Sleep disorders &

Treatments
By Ms. Sana Shamim
 Sleep
• A naturally recurring state
• Reduced or absent consciousness
• Relatively suspended sensory activity, and inactivity of
nearly all voluntary muscles
• Many processes vital to health & well-being take
Sleep/Wake Regulation

Circadian rhythms
• Cyclical changes that occur over 24 hour driven
by an internal “biological clock” in the brain
• Synchronized to external physical environment
 Sleep/Wake Regulation
Sleep homeostasis or internal drive

• Exact mechanism unknown

• Pressure to sleep increases until an internal threshold is

crossed causing sleep to occur

• Waking occurs when homeostatic drive decreases

sufficiently to cross opposite threshold
 Sleep Disorders
Insomnia Night Terror
Hypersomnia Somnambulism
Narcolepsy and Cataplexy 
Nocturnal Enuresis
Sleep Apnea Disorder
Movement Disorders
Nightmare
during sleep
 Insomnia
• Trouble falling asleep or staying asleep

• Stress, anxiety, hormonal changes, lifestyle, environmental factors,

physical ailments, or psychiatric illness

• Phases: Transient (less than 4 weeks), short term (1-6 months) or

chronic (> 6 months)

Sleep medication Helps fall asleep Helps stay asleep Can lead to dependence
Doxepin ✔

Estazolam ✔ ✔ ✔
Eszopiclone ✔ ✔ ✔

Ramelteon ✔

Temazepam ✔ ✔ ✔

Triazolam ✔ ✔

Zaleplon ✔ ✔

Zolpidem ✔ ✔

Zolpidem extended ✔ ✔ ✔
release
 Side effects (sleeping Pills)
• Dizziness or light headedness

• Headache

• Gastrointestinal problems, such as diarrhoea and nausea

• Prolonged drowsiness, more so with drugs that help you stay asleep

• Severe allergic reaction

• Sleep behaviours, such as sleep-driving and sleep-eating

• Daytime memory and performance problems

Hypersomnia
• Large group of disorders characterized by excessive
daytime sleepiness
• Can be primary (of central/brain origin), or secondary
to another medical condition
• Appropriate treatment will depend on the specific cause
Treatment
• Modafinil, may exert stimulant effects by decreasing GABA-mediated

neurotransmission, improves wakefulness in patients with excessive

daytime hyper somnolence.

• Methylphenidate (Ritalin) used for symptomatic management of primary

hyper somnolence , blocks the reuptake mechanism of dopaminergic

neurons, also stimulates the cerebral cortex and subcortical structures.

 Treatment
• Dextroamphetamine, increases the amount of circulating dopamine and norepinephrine

in the cerebral cortex by blocking the reuptake of norepinephrine or dopamine from the

synapse.

• Produces CNS and respiratory stimulation.

• CNS effect may occur in the cerebral cortex and reticular activating system.

• May have a direct effect on alpha- and beta-receptor sites in the peripheral system and

may also release stores of norepinephrine in adrenergic nerve terminals.

 Narcolepsy
• Chronic neurological disorder caused by the
brain’s inability to regulate sleep-wake cycles
normally, cause unknown.

• Characterized by frequent urges to sleep

occurring anytime.
 Cataplexy
• Sudden and transient episode of loss of muscle
tone accompanied by full conscious awareness
• Often triggered by emotions such as laughing,
crying, terror, etc
 Cataplexy
• Affects roughly 70% of people with narcolepsy

• Exact cause unknown, but strongly linked to

experiencing intense emotions and reduced levels
of the neurochemical hypocretin
 Treatment
• Stimulants.

• Selective serotonin reuptake inhibitors (SSRIs) or serotonin and

norepinephrine reuptake inhibitors (SNRIs).

• Fluoxetine and venlafaxine

• Suppress REM sleep, to help alleviate the symptoms of cataplexy,

hallucinations and sleep paralysis.

• Side effects weight gain, sexual dysfunction and digestive problems.

 Treatment
• Tricyclic antidepressants. protriptyline, imipramine and clomipramine, are effective for

cataplexy, but many people complain of side effects, such as dry mouth and light

headedness.

• Sodium oxybate. highly effective for Narcolepsy/cataplexy, helps to improve night time

sleep, may also help control daytime sleepiness.

• Side effects, such as nausea, bed-wetting and worsening of sleepwalking.

• Taking sodium oxybate together with other sleeping medications, narcotic pain relievers or

alcohol can lead to difficulty breathing, coma and death.

Obstructive Sleep Apnea (OSA)

•During sleep, breathing pauses or stops

for 10-20 seconds or more

•Oxygen levels in blood drop, normal

breathing starts again with a loud snort.
Obstructive Sleep Apnea (OSA)

•Results in excessive daytime sleepiness

•Often associated with overweight / obesity

•Can be treated with continuous positive

airway pressure (CPAP)
Somnambulism
• Arise from the slow wave sleep stage in a state of low
consciousness and perform activities that are usually
performed during a state of full consciousness

• Can be as benign as sitting up in bed, walking to the bathroom,

cleaning, or as hazardous as cooking, driving, violent
gestures, grabbing at hallucinated objects, or even homicide.
 Treatment
• Treating the underlying condition, sleep deprivation, chaotic sleep schedules, fever, stress,
magnesium deficiency, alcohol intoxication or a mental health disorder

• A change of medication, if it's thought that the sleepwalking results from a drug
( sedative/hypnotics, neuroleptics, minor tranquilizers, stimulants, and antihistamines)

• Anticipatory awakenings ― waking the sleepwalker about 15 minutes before the person usually
sleepwalks, then staying awake for five minutes before falling asleep again

• Medication, such as benzodiazepines or certain antidepressants, if the sleepwalking leads to the

potential for injury, is disruptive to family members, or results in embarrassment or sleep
disruption for the person who sleepwalks

• Learning self-hypnosis
 Nightmare
• A disturbing dream associated with negative feelings, such as anxiety or fear

• Occasional nightmares usually nothing to worry about

• May become a problem if often and disrupt sleep or cause fear going to sleep

• Begin in children between 3 and 6 years old and tend to decrease after about
age 10
• Some have them as teens or adults or throughout their lives
 Treatment

• Medical condition treatment

• Stress or anxiety treatment

• Medication. rarely used

• Imagery rehearsal therapy.

 Sleep/Night terrors
• Screaming, intense fear and flailing while still asleep

• More common in children, can also affect adults

• Usually lasts from seconds to a few minutes, but may last longer.

• Not usually a cause for concern, most children outgrow sleep terrors by
their teenage years

• May require treatment if they cause problems getting enough sleep or

they pose a safety risk.
 Treatment
• Treating an underlying condition. such as obstructive sleep apnea

• Improving sleep habits. Too little sleep may help reduce the incidence

• Addressing stress. Cognitive behavioural therapy, hypnosis,

biofeedback and relaxation therapy may help.

• Medication. Rarely used, particularly for children. If necessary, use of

benzodiazepines may be effective.
 Nocturnal enuresis
• Involuntary urination while asleep after the age at which bladder
control usually occurs

• Considered primary (PNE) when a child has not yet had a

prolonged period of being dry

• Secondary nocturnal enuresis (SNE) is when a child or adult begins

wetting again after having stayed dry.
 Treatment
• Tricyclic antidepressants

• Anticholinergics (e.g., oxybutynin) decrease frequency, and urgency and improve bladder

capacity. may be used in children with primary nocturnal enuresis and daytime wetting

• Desmopressin, most effective in children eight years and older who have enuresis with

nocturnal polyuria, normal bladder capacity, and less frequent bed-wetting

• Adding oxybutynin to desmopressin increases response rate in children with daytime wetting

• Combining desmopressin therapy with an enuresis alarm improves the response rate and

reduces relapse
General protocol for Sleep Problems
• Behavior modification programs, hypnosis, or
meditation may be effective

• Self-prescribed OTC sleep aids

• Prescription medications
OTC Sleeping Aids
• Not intended for long term use

• May interfere with alertness during the day

• Reduce the quality of sleep by decreasing the amount

of time spent in deep sleep
 Prescription Medications
• Must be used at the direction of a physician

• Often do not cure the cause of sleeping problems, just help alleviate
the symptoms

• Can be addictive / become drug dependent

• May cause physical side effects

• May interact with other medications or alcohol

Drugs for sleep related movement disorders

• Anti-Parkinsonian drugs (dopamine

agonists), may be used to treat restless legs
syndrome & periodic limb movement disorder

• Benzodiazepines, may be used to treat bruxism

(teeth grinding) and short-term insomnia
• Opiates, may be used to treat restless legs syndrome that
won't respond to treatment or is present in pregnancy.

• Anticonvulsants, may be used to treat nocturnal eating

syndrome, restless legs syndrome, periodic limb
movement disorder and insomnia related to bipolar
disorder.
THANK YOU