SAWA Summarizing Group by mikesanye

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									Sleep Disorders
                    Sleep
-Sleep is unconsciousness from which the
person can be aroused by sensory or other
stimuli

-Coma is unconsciousness from which the person
cannot be aroused
                      Sleep
1. Slow-wave sleep (non REM sleep)



2. Rapid eye movement sleep (REM sleep)
     Slow-wave deep (non-REM)
-Most sleep during night (75%).
-Exceedingly restful.
-Dec. peripheral vascular tone.
-10-30% dec. in blood pressure, resp. rate and
basal metabolic rate.
-dreams are usually not remembered.
     Rapid Eye Movement (REM)
-Occurs in normal night sleeps.
-Last for 5-30 min. and occur every 90 min.
-Rapid movement of the eyes.
-Usually ass. With active dreaming and active
bodily muscle movement.
-The heart rate and resp. rate become irregular
(dream).
-The brain is highly active.
               Theories of sleep
passive theory of sleep: excitatory areas of (RAS) in
the upper brain stem fatigued and became inactive.

active inhibitory process:
Stimulation of center located below the midpontile
level of the brain stem inhibiting excitatory areas of
(RAS) in the upper brain stem leading to sleep.
              Sleep Disorders
-1/3 of U.S. people suffer from sleep disorders.
-It is classified into:
1. Primary (Dyssomnias and Parasomnias)
2. Secondary
     Causes of 2ry sleep disorders
-Medical conditions (pain, met dis, endo dis)
-Physical conditions (obesity)
-Sedative withdrawal
-Use of stimulants
-Major depression
-Mania or anxiety
-Neurotransmitter abnormalities ( dopamine or
norepinephrine, ACH, serotonin).
      Dyssomnias (1ry sleep dis.)
It is disturbance in the amount, quality or timing
of sleep. It is subdivided into:

1.Primary Insomnia
2.Primary hypersomnia
3.Narcolepsy
4.Breathing-Related Disorder
5.Circadian Rhythm Sleep Disorder
           1. Primary Insomnia

-Difficulty in initiating or maintaining sleep .
-Occurs 3x or more per week for at least 1 month.
-Affects 30% of the population.
-Often exacerbated by anxiety and preoccupation
with getting enough sleep.
        Primary Insomnia (cont.)
Treatment:
1. Sleep hygiene measures (1st line)
2. Pharmacotherapy (for short term use):
-Benadryl
-Ambien (zolpidem)
-Sonata (zaleplon)
-Desyrel (trazodone)
         2. Primary Hypersomnia
-At least 1 month of excessive daytime sleepiness not
due to any medical or other condition.
-Treatment:
1. Stimulant drugs as amphetamine (1st line)
2. SSRI may be useful in some patients.
                3. Narcolepsy
-Repeated, sudden attacks of sleep during the day
for at least 3 months, ass. With:
1. Cataplexy (collapse due to sudden loss of
muscle tone).
2. Short REM latency.
3. Sleep paralysis ( brief paralysis upon awakening).
4. Hypnagogic, hypnopompic hallucinations.
             Narcolepsy (cont.)
-Occur in 0.02-0.16% of population.
-Equal incidence in males and females.
-Onset most commonly in childhood and
adolescence.
-May have genetic component.
-Patients usually have poor nighttime sleep.
            Narcolepsy (cont.)
-Treatment:
1. Timed daily naps.
2. Stimulant drugs (amphetamines and
methylphenidate).
3. SSRI or oxalate for patients with cataplexy.
        4. Breathing-Related dis.
-Sleep disruption and excessive daytime sleepiness
caused by abnormal sleep ventilation from
either:
1. Obstructive Sleep Apnea [OSA] which is
correlated to snoring or
2. Central Sleep Apnea [SPA] which is correlated
to heart failure.
OSA risk factors:
-Male gender.
-Obesity
-male shirt collar size >17
-Previous upper airway surgeries.
-Deviated nasal septum.
- retrognathia
Large uvula
     Breathing-Related dis. (cont.)
-Treatment:
1. OSA:
Nasal continuous positive airway pressure
(nCPAP), weight loss, nasal surgery or
uvulopalatoplasty.
2. CSA:
Mechanical ventillation with a backup rate.
               Parasomnias
-Abnormal events in behavior or physiology
during sleep. It is subdivided into:

1. Nightmare disorder.
2. Night Terror disorder.
3. Sleep Walking disorder (somnambulism).
            1. Nightmare dis.
-Repeated awakenings with recall of extremely
frightening dreams.
-Occurs during REM sleep.
-Onset most often starts at childhood.
-Occur more frequently during time of stress.
-NO SPECIFIC TREATMENT but tricyclics
could be used.
        2. Night Terror disorder
-Repeated episodes of fearfulness during sleep.
-Episodes usually occur during the slow-wave
deep stage of sleep.
-Patients usually don’t remember the episodes.
-It usually begins with a scream and ass. With
intense anxiety.
        Night Terror dis. (cont.)
-Usually occur in children.
-More common in boys.
-Tend to run in families.
-High ass. With comorbid sleepwalking dis.
-No specific treatment but giving diazepam before
bedtime might be effective.
  3. Sleepwalking dis. (Somnambulism)
-Repeated episodes of getting out of bed and
walking.
-Ass. With blank stare and difficulty in being
awakened.
-Onset bet. Age 4-8 yrs.
- More common in boy tends to run in family
-The best treatment is to prevent injury in
surrounding environment.
Thank you

								
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