PSY 4327 Lecture Notes - Lecture 1: Circadian Rhythm Sleep Disorder, Idiopathic Hypersomnia, Sleep Disorder
15 May 2018
School
Department
Course
Professor
Sleep disorders
4 Categories:
1. Dyssomnias: difficulty initiating or maintaining sleep or excessive sleep
o Intrinsic sleep disorders
o Extrinsic sleep disorders
o Circadian rhythm disorders
2. Parasomnias:
o Arousal disorders
o Sleep-wake transition disorders
o REM-Related disorders
o Other parasomnias
3. Medical/Psychiatric:
o Medical reasons
o Neurological reasons
o Psychiatric reasons
4. Proposed
Dyssomnias:
A. Intrinsic sleep disorders
1. Psychophysiological insomnia: psycho somatic reaction to physical stress,
headaches, muscle tension, learned to associate going to bed with stressful emotions
that prevent sleep
2. Sleep state mis-perception: honest complaint of insomnia or excessive sleepiness,
where there is no evidence that sleep is anything other than normal, usually older
people, reason is because quality of sleep and how much sleep we need changes as
we age and we expect it to stay the same
3. Idiopathic insomnia: we think there might be something wrong in the neurology of
the brain, lifelong pattern, doesn’t change at different ages, inability to get adequate
sleep, always feel sleep deprived, wiring in the brain, something wrong with
sleep/wake control mechanisms in the brain
4. Narcolepsy: characterised by excessive sleepiness during the day, very abnormal
REM activity, dream all over the place, often but don’t always suffer from cataplexy
where muscles relax and will not respond, cause unknown, could be defective gene,
one of the most serious, cannot function properly in life, narcolepsy can take two
forms, person falls asleep all of a sudden and have muscle ataxia or they fall asleep
without muscle ataxia, where you keep doing the activity you were doing
a. Cataplexy: conscious hears and understands but muscles don’t work
b. Narcolepsy: unconscious sometimes muscles work and sometimes they
don't
5. Recurrent hypersomnia: recurrent episodes a year of extreme sleepiness, need
tonnes of sleep in the episodes and they can last days to weeks and can happen up to
every month, some sleep 18-20 hours a day, mostly effects teenage boys, very
disruptive, when they wake up they binge eat and are often hypersexual, sleep
cycles are longer than 90 minutes, REM is all over the place and shallow
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6. Idiopathic hypersomnia: patient complains of excessive sleepiness, prolonged
sleep at night, may episodes of non REM sleep that last up to 2 hours, not 90 minute
slots, less severe form of recurrent hypersomnia, may be 14-16 hours of sleep a day,
no binge eating or hyper sexuality
7. Posttraumatic hypersomnia: excessive sleepiness that results due to injury,
disease or trauma, goes away after a few weeks or months as the person recovers
from the trauma
8. Obstructive sleep apnea syndrome: common, breathing obstruction, airway is
interfered with, not enough oxygen to brain, cardiovascular problems go along with
it, higher chance of developing type II diabetes, treated with a CPAP machine (blows
air in), serious oxygen deprivation, weight loss may alleviate symptoms, symptoms:
snoring, morning headaches, chronic daytime sleepiness, complications: HBP, heart
disease, stroke, diabetes, some people only experience this when they have
consumed alcohol as it relaxes the muscles, smokers more likely, likelihood
increases with age
9. Central sleep apnea syndrome: very rare, neurological control of breathing
abnormality, use a machine that blows air in and out, not CPAP, not due to
obstruction but to muscle innervation issue
10. Central alveolar hypoventilation syndrome: everybody takes in less air when
they sleep but people with this disorder take in even less air because they cant do
the gas exchange, particular to people with lung problems, problem with older age
11. Periodic limb movement disorder: occurs when sleeper occasionally moves a
limb (usually leg) and is moved in exactly the same way repeatedly over the course
of the night, typical movement is kick or flex of the leg every 10 seconds, wakes up
the person and their partner causing insomnia and daytime sleepiness, treatable
with drugs
12. Restless leg syndrome: very common, characterized by uncomfortable feelings,
aching, itching, in legs right before you go to sleep, moving makes the feeling go
away but then it comes back, can cause severe insomnia, mild case is very common,
usually grow out of it, can be help by quitting smoking, hot baths or drugs, incurable,
causes imbalance of dopamine, hereditary, no known cause, primary (no cause) and
secondary (due iron deficiency, pregnancy, certain medications, alcohol or caffeine)
13. Intrinsic sleep disorder NOS (Not otherwise specified): catch all
B. Extrinsic sleep disorders: originate outside the body and can be caused by
environmental or behavioural factors
14. Inadequate sleep hygiene: caffeine, drugs or physical activity before bedtime
15. Environmental sleep disorder: common among students, heat, cold, noise or light
in the bedroom, moderated by the sleepers on sensitivity to noise, increases
towards the morning
16. Altitude insomnia: at high altitude and not use to the low air pressure, causing
lower oxygen levels, fatigue, headache, loss of appetite and insomnia
17. Adjustment sleep disorder: transient, insomnia caused by temporary stressful
events
18. Insufficient sleep syndrome: somebody who persistently and on purpose fails to
get enough sleep
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19. Limit-setting sleep disorder: usually found in children, stalls or refuses to go to
bed, stubbornness, absolute bedtime is set and met than most kids will follow it, but
when they are not enforced they will rebel and won’t get enough sleep
20. Sleep-onset association disorder: childhood, child cannot go to sleep unless
certain conditions are met (Ex. Blanket)
21. Food allergy (sensitivity) insomnia: lacking enzymes to digest, leads to
discomfort that interferes with sleep
22. Nocturnal eating (drinking) syndrome: when you wake up and cannot go back to
sleep unless you eat or drink, usually a disorder of childhood but can happen in
adults too, conditioning behaviour, once learned leads to repeated pattern, effects
men and women equally, 5 emotional triggers: worried, sadness, anger, loneliness
and being upset, can lead to diabetes
23. Hypnotic-dependent sleep disorder: caused by a tolerance to or withdrawal from
a drug that’s used to induce sleep, usually benzodiazepine, may have built up a
tolerance or a rebound effect
24. Stimulant-dependent sleep disorder: trouble getting to sleep due to a withdrawal
or tolerance to a stimulant drug or medication, like caffeine
25. Alcohol-dependent sleep disorder: depend on alcohol to get to sleep at night,
leads to a tolerance, alcohol wears off and they wake up, to qualify for the disorder a
person has to have done this for at least 30 days
26. Toxin induced sleep disorder: either insomnia or excessive sleep due to
poisoning, heavy metals, organic toxins, mold, etc.
27. Extrinsic sleep disorder NOS
C. Circadian rhythm disorders: they share a common theme of disrupting the way sleep
occurs over a 24-hour period.
28. Time zone change (jet-lag) syndrome: result of rapidly changing time zones,
result of an airplane flight usually, but you can create jetlag in yourself without
going anywhere by altering when you go to bed and wake up. Sleepiness, upset
stomach, other physical problems. Takes about a day and a half from each time zone
change to the east (Europe) but only a day from the west (Vancouver)
29. Shift-work sleep disorder: work schedules change, incomputable with your on
work sleep wake schedule. If you work the exact same shift every time, you can
adapt to this and not a problem anymore. The problem is when your shift rotate all
the time, especially backwards, and you are constantly trying to adapt to. Problems
that can occur: type 2 diabetes, digestion issues etc. easier to adapt to if you're
young.
30. Irregular sleep-wake pattern: when people do not have a set time for sleeping and
waking up. Ex: people who are restricted to staying in bed all day, hospital patients
etc.
31. Delayed sleep-phase syndrome: your sleep is delayed until long after you want to
go to sleep. Ex: you want to go to bed at 10 but cannot fall asleep before midnight.
Cannot fall asleep before your brain wants to fall asleep. Trouble waking up when
they want to. The body's clock is shifted later in the day.
32. Advanced sleep-phase syndrome: the person who has irresistible sleepiness
comes before the desired time of going to bed, nothing they do can keep them
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Document Summary
4 categories: dyssomnias: difficulty initiating or maintaining sleep or excessive sleep. Intrinsic sleep disorders: extrinsic sleep disorders, circadian rhythm disorders, parasomnias, arousal disorders, sleep-wake transition disorders, rem-related disorders, other parasomnias, medical/psychiatric, medical reasons, neurological reasons, psychiatric reasons, proposed. Takes about a day and a half from each time zone change to the east (europe) but only a day from the west (vancouver: shift-work sleep disorder: work schedules change, incomputable with your on work sleep wake schedule. If you work the exact same shift every time, you can adapt to this and not a problem anymore. The problem is when your shift rotate all the time, especially backwards, and you are constantly trying to adapt to. Problems that can occur: type 2 diabetes, digestion issues etc. easier to adapt to if you"re young: irregular sleep-wake pattern: when people do not have a set time for sleeping and waking up.
