SLEEP-WAKE DISORDERS

SLEEP
• serves a restorative, homeostatic
function

• essential to the restoration and

recovery of vital bodily and
mental functions
SLEEP CYCLE

NON-REM SLEEP REM SLEEP

• composed of stages 1 to 4 • high level of brain activity

• most physiological functions • physiological activity levels

are markedly lower than in similar to those in wakefulness
wakefulness
• occurs about every 90 to 100
minutes during the nights
NON- STAGE • EEG: alpha and theta
waves
REM 1 • Easily awoken
SLEEP
STAGE • EEG: spindles
2

STAGE • enuresis, somnambulism

3

STAGE • Dreams are lucid and

purposeful
4 • enuresis, somnambulism
• Nightmares

REM SLEEP • EEG: sawtooth waves

• Dreams are abstract and
surreal
SLEEP REGULATION
• S E R OTO N I N

• Re d u c e s s l e e p l a t e n c y a n d n o c t u r n a l
a wa k e n i n g s

• NOREPINEPHRINE

• Increase wakefulness

• ACETYLCHOLINE

• S h i f t f r o m wa k e f u l n e s s t o R E M s l e e p

• M E L ATO N I N

• entrainment of the brain to a 24-hour

s l e e p - wa k e c y c l e

• D O PA M I N E

• A l e r t i n g e ff e c t – a r o u s a l a n d
wa k e f u l n e s s
 SLEEP
DISORDERS

This Photo by Unknown Author is licensed under CC BY-SA-NC

SLEEP DISORDER
CLASSIFICATION
• Insomnia Disorder

• Hypersomnolence Disorder

• Narcolepsy

• Breathing-Related Sleep
Disorders This Photo by Unknown Author is licensed under CC BY
 INSOMNIA DISORDER
• dissatisfaction with sleep quantity or
quality with 1 of the following:

• Diffi culty initiating sleep

• Diffi culty maintaining sleep

• Early-morning awakening with

inability to return to sleep

• causes clinically signifi cant distress or

impairment

• occurs at least 3 nights per week

• present for at least 3 months

This Photo by Unknown Author is licensed under CC BY-NC-ND

 INSOMNIA DISORDER

This Photo by Unknown Author is licensed under CC BY-NC-ND

INSOMNIA DISORDER
• Pharmacological treatment

• Sedative-hyptotic drugs

• Hypnotic drugs

• Sedating antidepressants

• OTC sleep aids

• Melatonin

• Sedating antihistamines

This Photo by Unknown Author is licensed under CC BY-SA-NC

INSOMNIA DISORDER
• Cognitive-Behavior Therapy

• Universal sleep hygiene

• Stimulus control therapy

• Sleep restriction therapy,

• Relaxation therapies
This Photo by Unknown Author is licensed under CC BY-SA

• Biof eedback

• Cognitive training

This Photo by Unknown Author is licensed under CC BY-SA

HYPERSOMNOLENCE
DISORDER
• Sleepiness can be a consequence of

(1) insuffi cient sleep

(2) basic neurologic dysfunction in

brain systems regulating sleep

(3) disrupted sleep

(4) the phase of an individual's

circadian rhythm
HYPERSOMNOLENCE DISORDER
• treated by extending and regularizing the sleep
period

• wake-promoting substance modafi nil (Provigil;

fi rst-line treatment)

• traditional psychostimulants such as

amphetamines and their derivatives

This Photo by Unknown Author is licensed under CC BY-SA

This Photo by Unknown Author is licensed under CC BY-NC-ND

NARCOLEPSY
• sleep attacks - episodes of irresistible sleepiness,
leading to perhaps 10 to 20 minutes of sleep, occurring
any time

• appearance of REM sleep within 10 minutes of sleep

onset

• hypocretin dysf unction and defi cit

NARCOLEPSY

• tetrad of symptoms: • N o c u r e e x i s t s f o r n a r c o l e p s y, b u t
s y m p t o m m a n a g e m en t i s po s s i bl e
(1) excessive daytime
• f o r c e d na p s a t a r e g u l a r ti m e
sleepiness,
o f d ay
(2) cataplexy,
• s t i mu l a n t s

(3) sleep paralysis, and • M o da fi ni l , a n a 1 - a dr e n e r g i c

r ec e p t o r a g o n i s t
(4) hypnagogic
hallucinations • t r i c yc l i c dr ug s o r SS R i s t o
r ed u c e c a t a p l e x y
BREATHING-RELATED DISORDERS
• OBSTRUCTIVE SLEEP APNEA HYPOPNEA

• weight loss, surgical intervention, positive airway pressure, and oral

appliances

• CENTRAL SLEEP APNEA

• SLEEP-RELATED HYPOVENTILATION
CIRCADIAN RHYTHM SLEEP DISORDERS

CHRONOTHERAPY

• D e l a y e d S l e e p P h a s e Ty p e • to r ese t th e biolog i c al c lock

• A d v a n c e d S l e e p P h a s e Ty p e
• prog r ess iv ely ph ase d el ay i ng a

• I r r e g u l a r S l e e p -Wa k e Ty p e per son un ti l t he c ir ca dia n

os ci ll at or i s sy n ch ron iz ed with
• N o n - 2 4 - H o u r S l e e p -Wa k e Ty p e ( F r e e
the de si re d s lee p-wa ke sc he dul e
Running)

• S h i f t Wo r k Ty p e

• J e t L a g Ty p e
PARASOMNIA
• disorders of partial arousal • NREM SLEEP AROUSAL DISORDERS

• a diverse collection of sleep • Sleep walking

disorders characterized by
• Sleep terrors
physiological or behavioral
phenomena that occur during or are • PARASOMNIAS ASSOCIATED WITH
potentiated by sleep REM SLEEP

• REM Sleep Behavior Disorder

• Recurrent Isolated Sleep

Paralysis

• Nightmare Disorder
SLEEP-RELATED MOVEMENT DISORDERS
• Re st le ss L eg Sy nd rom e

• Per iodi c L im b M ovem e nt Di sor der

• Sle ep- Rel at ed L eg C ram p s

• Sle ep- Rel at ed B ru xi sm

• Sle ep- Rel at ed Rhy t hm i c Move m ent D is orde r