Sleep and sleep wake disorders Notes

NOTES NOTES SLEEP & SLEEP-WAKE DISORDERS GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES ▪ Mental disorders impacting normal sleep SIGNS & SYMPTOMS ▪ See individual disorders CAUSES DIAGNOSIS ▪ Stress, substance use, medical conditions ▪ See individual disorders COMPLICATIONS ▪ Affects quantity/quality of sleep, causing lack of restorative sleep → irritability, anxiety, depression TREATMENT ▪ See individual disorders BRUXISM osms.it/bruxism PATHOLOGY & CAUSES SIGNS & SYMPTOMS ▪ Repeated teeth grinding/clenching ▪ Nocturnal (sleep bruxism) or diurnal (awake bruxism) ▪ Awake variant more associated with stress ▪ Dental abfraction/attrition → hypersensitivity ▪ Tooth fractures/loosening/loss ▪ Tongue biting → crenated/scalloped tongue ▪ Cheek biting → canker sores ▪ Sleep bruxism: jaw pain in morning ▪ Awake bruxism: jaw pain increases throughout day CAUSES ▪ Obstructive sleep apnea, misaligned teeth, stress, dehydration, medication side effects, illicit drugs COMPLICATIONS ▪ Can cause temporomandibular joint disorder DIAGNOSIS OTHER DIAGNOSTICS ▪ Persistent grinding/clenching of teeth ▪ Not caused by other condition OSMOSIS.ORG 743

TREATMENT MEDICATIONS ▪ Avoid stimulants, depressants OTHER INTERVENTIONS Figure 103.1 Bruxism causes flattening of the occlusal surfaces as seen here. ▪ Sleep bruxism: mouth guards, occlusal splints, dental plates, muscle relaxants, oral surgery ▪ Awake bruxism: behavior modification ▪ Minimize chewing INSOMNIA osms.it/insomnia PATHOLOGY & CAUSES ▪ Repeated difficulty falling asleep, waking up throughout night, waking up too early ▪ Affects quantity/quality of sleep, causing lack of restorative sleep ▪ Individuals often self-medicate with alcohol/benzodiazepines CAUSES ▪ Stress, stimulants, depressants, psychiatric/ physical conditions (e.g. pulmonary disease) RISK FACTORS ▪ Heightened cortisol levels/ sensitivity ▪ Reduced levels of estrogen/progesterone ▪ Increases with age SIGNS & SYMPTOMS ▪ Excessive time spent falling asleep ▪ Repeated waking up during night ▪ Daytime sleepiness, fatigue → irritability, anxiety, depression 744 OSMOSIS.ORG DIAGNOSIS OTHER DIAGNOSTICS ▪ Poor sleep quantity/quality, associated with ▫ Difficulty falling asleep ▫ Difficulty maintaining sleep (waking up/ being unable to fall back to sleep) ▫ Waking up too early, being unable to fall back to sleep ▪ Affects day-to-day functioning ▪ Difficulty with sleep ≥ three nights a week for ≥ three months ▪ Must have sufficient opportunity to sleep TREATMENT MEDICATIONS ▪ Melatonin agonists, non-benzodiazepine sedatives, occasionally benzodiazepines OTHER INTERVENTIONS ▪ Improve sleep hygiene ▫ Regular sleep schedule, exercise; reduce alcohol, caffeine, smoking (esp. in evening); avoid daytime naps and going to sleep hungry ▪ Stimulus control ▫ Use bed only to sleep; remove bright

Chapter 103 Sleep & Sleep-Wake Disorders lights, minimize noise ▪ Don’t force sleep (try for 20 min, then stop) ▪ Behavior therapy NARCOLEPSY osms.it/narcolepsy PATHOLOGY & CAUSES ▪ Recurrent sleep phenomena (e.g. sleepiness/dreaming) during wakefulness ▪ Associated with a lack of orexin (neuropeptide) ▪ Orexin (A and B) increases state of wakefulness when binding with postsynaptic neurons ▪ Individuals fall asleep faster and enter REM faster CAUSES ▪ Damage to orexin-transporting neurons ▫ By autoimmune process/injury) RISK FACTORS ▪ Genetic factors, low levels of histamine, infections, autoimmune diseases DIAGNOSIS OTHER DIAGNOSTICS ▪ Recurrent feelings of sleepiness during daytime > three times/week ≥ three months ▪ ≥ one of following ▫ Cataplexy ▫ Hypocretin deficiency ▫ Short rapid eye movement (REM) sleep ▪ Not caused by other condition/substance TREATMENT MEDICATIONS ▪ Selective serotonin reuptake inhibitors (SSRIs), stimulants (e.g. modafinil) SIGNS & SYMPTOMS ▪ Daytime sleepiness ▪ Cataplexy (strong emotions cause muscle weakness) ▪ Hallucinations ▫ Hypnagogic: happen when falling asleep ▫ Hypnopompic: happen when waking up ▪ Sleep paralysis ▫ Regaining consciousness while body’s muscles are paralyzed during sleep OSMOSIS.ORG 745

NIGHT TERROR osms.it/night-terror PATHOLOGY & CAUSES ▪ Repeated night/sleep terrors ▫ Periods of intense fear occurring at night ▪ Usually occur during deep non-REM sleep CAUSES ▪ Linked to past traumatic events, sleep deprivation DIAGNOSIS OTHER DIAGNOSTICS ▪ ▪ ▪ ▪ ▪ Presence of night terrors No recollection of imagery during episode Incomplete/absent memory of episode Affects day-to-day life Not caused by other condition/substance TREATMENT RISK FACTORS ▪ Most common in children (3–8 years old) SIGNS & SYMPTOMS OTHER INTERVENTIONS ▪ Reduce stress, follow nighttime routine ▪ Often resolves spontaneously (esp. in children) ▪ Night terrors ▫ Begins with sharp scream → individual sits up → unresponsive → when awoken, individual confused, has no memory of episode NOCTURNAL ENURESIS osms.it/nocturnal-enuresis PATHOLOGY & CAUSES ▪ Repeated, uncontrolled passage of urine into bed/clothes, during nighttime ▪ Often occurs during REM sleep CAUSES ▪ Poor bladder control (for physiological developmental reasons)/simply exceeding bladder capacity ▪ Genetic, environmental ▫ Comorbid with other mental disorders ▫ More common in biological males 746 OSMOSIS.ORG SIGNS & SYMPTOMS ▪ Repeated, uncontrolled passage of urine into bed/clothes during the nighttime DIAGNOSIS OTHER DIAGNOSTICS ▪ Repeated, uncontrolled passage of urine into bed/clothes during the nighttime ▪ “Clinically significant” ▫ Occurs ≥ two times/week for ≥ three consecutive months or affects day-to-

Chapter 103 Sleep & Sleep-Wake Disorders day functioning ▪ ≥ five years old ▪ Not caused by other condition/substance TREATMENT ▪ Often resolves spontaneously MEDICATIONS ▪ Desmopressin → reduces urine production PSYCHOTHERAPY ▪ Behavioral therapy ▫ Esp. bedwetting alarm therapy ▫ Moisture-detecting alarm wakes individual up during enuresis OTHER INTERVENTIONS ▪ Bladder program ▫ To build good habits OSMOSIS.ORG 747