SleepDisordersGrossePointeMen sClub7 2007

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SleepDisordersGrossePointeMen sClub7 2007 Powered By Docstoc
					   Making Your Sleep
Healthy and Happy: Sleep
   Dr. Barbara C. Fisher
 United Psychological Services
      Certified Behavioral Sleep Medicine
             47818 Van Dyke Rd.
            Shelby Twp., MI 48317
       Seminar Objectives
1. Defining sleep
2. Sleep parameters: Process S and C,
   sleep stages
3. Aging changes
4. Common sleep disorders: Circadian
   Rhythm, Sleep Apnea, RLS, PTSD
5. Good sleep hygiene
6. Behavioral therapies
            Sleep Disorders

• Two factors influence how sleepy or alert
  anyone is during a 24 hour period of time.
• 1. Sleep-Wake Balance Process S: How long
  it has been since you last slept- the longer
  you stay awake the sleepier you become
• 2. Circadian Rhythm Process C: Your body’s
  biological clock; the natural timing system
  which tells you when to sleep and when to be
        Circadian Rhythm

• Master clock
• Modulates daily cycles of:
  – Core body temperature
  – Blood pressure
  – Hormone secretion
  – Immune response
  – Sleep wake cycle
         Normal Adult Sleep
• Average amount of sleep per night: range
  of 6.5 to 8.3 hours
• Normal sleep latency: 10 minutes
• Normal sleep structure
   – 5% stage 1
   – 50% stage 2
   – 15-25% stages 3 and 4 (slow wave sleep)
   – 25% REM
• Napping occurs at the beginning and the
  end of life (in our culture)
     Poor sleep at night leads to:

•   Mood and emotional changes
•   Aggressiveness, poor impulse control
•   Augments depression
•   Cognitive deficits: attention, memory,
    confusion, not thinking clearly, easier
    to make mistakes
   Sleep Changes with Age
• Increased awakenings and arousals
• Decreased REM sleep
• (Probably) decreased SWS
• Increased stage shifts
• Fewer “cycles”
• Reduced sleep efficiency
• Phase advancement
Circadian Rhythm Sleep Disorders

•   Delayed Sleep Phase type
•   Advanced Sleep Phase type
•   Irregular sleep-wake type
•   Free Running Type
•   Jet Lag type
•   Shift Work type
•   Due to medical condition or substance
Sleep Related Breathing Disorders
• Central Sleep Apnea (Cheyne Stokes, High
  altitude, Medical condition, Substance abuse,
• OSA (arrthymia 58%)
• Sleep related Hypoventilation/Hypoxemic
• Sleep related Hypoventilation/Hypoxemic due
  to medical condition
• Sleep Related Breathing Disorder/ Upper
  Airway Resistance Syndrome (UARS)
              Sleep Apnea
• Decreased REM sleep, sleep not refreshing
• Chronic, loud snoring, gasping or choking
• Excessive daytime sleepiness (drowsy when
   Automobile or work related accidents due to
• Personality changes or cognitive difficulties:
   Neuropsychological evaluation reveals
     memory deficits and frontal deficits
Causes of Sleep Apnea

 Age (tonicity decreases)
 Smaller than normal jaw
 Enlarged tonsils
 Lateral pharyngeal walls close in
 Large tongue
 Tongue moves posterior which displaces
  the soft palate
 Tissues that partially block the entrance to
  the airway
•   Adjustment Insomnia
•   Psychophysiological Insomnia
•   Paradoxical Insomnia
•   Idiopathic Insomnia
•   Inadequate Sleep Hygiene
•   Behavioral Insomnia of Childhood
•   Insomnia due to substance abuse
•   Insomnia due to a medical condition
Factors Affecting the Development
           of Insomnia
                                    Substance Abuse
                                    Performance Anxiety
                                    Poor sleep hygiene


   Predisposing                              factors

   Personality                      Situational
   Sleep-Wake cycle                 Environmental
   Circadian Rhythm                 Medical
   Coping Mechanisms                Psychiatric
                                    Prescription Medication
Periodic Limb Movement Disorder
• Stereotypic, repetitive movements of the
  legs (or arms)
• During sleep / inactivity
• Every 20-40 seconds
• May be associated with arousals from
• Occur in minimum clusters of 4
    Patient Complaints with RLS
• Sleep disturbances

• Difficulty falling asleep and staying asleep

• Need to walk around (“nightwalkers”)

• Daytime sleepiness
         Associated Conditions

•   Neuropathies, myelopathies, and radiculopathies
•   Pregnancy
•   Anemia (iron deficiency)
•   Chronic renal failure
•   Folate / B12 deficiency
•   Medications (tricyclics, SSRI’s, caffeine)
•   Obesity
•   Hypothyroidism
            RLS and ADHD
• RLS were greater in patients who had
  ADHD versus those who did not-
• Recommendation if patient diagnosed
  with ADHD need to screen for RLS
• Recommendation if patient diagnosed
  with RLS need to screen for ADHD
• Consider medication such as dopamine
       PTSD Sleep Problems
• Universal complaints, fragmented sleep
• Inability to sleep, difficulty initiating &
• Anxiety arousals are common in PTSD
• REM and non-REM nightmares
• Repetitive nightmares are common
• Nightmares often represent a "re-living" of
  the original trauma and associated emotions
    Good Sleep Habits
•    Regular routine to unwind
     at night
•    Avoid all products containing caffeine
     (soda and chocolate)
•    Avoid smoking and smokeless tobacco
•    Avoid use of alcohols
•    No stimulating activities in the evening
•    Promote calm family atmosphere prior to
    Good Sleep Habits
•   Avoid falling asleep while
    watching television or video
•   Establish regular exercise routine and
    healthy diet
•   Avoid late afternoon and evening bright
•   Avoid changing pattern on weekends
•   Avoid napping-short power nap only
    American Academy of Sleep Medicine, 2002
   Identify the Sleep Factors
• Sleep History and Sleep Schedule
• Sleep logs/diary: morning and bedtime
• Actigraphy
• Bedtime routine, bedroom environment
• Sleep related cognitions
• Daytime sleepiness, memory
      Behavioral Treatment
• Sleep hygiene
• Daytime, evening, morning habits
• Exercise-evening walk for the aged
• Limit napping
• Nocturnal activities hour
• Bedroom environment
• Cognitive behavioral therapy (CPT): 6
  sessions for Insomnia
  Problematic Sleep Habits
Night time habits:
• Irregular sleep wake schedule
• Too much time in bed: TIB
• Falling asleep to the radio/TVs
• Trying too hard to sleep
• Clock watching
• Long awakenings
 Problematic Sleep Habits
Morning Habits
• Lingering in bed awake in morning
• Extra sleep on weekends
• Bedroom disturbance
  (noise, sun light)
    Address the Sleep Problem:
            Don’t Wait
• Daytime sleepiness is a big deal!
• Don’t try to do everything at night-
  schedule your day for maximum
• Set specific times in office or
  home for paperwork vs. phone
  calls on daily basis-avoid
   build-up and worry
Don’t Worry-Be Happy
• Too anxious: Exercise twenty minutes on
  a daily basis-often running or biking are
• Feeling overwhelmed: Watch the stress
  & feeling overwhelmed- too many things
  are going on at one time
    Don’t Worry-Be Happy
• Too much to do and no time to do it:
  Manage time by specifically estimating each
  task- add up time for exact time estimates-
  to decrease over-planning
• Distractibility increased:
  – Stress & lack of food tend to
    increase distractibility-
    increased lack of focus
  Don’t Worry-Be Happy
• Staying up late to complete all your goals:
  Issue of diminishing returns: Time spent vs.
  being tired-examine from larger perspective-
  what really has to be done in the grand
  scheme of things.
• Is that last task more important than health?
 Don’t Worry-Be Happy
• Easily frustrated- short fuse:
 Result of too much stress, lack of food, feeling
  totally overwhelmed. These are wake up calls
     for life changes & “nice moments of time”
• More tired= Energy loss, channel clickers
• Wake up call for life changes: Check sleep,
  eating habits. These are often the result of
  continually compensating for something else
  such as a sleep disorder or ADD/ADHD.
Sleep is a necessary
   function of life
 Make it Healthy: Increase
     your happiness
  Good Night and Good Luck

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