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Sleep, sleep disorders

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M ria T nde Magyar MD, PhD. Each of us will spend about 27 years of our lifetime sleeping. ... dreaming, erection. muscleatonia, BUT: myoclonus! NREM ... – PowerPoint PPT presentation

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Title: Sleep, sleep disorders


1
Sleep, sleep disorders
  • Mária Tünde Magyar MD, PhD

2
About the sleep
  • Each of us will spend about 27 years of our
    lifetime sleeping..
  • ..And 1/3 part of the population has sleep
    disorder

3
Why we sleep remains one of natures greatest
mysteries
  • (MG Frank, The function of sleep, 2006)
  • Somatic theories of sleep function
  • Neural metabolic theories detoxification and
    regeneration
  • Cognitive theories of sleep function learning
    and brain development

4
Regulation of sleep
  • Cirkadian timing lasts about 24 hours
  • Hypothalamus
  • Suprachiasmatic nucleus
  • Pituitary gland melatonin
  • Ultradian timing lasts less than 24 hours
  • Prepontin nuclei
  • Raphe nuclei
  • L. coeruleus

5
Normal human sleep
  • Sleep cycle occurs about every 90 minutes,
  • approximately 4-6 cycles occur per major sleep
    episode
  • Microarousal
  • NREM (70-80)
  • slow wave sleep
  • heart rate, BP, breathing ?
  • body temperature, muscle tone ?
  • REM (20-25)
  • rapid eye movement, paradox, fast wave sleep
  • heart rate, BP, breathing ?, metabolic rate ?
  • dreaming, erection
  • muscleatonia, BUT myoclonus!

6
NREM
  • stage (3-8) drowsiness, sleepiness EEG
    a-activity, muscle tone, eye movement ?,
    myoclonus!
  • stage (45-55) EEG K-complexes, sleep
    spindles, no eye movement
  • stage (5-10) EEG delta waves
  • stage (15-20) slow wave sleep

7
REM
  • Tonic stage (desyncronized EEG low voltage,
    frequency ?, muscle atonia)
  • Phasic stage (rapid eye movements fast,
    saccadic eye movements , irregular breathing,
    heart rate ?, myoclonus, apnea, hyperpnea,
    dreaming!!!)

8
Sleep disorders
9
Polysomnography
  • multiparametric monitoring during 1 sleep period
    (1 night)
  • EEG
  • Electrooculogram
  • EMG
  • ECG
  • Respiratory effort
  • SpO2
  • Body position
  • Snoring

10
More than 80 sleep disorders are known
(International Classification of Sleep
Disorders, 2nd EditionAmerican Academy of Sleep
Medicine, 2005)
  • Insomnias (33)
  • Sleep related breathing disorders (1,4-40)
  • Hypersomnias (0,3-16,3)
  • Cirkadian rhythm sleep disorders
  • Parasomnia
  • Sleep related movement disorders
  • Isolated symptoms, normal variants
  • Other sleep disorders

11
Traditional classification of sleep disorders
  • Dyssomnias abnormalities in the quantity,
    quality or timing of sleep. They are associated
    with difficulty initiating or maintaining the
    sleep or daytime sleepiness.
  • Parasomnias abnormal behavioral or physiological
    events occurring during sleep but dont involve
    the sleep mechanisms per se.

12
I. Insomnias
  • Difficulty in initiating sleep or in staying
    asleep or waking up earlier
  • Nonrefreshing, nonrestorative sleep
  • Fatigue, concentration or memory impairment
  • Mood disturbances, motivation, initiative
    reduction
  • Daytime sleepiness
  • Tension headache

13
I. Insomnias
  • Prevalence 33
  • Accompanied with daytime consequences 10
  • Last less than 1 month 4 (transient insomnia)
  • Last more than 1 year 85 (persistent insomnia)
  • Malefemale 11.4
  • Increase with age above 65 years 50

14
I. Insomnias
  • Primary (idiopathic)
  • Secunder
  • Inadequate sleep hygiene (10)
  • Paradoxical insomnia (10)
  • Insomnia due to mental disorder (30-40)
  • Psychophysiological insomnia (15)
  • Insomnia due to drug or substance
  • Insomnia due to medical conditions
  • Sunday night insomnia

15
Treatment
  • Treating the medical or psychiatric conditions
    (sec. insomnias)
  • Nonpharmacologic
  • behavioral treatments normalizing the circadian
    rhythm
  • sleep hygiene
  • cognitive behavior therapy
  • sleep restriction therapy
  • Pharmacologic treatment

16
Pharmacologic treatment
  • Benzodiazepines
  • midazolam, triazolam rebound insomnia
  • cinolazepam, quazepam
  • brotizolam, temazepam
  • nitrazepam drowsiness

17
Pharmacologic treatment
  • Selective GABAA agonists nonbenzodiazepines
  • no rebound insomnia
  • zolpidem, zopiclon
  • Melatonin receptor agonist
  • ramelteon

18
II. Sleep related breathing disorders
(International Classification of Sleep Disorders,
2nd EditionAmerican Academy of Sleep Medicine,
2005)
1.
2.
3. Sleep related hypoventilation/hypoxemia
19
Apnea-hypopnea index (AHI)
  • Numbers of apneas and hypopneas/ 1 sleeping hour
  • Severity of sleep related breathing disorders
  • Normal AHI
  • Mild AHI 5-15/h
  • Moderate AHI16-30/h
  • Sever AHI30/h

Sleep, 199922667-89.
20
OSAHS symptoms
  • Daily
  • Excessive daytime sleepiness
  • Unrefreshing sleep
  • Memory disturbances
  • Morning headache
  • Depression
  • Decreased libido
  • Stomach ache
  • Nightly
  • snoring
  • apneas
  • choking, gasping
  • arousals
  • sweating
  • dry mouth
  • palpitation
  • nycturia

21
OSAHS diagnostic criteria
  • (1. or 2.) and 3.

AASM, Sleep, 199922667-89.
22
Risk factors of OSAHS
  • Obesitas
  • Age
  • Male gender
  • Pozitive family history of OSAHS
  • Alcohol consumption before bedtime
  • Race
  • Smoking
  • Sedatives
  • Craniofacial anomalies
  • Hypothyroidism, acromegaly

23
Treatment of bening snoring
  • Weight loss, alcohol withdrawal
  • Position training
  • Nasal, pharyngeal surgery (UPPP)
  • Oral appliances

Treatment of OSAHS nasal CPAP
24
IV. Cirkadian rhythm sleep disorders
  • Primary
  • Delayed sleep phase type
  • Advanced sleep phase type
  • Irregular sleep phase type
  • Secondary
  • Jet lag type
  • Shift work type
  • Treatment
  • Sleep hygiena
  • Cronotherapy
  • Light therapy
  • Melatonin, zolpidem

25
V. Parasomnias
  • In NREM
  • Myoclonus
  • Enuresis nocturna
  • Pavor nocturnus, night terrors
  • Sleep walking - somnambulism
  • Bruxism
  • In REM
  • Nightmares
  • REM sleep behavior disorder

26
VI. Sleep related movement disorders
  • Restless legs syndroma
  • Therapy dopamin agonists
  • Periodic limb movement disorder
  • Sleep related leg cramps
  • Sleep related rhythmic movement disorder
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