Sleep wake disorder.pptxThese are just a

Definition:
Sleep wake disorder:
Sleep disorders (or sleep-wake
disorders) involve problems with the quality,
timing, and amount of sleep , which result in
daytime distress and impairment in
functioning.

Understanding SWD:
These are the group of disorder
that involve disturbance in the
quality , timing and amount of
sleep or in a behavior for
psychological condition that
associated with the sleep.

Importance of Sleep:
• Sleep is a basic human need
• Critical to both physical and mental health.
There are two types of sleep:
 Rapid eye movement (REM) – when most dreaming
occurs
Non-REM – has three phases, including the deepest sleep
• Sleep is also important circadian rhythm.
• How much sleep we need varies depending on age and
varies from person to person.

According to the National Sleep
Foundations:
• Most adults need about seven to nine hours of restful
sleep each night.
• Many of us do not get enough sleep. A third of adults
report that they usually get less than the recommended
amount of sleep and only about 30% of high school
students get at least eight hours of sleep on an average
school night.2 An estimated 34 percent of Americans
report their sleep quality as “poor” or “only fair.”
• More than 50 million Americans have chronic sleep
disorders
5

o Rapid eye movement sleep:
• The phase of sleep in which most dreams occur.
• During rapid eye movement sleep, a person’s brain activity,
breathing, heart rate, and blood pressure increase, and the eyes
move rapidly while closed
• . The muscles in the arms and legs become temporarily unable to
move.
• Rapid eye movement sleep is thought to play an important role in
memory and learning.
• Also called REM sleep
7

o Non-rapid eye movement sleep:
• The phase of sleep that is considered the quiet or restful phase.
• During the three stages of non-rapid eye movement sleep, a
person falls asleep and then moves from a light sleep into a deep
sleep
• . This is when a person’s brain activity, breathing, and heart rate
slow down, body temperature drops, muscles relax, and eye
movements stop
• . Non-rapid eye movement sleep plays an important role in
helping the body repair tissues, build bone and muscle, and
strengthen its immune system.
• Also called non-REM sleep and NREM sleep
8

 Insomnia disorder:
 Difficulty in initiating or
maintaining sleep
 Dissatisfaction with sleep
quantity and quality.
 This happens even if you have
the time and the right
environment to sleep well.
 More common among middle-
aged and older adults. APA
10

 Percentage of insomnia in worldwide:
In Asia, studies on the Chinese ageing population show that 6–41%
of the elderly experience insomnia.
In Egypt, 50% of the patients older than 60 years old had insomnia.
An Iranian study conducted in six hospital clinics with 696
individuals reported a much higher prevalence rate of 62.1%
In Pakistan study suggest that 42.1% of the people met the criteria
of insomnia.
11

 Different type of insomnia:
• Acute insomnia
• Acute insomnia is short-term insomnia that can last from a few days to a few
weeks. It’s the most common type of insomnia.
• Also referred to as adjustment insomnia because it typically occurs when you
experience a stressful event.
• Such as the death of a loved one or starting a new job.

• Chronic insomnia:
• Insomnia is considered chronic if you have trouble sleeping at least three days per
week for at least one month.
• Chronic insomnia can be primary or secondary.
• Primary chronic insomnia, which is also called idiopathic insomnia, doesn’t have
an obvious cause or underlying medical condition.
• Secondary insomnia, also called comorbid insomnia, is more common. It’s chronic
insomnia that occurs with another condition.
• Common causes of chronic insomnia include
• chronic medical conditions, such as diabetes, Parkinson’s disease, hyperthyroidism.
• mental health conditions, such as depression, anxiety, and attention deficit
hyperactivity disorder
• medications, including chemotherapy drugs, antidepressants.
• caffeine and other stimulants, such as alcohol, nicotine, and other dugs.
13

• Onset insomnia:
• Onset insomnia is trouble initiating sleep. This type of insomnia can be
short term or chronic.
• According to a 2009 study, people with chronic onset insomnia often
have another sleep disorder, such as restless leg syndrome or periodic
limb movement disorder.
• Maintenance insomnia:
• Maintenance insomnia is difficulty staying asleep or waking up too early
and having trouble getting back to sleep.
• This type of insomnia causes you to worry about not being able to fall
back asleep and not getting enough sleep.
• Maintenance insomnia can be caused by mental health conditions, such
as depression.
14

 Hyper somnolence disorder:
• Hypersomnia is a condition in which you
feel extreme daytime sleepiness.
• If you have hypersomnia, you fall asleep
several times during the day.
• That occur even after full night sleep.
• Distress and impairment during day time
functioning.
15

Who gets hypersomnia?
• Hypersomnia is more common in females
than males. It's thought to affect about 5%
of the population. It’s usually diagnosed in
adolescence or young adulthood (mean age
is 17 to 24 years.
• Hypersomnolence was more prevalent in
adolescent girls compared to boys . The
prevalence of hypersomnolence varied by
age group in both boys and girls, with
teens between the ages of 15–16 years
endorsing the highest rates of
hypersomnolence , followed by 17–18
year-olds.

 Narcolepsy
• The name Narcolepsy come from French word
narcolepsie
• Combination of Greek word narke (numbness) and
leptos(seizure)
• Chronic sleep disorder
• Cause drowsiness and frequent nap attacks during day
time.
• Occurring at least 3 time a week for past 3 months.
• Also characterized by cataplexy , hallucination ,and
sleep paralysis.
17

Hyper somnolence VS Narcolepsy
Hypersomnolence:
 Pathological condition
 Characterize by unusual
sleepiness.
 Symptoms are excessive night
time sleep ,sleepiness daytime.
Narcolepsy:
 Chronic neurological disease
 Characterize by excessive and
sudden daytime sleep.
 Symptoms are excessive day
time sleep , temporary paralysis
, hallucination, muscle
weakness etc.
18

Rate of narcolepsy in PAKISTAN:
• This result was in agreement with previous
studies that were conducted in Karachi, in
which the prevalence rate of sleep disorders
ranged from 20% to 30% [19–23].
• Our study showed that narcolepsy prevalence
is 43.5%, and it is dominant in females
(45.3%)
19

 Obstructive sleep apnea
• Characterized by episodes of complete
collapse of the airway or partial collapse
with an associated decrease in oxygen
saturation or arousal from sleep.
• It often associated with snoring ,
chocking , gasping
20

Symptoms of OSA
• Excessive daytime sleepiness.
• Loud snoring.
• Observed episodes of stopped breathing during sleep.
• Waking during the night and gasping or choking.
• Awakening in the morning with a dry mouth or sore
throat.
• Morning headaches.
• Trouble focusing during the day.
21

 REM Sleep behavior disorder:
• Complex motor behavior during REM sleep.
• Like punching , shouting , jumping out of bed
• Often associated with Parkinson disease and
other neurological disorder.
• Characterized by dream-enactment behaviors.
• That emerge during a loss of REM sleep atonia.
22

 Non REM Sleep arousal disorder:
23
• Incomplete awakening from sleep.
• Involve behaviors such as sleepwalking, night terrors,
or confusion.
• During these episodes, individuals may exhibit intense
fear, panic, or confusion.
• They may engage in automatic behaviors, such as
sitting up in bed, walking around, or even leaving the
bed and moving around the house.
• Although they may seem awake, individuals usually
have limited awareness of their surroundings and may
not respond to attempts at communication.

 Sleep related hypoventilation disorder:
• It is a respiratory disorder
• Characterized by abnormally slow or shallow
breathing during sleep.
• Leading to insufficient oxygen intake and increased
levels of carbon dioxide in the blood.
• It often associated with obesity, neuromuscular
disorder.
24

 OSA vs SRH
 Obstructive Sleep Apnea
(OSA):
 OSA occurs when the muscles in
the throat relax too much during
sleep.
 Causing the airway to collapse
partially or completely.
 This obstruction leads to pauses in
breathing or shallow breathing
episodes.
 Common symptoms include loud
snoring, choking or gasping during
sleep, daytime sleepiness, and
difficulty concentrating.
 Sleep-related
Hypoventilation:
 Sleep-related hypoventilation refers
to a condition where a person's
breathing is insufficient during
sleep,
 leading to elevated levels of carbon
dioxide (hypercapnia) and reduced
levels of oxygen (hypoxemia) in the
blood.
 hypoventilation can occur due to
various factors such as reduced
respiratory drive, lung diseases,
neuromuscular disorders, or obesity
hypoventilation syndrome (OHS 25

Central sleep apnea:
• Lack of respiratory effort
during sleep.
• Cause stop of air flow
• Lead to decree in oxygen
saturation.
• Often associated with heart
failure, stroke and other
neurological disorder.
26

 What is Central Apnea?
• Nerves from the area of the brain called the brainstem
control breathing
• . Any damage to the brainstem or the spinal cord from
things such as trauma, brain tumors and brain bleeds
can cause breathing to be too shallow or stop all
together. This is called central apnea.
• There are also genetic conditions (something you were
born with) which effect the part of the nervous system
that control breathing.
27

Night mare disorder:
• A type of sleep disorder that involves undesirable
experiences that occur while you're falling asleep,
during sleep.
• Recurrent episodes of disturbing or frighting dream
that wake individual from sleep.
• Associated with significant distress of impairment in
social, occupational and other areas of functioning.
28

 Circadian rhythm sleep wake
disorder:
• Also known as sleep-wake cycle disorders.
• Problems that occur when your body's internal clock,
which tells you when it's time to sleep or wake, is out
of sync with your environment.
• Your internal clock, called a circadian clock.
• It involve mis – match between an individual sleep
wake schedule.
• Characterized by insomnia , excessive sleepiness or
both.
• Associated with shift of work and irregular sleep
schedule.
29

o Medical condition:
• Cardiac conditions.
• Neurological conditions.
• Endocrine conditions.
• Pulmonary conditions.
• Gastrointestinal conditions.

o Psychological conditions:
• Depression may cause alternation in REM sleep.
• 40% people with depression have insomnia.
• PTSD cause night mares which lead to disturbance in
sleep.
• Anxiety disorder predispose to insomnia.
32

o Environmental problems:
• Stress full or life threating event may cause
insomnia.
• Shift work may disturb sleep cycle.
• Sleep deprivation may occur due to result of our
warm or noisy environment.
33

o Substance use:
• Drugs of abuse and alcohol have disruptive effects on
sleep,
• Interfering with the ease of falling asleep.
• Increasing the difficulty in maintaining sleep.
• Altering the cycling of sleep stages from non-rapid
eye movement (NREM) sleep to rapid eye movement
(REM) sleep.
• Insomnia may result of use of caffeine , alcohol or
withdrawal from any of these.
• Medications that cause insomnia include
Corticosteroids and Bronchodilator’s
34

o Treatment:
• Cognitive behavior therapy.(CBT)
• Light therapy
• Alternative therapy
Medications:
Changing life style:

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