SU 5353 / s9:5all Bydlore 935 gail sale / alae Sleep disorders Stages of Sleep * Non Rapid eye movement ( NREM): including stage 1-4 Sleep stage 1 - brief transition stage when first falling asleep Stages 2 through 4 (slow-wave sleep) successively deeper stages of sleep Characterized by an increasing percentage of slow, irregular, high- amplitude delta waves Stage 1: drowsness, EEG (Lal! gluld! «.2s) stage 2: EEG: Sleep Spindles and K-Complexes. Stage 3 and 4: - EEG: Delta wave ( Slow-wave sleep)Stages of Sleep Upon reaching stage 4 and after about 80 to 100 minutes of total sleep time, sleep lightens, returns through stages 3 and 2 REM sleep emerges, characterized by EEG patterns that resemble beta waves of alert wakefulness Rapid eye movement J Je 5 234 sLuiyl Sol! BSI alice) muscles most relaxed (Baa lull poy laid ol tga gp tall nia 3 Tapid eye movements occur ~" paresis J! dosal Sao Osten elas! Jao Ii) ous Erection Early morning Erection Increase HR, BR, Respirations poikilothermia Circadian rhythm gluiW a> slid! aclu! Circadian Rhythm light view J} 9 te eSowall responds to light, as a signal to be awake, and dark, as a sigr Any rhythmic change that continues at close to a 24- hour cycle in the absence of 24-hour cues. body temperature circadian J! 3 eSouall quod alle ylXo 8 lui! poy sic Wiad cortisol secretion Is eal! J¥S cortisone J! 31,4! us temperature J! la rhythm sleep and wakefulness 4) 4-Lu 25 I circadian rhythm J! Jsbis sleep and wakefulness In the absence of time cues, the cycle period will become somewhat longer than 24 hours nal to fall asSleep Deprivation Has little effect on performance of tasks requiring physical skill or intellectual judgment Hurts performance on simple, boring tasks more than challenging ones Bly So ca Le Chall pate Ths see pods Sia) shud! Alun Jie gloria JS 65! Jacl Sleep Disorders Primary sleep disorders Dyssomnias sii aiss Ue) -Primary insomnia -Primary hypersomnia -Narcolepsy -Breathing-related sleep disorder -Circadian rhythm sleep disorder -Dyssomnia not otherwise specified Parasomnias [sil atl joss Sissi Nightmare disorder ‘Sleep terror disorder, “Sleepwalking disorder ‘Parasomnia not otherwise specified.INSOMNIA ‘the most common Difficulty initiating sleep sao -Frequent awakenings ( including early morning awakening) .Subjective feeling of insufficient sleep 7 -Preoccupation with sleep complaints. mained Duration at least one month l oF JY ipa yo pid plyel oi) Treatment (not more than 2 weeks), to avoid dependence. ey eT PUL ie Maps Salt guts mig Call ut pl Arise at the same time daily. ope al lb sls Col Jobst tat a Limit daily in-bed time to the usual amount present before the sleep disturbancé. Discontinue central nervous system (CNS)-acting drugs (caffeine, nicotine, alcohol, stimulants). -Avoid daytime naps (except when sleep chart shows they induce better night sleep). Establish physical fitness by means of a graded program of vigorous exercise early in the day. | aes} Sens a5 os.all gab Huull sls! S20) ‘Avoid evening stimulation; substitute radio or relaxed reading for television. Try very hot, 20-minute, body-temperature-raising bath soaks near bedtim: .Eat at regular times daily; avoid large meals near bedtime, it J! le wo5 JS 5 pall -Practice evening relaxation routines, such as progressive muscle relaxation or meditation. Maintain comfortable sleeping conditions a0 pS Gaby 12 MeL gi aka Le Se JLUY all a Hail! SU BUT Teas pS insomnia passe gil yall ‘seal! Ja dy Lig den 12 gle halflife J! Sead Lill ld gm39 Baby las std + pol gay ill muscle spasm Jas) lil 3 sl yo cask es d exercise Jani adi ts muscle relaxation Joow dos8 Js) ad vial! gl Thal! ciby 55S goslall 1aPrimary Hypersomnia The predominant complaint is excessive sleepiness for at least 1 month (or less if recurrent) as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily. A tts 2 5 Baga TEally ppl JN aan gl Treatment is through stimulant drugs «7 URsts ge Syke gag eile il dele sasyll Ubel ode Narcolepsy Pees Irresistible attacks of refreshing sleep that occur daily over at least 3 months. | Cataplexy J! J« Rapid eye movement sleep J! Laas issne 395) The presence of one or both of the following: cataplexy (ie,, brief episodes of sudden bilateral loss of muscle tone 18s pie ply Byleall By ob Joa gate seat mad 9) 055 dd SLY Jo eal apt adele aBreathing-Related Sleep Disorder eS at He Se Be IS a Sse sa a I GS Jeb ae ul tT Sleep disruption, leading to excessive sleepiness or insomnia, that is judged to be due to a sleep-related breathing condition (e.g., obstructive or central sleep apnea syndrome or central alveolar hypoventilation syndrome). olie os nail oe ghtid adenoid ease 9a pal I och dll aa Sp log (35 at gate cleat! Ga interrupted Circadian Rhythm Sleep Disorder A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep-wake schedule required by a person's environment and his or her circadian sleep-wake pattern. circadian JI wade sity Lasts cosdlaall Joos Jet lag type —? (635 Malaual tabaio yo ayia sic rhytht Shift work me een alls 25% Lialls cla! Igmays gist gill gadBegall Joos sla! JSll Igaly gy8ds lab guar bo mismatch between a person's intrinsic circadian rhythm and external sleep_wake demands.Nightmare Disorder Repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. On awakening from the frightening dreams, the person rapidly becomes oriented and alert. Usually occur during rapid eye movement sleep easel pad 25 ley cauill ga Jol GleLull 5 eos Lig Esdgall She UI poall dla a5 Esshe sites gan cy Sleep Terror Disorder -Recurrent episodes of abrupt awakening from sleep. Intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode. Relative unresponsiveness to efforts of others to comfort the person during the episode. .No detailed dream is recalled and there is amnesia for the episode. ‘usually occur during non rapid eye movement sleei inst 5 ey ightmare dt waz le) al Jo cl (235i lb Gl pga las sg aggressive Lin! Saag Hil 9 963 oucySleepwalking Disorder .Repeated episodes of rising from bed during sleep and walking about. While sleepwalking, the person has a blank, staring face, is relatively unresponsive to the efforts of others to communicate with him or her, and can be awakened only with great difficulty. The person has amnesia for the episode. usually occur during non rapid eye movement sleep asl ye $8 sz0 9S) (See ll ga Jo¥l lal 8 tg Byluull Sguus agdy (Sao Wiad yodutl Uglary sonia Gl pgedle WHE Lig gaslly padull go Ad Sao Hall IiSag pail ell agile GS (Sang yal yiSe ob poyall Is Sleep disorder due to general medical condition —> eg - pain ( Whatever the cause) - Hyperthyroidism or early pancreatic -Substance induced sleep disorder | ‘tumor (insomnia without pain) -Sleep disorder NOS21-year-old man comes to the physician because he has been falling asleep in inappropriate places, even though he has been getting enough rest at night. The patient states that he has fallen asleep while eating and driving. He notes that he stays asleep approximately 20 minutes and when he first wakes up, he is unable to move. He notes that sometimes he can even fall asleep while standing, and has been told by others that during those times he simply drops to the floor suddenly. He is fitted with a portable monitor, and it is found that during these episodes he enters an REM sleep stage immediately. Which of the following is the most likely diagnosis? a. Narcolepsy b. Sleep apnea c. Primary hypersomnia d. Kleine-Levin syndrome e. REM sleep behavior disorder 13, Which of the following findings is associated with NON-REM sleep? a. Penile tumescence b. Apnea c. Nightmares d. Dreaming e. Night terrors*