Psychopathology

Presentation and Assignment #1

Group #5
Group members

Asma Khalid 22BP105

Zobia Ashfaq 22BP109

Amna Jabbar 22BP107

Areeba 22BP104

Iqra Iman 22BP102

Ramsha Arshad 22BP106

Hina Umar 22BP113

Submitted to: Ma’m Meher un Nisa

 SLEEP WAKE DISORDERS
Etiology
The major causes of insomnia may be divided into medical conditions, psychological conditions,
and environmental problems.
Medical conditions
 Cardiac conditions that may give rise to disordered sleep include ischemia and
congestive heart failure.
 Neurologic conditions include stroke, degenerative conditions, dementia, peripheral
nerve damage, myoclonic jerks, restless leg syndrome, hypnic jerk, and central sleep
apnea.
 Endocrine conditions affecting sleep are related to hyperthyroidism, menopause, the
menstrual cycle, pregnancy, and hypogonadism in elderly men.
 Pulmonary conditions include chronic obstructive pulmonary disease, asthma, central
alveolar hypoventilation (the Ondine curse), and obstructive sleep apnea syndrome
(associated with snoring).
 Gastrointestinal (GI) conditions include gastroesophageal reflux disease.
 Hematologic conditions include paroxysmal nocturnal hemoglobinuria, which is a rare,
acquired, hemolytic anemia associated with brownish-red morning urine.

Substances that may result in insomnia include stimulants, opioids, caffeine, and alcohol, or,
withdrawal from any of these also may cause insomnia. Medications implicated in insomnia
include decongestants, corticosteroids, and bronchodilators.
Other conditions that may affect sleep include fever, pain, and infection.

Psychiatric conditions
It should be borne in mind in mind that the major psychiatric conditions now are known to have
a biologic basis and thus constitute a subset of medical conditions.
 Depression may cause alterations in sleep. As many as 40% of people with depression
have insomnia.
 Posttraumatic stress disorder (PTSD) can produce vivid and terrifying nightmares.
 Anxiety disorders predispose to insomnia. The most common of these are generalized
anxiety disorder, panic disorder, and anxiety disorders not otherwise specified.
 Thought disorders and misperception of sleep state are other potential states that cause
insomnia.
Psychotropic medications, such as antidepressants, may interfere with normal sleep patterns.
Rebound insomnia from benzodiazepines or other hypnotic agents is common.

Environmental problems
Stressful or life-threatening events (eg, bereavement or PTSD) may cause insomnia. Shift work
may disturb the sleep cycle, as may jet lag or changes in altitude. Sleep deprivation may occur as
a result of an overly warm sleeping environment, environmental noise, or frequent intrusions
(such as occur in an intensive care unit [ICU]).
Environmental conditions, such as temperature, noise, light, bed comfort and electronic
distractions, play a significant role in one’s ability to get proper sleep—and, subsequently, in
overall sleep-related wellness.
For instance, in an Israeli study of eighth- and ninth-grade students, researchers found that those
adolescents with excessive electronic media habits experienced daytime sleep-related problems.
The study found that students with televisions in their bedrooms went to bed later in the night
and slept less than those without televisions. The authors of the study point out that these
findings raise a public health concern regarding lifestyle and functioning in young people. (10)
Environmental noise is another significant factor when it comes to influencing sleep-wake
behavior and sleep quality. Research shows that high sound levels during sleep—whether from
traffic, neighbors, or disturbances in your own home—can decrease your sleep intensity, cause
you to wake more often during the night, and can even increase your stress hormone secretion.
According to a German study by Kohlhuber, et al., the results of this poor sleep quality reach far
beyond the short-term consequences of reduced cognitive performance and general tiredness.
Their study showed that the long-term consequences of repeated sleep loss due to environmental
noise may include heart disease and increased medication intake.
Some other factors are;
 Working the night shift (this work schedule messes up “biological clocks.”)
 Genetics (narcolepsy is genetic).
 Medications (some interfere with sleep).
 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 medicines that older people
commonly use).

Treatment
Sleep wake disorders can be treated in several ways based on the nature of disorder
Medications
Many agents are useful in treating insomnia. Short-term drug therapy is preferred to restore a
normal sleep pattern. Generally, hypnotic drugs are approved for 2 weeks or less of continuous
use. In chronic insomnia, longer courses may be indicated, which require long-term monitoring
to ensure ongoing appropriate use of the medication.

Benzodiazepines
Benzodiazepine receptor agonists are the mainstay in treatment of insomnia. This class of drugs
suppresses rapid eye movement (REM) sleep and reduces stages 3 and 4 sleep while increasing
stage 2 sleep.
Benzodiazepines are a type of sedative medication. This means they slow down the body and
brain’s functions. They can be used to help with anxiety and insomnia (difficult getting to sleep
or staying asleep).

Non benzodiazepine Hypnotics

These are also known as “Z” drugs. These agents are used for the treatment of acute and short-
term insomnia.
Non benzodiazepines (e.g., eszopiclone [Lunesta], zaleplon [Sonata], zolpidem [Ambien]) are
effective treatments for chronic insomnia and, based on indirect comparisons, appear to have
fewer adverse effects than benzodiazepines

Melatonin Receptor Agonists

Melatonin receptor agonists (tasimelteon, ramelteon) have been approved by the FDA.
Tasimelteon is indicated for non–24-hour sleep-wake disorder. Ramelteon is indicated for
insomnia characterized by difficulty with sleep onset.
Melatonin is a hormone that your brain produces in response to darkness. It helps with the timing
of your circadian rhythms (24-hour internal clock) and with sleep. Being exposed to light at night
can block melatonin production.
It helps control your sleep patterns. You can take a manmade version of melatonin for short-term
sleep problems (insomnia). It makes you fall asleep quicker and less likely to wake up during the
night. It can also help with symptoms of jetlag.

Antidepressants, Other
Although no antidepressants have been specifically approved for use in the treatment of sleep
disorders, but at present, prescribing antidepressants for short-term treatment of insomnia can be
useful if there is some amount of concomitant depressive symptomology or a history of
depression, raising the impression that the present insomnia may be a prodromal sign for a new
depressive episode, the cyclic antidepressant trazodone is routinely used for this purpose.

Psychological treatment
Cognitive behavioral therapy for insomnia is a structured program that helps you identify and
replace thoughts and behaviors that cause or worsen sleep problems with habits that promote
sound sleep. Unlike sleeping pills, CBT helps you overcome the underlying causes of your sleep
problems.
The behavioral part of CBT helps you develop good sleep habits and avoid behaviors that keep
you from sleeping well.
Depending on your needs, your sleep therapist may recommend some of these CBT-I techniques:
 Stimulus control therapy. This method helps remove factors that condition your mind to
resist sleep. For example, you might be coached to set a consistent bedtime and wake
time and avoid naps, use the bed only for sleep and sex, and leave the bedroom if you
can’t go to sleep within 20 minutes, only returning when you’re sleepy.
 Sleep restriction. Lying in bed when you’re awake can become a habit that leads to poor
sleep. This treatment reduces the time you spend in bed, causing partial sleep deprivation,
which makes you more tired the next night. Once your sleep has improved, your time in
bed is gradually increased.
 Sleep hygiene. This method of therapy involves changing basic lifestyle habits that
influence sleep, such as smoking or drinking too much caffeine late in the day, drinking
too much alcohol, or not getting regular exercise. It also includes tips that help you sleep
better, such as ways to wind down an hour or two before bedtime.
 Sleep environment improvement. This offers ways that you can create a comfortable
sleep environment, such as keeping your bedroom quiet, dark and cool, not having a TV
in the bedroom, and hiding the clock from view.
 Relaxation training. This method helps you calm your mind and body. Approaches
include meditation, imagery, muscle relaxation and others.
 Remaining passively awake. Also called paradoxical intention, this involves avoiding
any effort to fall asleep. Paradoxically, worrying that you can’t sleep can actually keep
you awake. Letting go of this worry can help you relax and make it easier to fall asleep.
 Biofeedback. This method allows you to observe biological signs such as heart rate and
muscle tension and shows you how to adjust them. Your sleep specialist may have you
take a biofeedback device home to record your daily patterns. This information can help
identify patterns that affect sleep.
Treatments for Sleep Apnea
Conservative (non medical)
These nonmedical treatments or approaches can typically improve obstructive sleep apnea or
resolve it. They aren’t cures, but they can reduce apnea to the point where it stops happening or
isn’t severe enough to cause symptoms. These include:

 Weight loss. A 10% decrease in body weight can significantly improve sleep apnea for
people who have excess weight or obesity.
 Position changes while sleeping and sleep aid items. Sleeping on your back makes
sleep apnea more likely to happen. Special support pillows and similar items can help
change the position in which you sleep, keeping you off your back so soft tissue doesn’t
press on your windpipe and block breathing.
 Nasal sprays, adhesive strips, etc. These over-the-counter products improve breathing
by making it easier for air to travel through your nose. While they can’t help moderate or
severe sleep apnea, they can sometimes help snoring and mild sleep apnea.
 Treating the underlying condition. Treating conditions such as heart failure can often
improve central sleep apnea.
 Medication changes. Working with your doctor to decrease or stop opioid pain
medications may be able to improve or even resolve central sleep apnea.
Breathing devices
A breathing device, such as a CPAP machine, is the most common treatment for sleep apnea. A
CPAP machine provides constant air pressure in your throat to keep the airway open when you
breathe in.
Depending on the type of sleep apnea you have, you may need another type of breathing device
such as an auto-adjusting positive airway pressure (APAP) machine or a bilevel positive airway
pressure (BPAP) machine.

Tips for sleeping well

Sleeping well is necessary for good health. But for many people, it’s hard to do. Try these simple
strategies to enjoy better quality sleep.
Get treatment for sleep disorders
If you suspect you have insomnia, sleep apnea, or another sleep disorder, talk with your doctor.
Many sleep disorders can be managed through lifestyle changes or other treatments.
For example, your doctor may advise you to:
 Change your sleep environment or habits.
  Practice meditation or other relaxation strategies.
 Take prescription medications.
 Undergo a sleep study, known as a polysomnogram, to further evaluate the cause of your
sleep disturbance.
Practice healthy sleep hygiene
Healthy sleep habits can help you fall asleep, stay asleep, or enjoy better quality sleep.
For example, a consistent sleep schedule is important. Try to go to bed and wake up at the same
times each day, even on weekends and holidays.
 Making your bedroom more sleep-appropriate and comfortable can also help. Take steps
to keep it dark, cool, comfortable, and quiet, such as the following:
 Consider limiting indoor sources of light, buying dark curtains, and using earplugs.
 Update your mattress, pillows, and bedding as needed.
 Limit use of screens (TV, phone, tablet, or computer) 30 to 60 minutes before sleep.
Developing a pre-sleep routine can also help prepare your body and mind for sleep. This routine
should include relaxing activities, such as:
 Taking a warm bath, Drinking herbal tea, Reading a calming book, Listening to calming
music, Writing in a journal, Practicing restorative yoga, Meditating etc
 Avoid loud noises, bright lights, glowing computer screens, and other stimulating things
before bedtime.
Since stress often causes sleep deprivation, efforts to reduce stress are also important. For
example, consider:
 Simplifying your lifestyle, Setting priorities, Taking regular breaks
 Prioritize self-care by eating a well-balanced diet, getting regular exercise, and making
time for activities you enjoy.
 Avoid caffeine, especially late in the day, Avoid alcohol, which can disrupt sleep stages.
 Don’t drink too many liquids at night to lessen your need for bathroom trips.
 Avoid daytime naps, or limit them to 30 minutes or fewer.
If these lifestyle changes don’t help you get the sleep you need, talk with a healthcare
professional.
You may have an underlying health condition that’s keeping you awake at night. A doctor can
recommend next steps and strategies to improve your sleep.