Cutting down on caffeine, listening to music, lowering the thermostat, making your bed more comfortable, and sleeping in total darkness are all effective ways to cure insomnia. The most prevalent cause of insomnia is stress or emotional anxiety. Seeking advice from a mental health expert will help you address the root of the problem. If a person suffer from this disorder, an alternative treatment option is to consult a therapist that specializes in stress management, weight loss and emotional eating habits, and emotional issues around lifestyle choices.

Sleep Apnea
People with sleep apnea stop breathing in their sleep, often hundreds of times per night. Obstructive sleep apnea (OSA) is the most common form of this sleep disorder. Soft tissue in the throat collapses and blocks the airway, waking the sufferer. Central sleep apnea (CSA) is similar, but the airway is not blocked by tissue; the brain simply does not tell the body to breath. This problem is harder to treat since it involves the Central Nervous System (CNS). Sufferers of obstructive sleep apnea have plenty of treatment options. Weight loss may be the answer, but even sleeping in a different position could help immensely. Special mouthpieces can also cure sleep apnea. Suffers should avoid alcohol and other depressants, as these cause muscles to relax. If a person suffer from this disorder, an alternative treatment option is to consult a therapist that specializes in stress management, weight loss and emotional eating habits, and emotional issues around lifestyle choices.

Restless Legs Syndrome
When those suffering from restless leg syndrome (RLS) sit still for too long, they feel sensations like tingling and pain in their legs. Since this problem is typically worst evenings and nights, restless leg syndrome can make it especially hard to fall asleep. It helps to walk and shake the irritated leg. Unfortunately, nobody wants to get up and walk around after three hours of sleep! Restless leg syndrome may be symptomatic of pregnancy, anemia, nerve disease, diabetes, or kidney failure. Heredity and age are other factors. Obesity, caffeine, alcohol, smoking, H2histamine blockers, and antidepressants can also cause this sleep disorder. Lifestyle changes may cure restless leg syndrome; otherwise, prescribed medicine could be necessary. Cognitive behavioral therapy (CBT) is a form of therapy that emphasizes observing and changing negative thoughts (such as, "I'll never fall asleep"). It also employs actions intended to change behavior. This has been used as an alternative treatment option for sleeping disorders.

Prevention of Sleep Disorders
Good sleep habits can help you get a good night's sleep. Here are some tips: Try to go to bed at the same time every night and get up at the same time every morning. Try to avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can make you wake up later in the night. Get regular exercise. Try not to exercise close to bedtime because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for 3 hours before the time you go to sleep. Don't eat a big meal late in the day, although a light snack before bedtime may help you sleep. Make your sleeping place comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a "white noise" machine to cover up the sounds. Create a routine to help you relax and wind down before sleep, such as reading a book or taking a bath. Watching the news just before bed may keep some people awake, especially if the news is upsetting. If you have trouble lying awake worrying about things, try making a to-do list before you go to bed. This may help you to "let go" of those worries overnight. See your health care provider if you think you have a sleep problem or a sleep disorder.

Prognosis of Sleep Disorder
The prognosis depends on the specific disorder. Children usually outgrow sleep disorders. Narcolepsy is a life-long disorder. The prognosis for sleep disorders related to other conditions depends on successful treatment of the substance abuse, medical condition, or other mental disorder. The prognosis for primary sleep disorders is affected by many things, including the patient's age, sex, occupation, personality characteristics, family circumstances, neighborhood environment, and similar factors.

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