Sleep Disorder

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Psychiatric Mental Health
Chapter 20: Sleep Disorders

•Sleep is a major function of daily living and mental health.

•The average adult should get 7 to 9 hours of sleep daily.

•However, many people are in the habit of frequently cutting back on sleep to meet other social needs.

•The most common and major consequence of sleep loss is excessive sleepiness.

•Sleep deprivation is another consequence of sleep loss that complicates health, safety, and quality of life for individuals.

•Prolonged sleep deprivation can produce psychomotor impairments equivalent to excessive alcohol consumption symptoms.

•Sleep is a neurological process that involves interaction between the central nervous system and the environment.

•The normal sleep cycle is divided into two states: NREM (non-rapid eye movement) & REM (rapid eye movement) sleep. * NREM makes up for the majority of sleep cycle. It is broken down into for stages ranging from attributes of psychomotor activities of the body. * Stage 1

* Stage2
* Stage3
* Stage4
* HOWEVER, REM is the longest sleep PERIOD. This stage of the sleep cycle is the longest in time wise and length. *
•Structural organization of NREM and REM sleep is known as sleep architecture & is displayed graphically as a hypnogram. (pg. 463)

•Sleep continuity is the distribution of sleep and wakefulness across the whole sleep period.

•Sleep fragment is the disruption of sleep stages that results in frequent shifts in sleep staging.

Functions of Sleep 

*Very little is know about the true functions of sleep 

*Functions of sleep include: 
-tissue restoration
-body restoration (NREM sleep) 
-energy conservation 
-memory reinforcement 
-consolidation (REM sleep) 
-regulation of immune function 
-metabolism and regulation of certain hormones
-thermoregulation 

Sleep Requirements 

* Most adults require 7-8 hours of sleep 
* Long sleeper require 10 or more
* Short sleeper require less than 5 
* To determine you sleep requirement establish a routine bedtime and allow yourself to sleep undisturbed without an alarm clock for several days.

Sleep Patterns

* The percentage in each stage of sleep and sleep efficiency (defined as a ratio of sleep duration to time spent in bed) varies according to age. 
-e.g. infants sleep 16-18 hours a day, enter sleep through REM sleep instead of NREM sleep, and spend 50% of sleep time in REM sleep.  *By age 3 the percentage of REM sleep decreases to 20% to 25% and stays constant throughout old age  *Slow wave sleep is maximal in young children and declines with age to almost none. Especially true in men * As a result to a decline in slow wave sleep, awakening in the middle of the night occurs, including a reduction in sleep efficiency with age  

—There are four commonly used tests that helps in diagnosing a sleep disorder: —Polysomnography (PSG)
—The Multiple Sleep Latency Test (MSLT)
—The Maintenance of Wakefulness Test (MWT)
—Actigraphy

Primary Sleep Disorders are those not directly attributable to another medical, psychiatric, or substance abuse disorders. Primary Sleep Disorders are further subdivided into Dyssomnias and Parasomnias

1.Dyssomnias are sleep disturbances associated with the intiation and maintenance of sleep or of excessive sleepiness. They include: * Primary Insomnia: patients complain that they have difficulty with sleep intiation, sleep maintenance, early awakening, or non-refreshing non-restorative sleep. This condition must persist for at least 1 month and not related to any known physical or medical diagnosis. * Primary Hypersomnia: excessive sleepiness for at least 1 month, evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily and cause significant distress and social and vocational impairment. * Narcolepsy is described as episodes of irresistible attacks of refreshing sleep, cataplexy, sleep...
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