PSYC 235 Chapter 8 (Part II): Week Fifteen – Sleep Wake Disorders
10 Feb 2017
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Week Fifteen – Sleep-Wake Disorders
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Insomnia can be a symptom of other disorders (PTSD, major depressive disorder, bipolar disorder)
To treat insomnia, use sleep meds primarily, but an issue is that once people start, it tends to be long-
term because not addressing underlying issues & tends to be addictive
CBT-I works well for all types of insomnia
Insomnia
Difficulty initiating sleep
Difficulty maintaining sleep
Early morning awakenings with inability to return to sleep
Cognitive Behavioural Therapy for Insomnia (CBT-I)
Same tenants as CBT for depression or anxiety
4-8 weeks
Greater emphasis on the behavioural component in CBT-I
Seems to work well in a group format, but can be done individually as well
CBT-I: First Week
Sleep tracking (identify type of insomnia, number of hours slept & other factors that may be
interfering)
A lot of people having racing & anxious thoughts
CBT-I: Week 2
Sleep consolidation
o Condense the amount of sleep people get
o Look at diaries to identify how much sleep they are actually getting
o Set bedtime to support actual amount of sleep they get
Restrict naps – 1 nap can be between 1-4pm (approx. 1 hour)
Sleep conditioning
o Bed may become a place of anxiety, so coditio aroud the edroo e’t
o Recommend people do’t stay awake in bed for more than 20 minutes
Limit other factors that may be interfering with sleep
o The bed must only be associated with sleep
o A lot of people do other activities in bed (homework, watch TV), keeping the mind active &
associating the cue of the bed with an active state
o Avoid drinking & smoking
Limit sleep medication use
o Through the progression of CBT-I, create less reliance on meds & more on behavioural cues
Interventions for worry
o Mindfulness strategies, calm breathing, muscle relaxation
o Find orry tie at a tie other tha ed tie
o Use imagery to notice thoughts & see them float by on a cloud
CBT-I: Weeks 3+
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Slowly increase sleep time
o Increase ~15-30 max each week until they are at a point where they feel well rested
Further reduce naps
Continue sleep conditioning
Continue interventions for worry
Efficacy
CBT-I was comparable to or better than pharmacological treatment for insomnia
Used to rely a lot on sleep meds
Zopiclone – widely used sleep medication
Polysomnography – objective easureet of a perso’s sleep effiiey
With zopiclone, people are not more efficient in their sleep, but CBT does improve efficiency
Based on self-report, there are some increases in both zopiclone & CBT, but more in CBT
Once you are done a treatment protocol for CBT, usually people keep it up & get their sleep back on
track, whereas medications are more long-term & it is hard to get regular sleep patterns on track
Textbook Chapter 8 (pg. 284-299) – Sleep-Wake Disorders
Sleep-Wake Disorders: The Major Dyssomnias
Infants sleep as much as 16 hours per day, & people in their early 20s average 7-8 hours per day
When people pass 50, their total sleep per day can drop below 6 hours
People who do not get enough sleep report more health problems & are more often hospitalized than
people who sleep normally
Chronic physical health problems are often linked to insomnia, such as circulatory problems, digestive
& respiratory diseases, migraines, allergies, & rheumatic disorders
Immune system functioning is reduced with the loss of even a few hours of sleep
Sleep problems result in substantial expenditures due to lost worker productivity & absenteeism
An Overview of Sleep Disorders
2 broad states of sleep:
o 1. The slow-wave state of deep sleep
o 2. The rapid eye movement (REM) state when brain appears awake & sleeper dreams
Between the broad states are transition stages:
o Stage 1 – wakefulness into drowsiness & then sleep; drift in & out of awareness of surroundings
o Stage 2 – truly sleeping, yet sleep is light
o Stage 3 & 4 – deep, slow-wave
90-minute cycles occur: light sleep, to deeper sleep, back to light sleep, ending with REM sleep
Schizophrenia, depression, bipolar & anxiety-related disorders are associated with sleep complaints
Individuals with developmental disorders are at greater risk for sleep disorders (ex. ADHD)
Brain circuit in limbic system is involved with anxiety & as well as dream sleep
o Mutual neurobiological connection suggests that anxiety & sleep may be interrelated
o Insufficient sleep can stimulate overeating & may contribute to obesity
o REM sleep seems to be related to depression
CBT improves depression in men & normalizes REM sleep patterns
Sleep deprivation has temporary antidepressant effects on some people
Sleep disturbances are experienced by 37% of SZ patients just before onset of psychotic episode
2 major categories of sleep-wake disorders:
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o Dyssomnias: involve difficulties getting enough sleep & complaints about the quality of sleep
o Parasomnias: abnormal events that occur during sleep, such as nightmares & sleepwalking
Polysomnographic (PSG) evaluation: patients spend one or more nights in sleep lab, monitoring
respiration, leg movements, brain wave activation (measured by EEG), eye movements, muscle
movements & heart activity
o Daytime behaviour & typical sleep patterns are also noted (ex. use of drugs, anxiety about work
or interpersonal problems, naps, psychological disorder, etc.)
An actigraph is a wristwatch-size device that is less time-consuming & less costly to use as a
comprehensive assessment of sleep (records the number of arm movements)
Sleep efficiency (SE): the percentage of time actually spent asleep (calculated by dividing amount of
time sleeping by amount of time in bed)
Daytime sequelae is behaviour while awake (feel rested vs anxious & fatigued)
Insomnia Disorder
After being awake ~1-2 nights, a person begins having microsleeps lasting several seconds or longer
Fatal familial insomnia: a rare degenerative brain disorder; total lack of sleep leads to death
Diagnostic Criteria for Insomnia Disorder
A. A predominant complaint of dissatisfaction with sleep quantity or quality associated with one or more
of the following symptoms:
1. Difficulty initiating sleep (in children, this may manifest as difficulty initiating sleep without
caregiver intervention)
2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to
sleep after awakenings (in children, this may manifest as difficulty returning to sleep without
caregiver intervention
3. Early-morning awakening with inability to return to sleep
B. The sleep disturbance causes clinically significant distress in social, occuptiaonal, educational,
academic, behavioural, or other important areas of functioning
C. The sleep difficulty occurs at least 3 nights per week
D. The sleep difficulty is present for at least 3 months
E. The sleep difficulty occurs despite adequate opportunity for sleep
F. The insomnia is not better explained by & does not occur exclusively during the course of another
sleep-wake disorder (e.g., narcolepsy, breathing-related sleep disorder, a circadian rhythm sleep-wake
disorder, a parasomnia)
G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug abuse, a
medication)
H. Co-existing mental disorders & medical conditions do not adequately explain the predomninant
complaint of insomnia
Specify if:
With non-sleep disorder mental comorbidity, including substance use disorders
With other medical comorbidity
With other sleep disorder
Specify if:
Episodic: symptoms last at least 1 month but less than 3 months
Persistent: symptoms last 3 months or longer
Recurrent: two (or more) episodes within the space of 1 year
Statistics for Insomnia Disorder
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Insomnia can be a symptom of other disorders (ptsd, major depressive disorder, bipolar disorder) To treat insomnia, use sleep meds primarily, but an issue is that once people start, it tends to be long- term because not addressing underlying issues & tends to be addictive. Cbt-i works well for all types of insomnia. Early morning awakenings with inability to return to sleep. Same tenants as cbt for depression or anxiety. Greater emphasis on the behavioural component in cbt-i. Seems to work well in a group format, but can be done individually as well. Sleep tracking (identify type of insomnia, number of hours slept & other factors that may be interfering) A lot of people having racing & anxious thoughts. Sleep consolidation: condense the amount of sleep people get, look at diaries to identify how much sleep they are actually getting, set bedtime to support actual amount of sleep they get. Restrict naps 1 nap can be between 1-4pm (approx.
