Psychopathology (PSYC 4240) Day 9
Psychopathology (PSYC 4240) Day 9 PSYC 4240
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This 5 page Class Notes was uploaded by Selin Odman on Thursday May 26, 2016. The Class Notes belongs to PSYC 4240 at University of Georgia taught by Miller in Summer 2016. Since its upload, it has received 11 views. For similar materials see Psychopathology in Psychology (PSYC) at University of Georgia.
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Date Created: 05/26/16
Psychopathology (PSYC 4240) Day 9 5/26/16 Sleep Disorders Two Major Types of DSM-IV Sleep Disorders Dyssomnias: difficulties in getting enough sleep, problems in timing of sleep and complaints about quality of sleep -Insomnia -Hyper somnolence Disorder -Narcolepsy -Breathing related sleep disorder -Circadian rhythm sleep disorder Parasomnias: abnormal behavioral and physiological events during sleep -Nightmare disorder -Sleep terror disorder -Sleep walking disorder Assessment: Polysomnographic (PSG) Evaluation Spend 1+ night in sleep lab -Electroencephalography (EEG): Brain wave activity -Electrooculograph (EOG): eye movement -Electromyography (EMG): muscle movements Includes detailed history and assessment of sleep hygiene and sleep efficiency (Amount of time asleep/amount of time in bed) -Some degree of subjectivity in whether one has a sleep problem or not Insomnia Disorder Problems initiating and maintaining sleep, and/or nonrestorative sleep; early morning awakenings -3 nights a week for at least 3 months Facts and Stats Most prevalent of sleep disorder (6-10%) Affects more females than males (1.5x more) Comorbid with other disorders Associated Features Unrealistic expectations about sleep Believe lack of sleep will be more disruptive than it is Anxiety: neurotic personality styles; poor environmental conditions to sleep (noise; light) Some genetic contribution Hypersomnia and Primary Hypersomnia Excessive sleepiness despite sleeping 7+ hours -One of 3: recurrent periods of sleep or lapses into sleep during the day; main sleep episode of 9 or more that in nonrestorative; difficulty being fully awake after abrupt awakening -3 times a week for 3 months Facts and Stats Rare Symptoms get worse over time (some people sleep 20 or more hours) Likely a genetic component Associated Features Complaints of feeling sleepy throughout the day even though they can sleep throughout the night Narcolepsy Recurrent periods of irrepressible need for sleep, sleep lapses or need for naps -3 times a week for 3 months Cataplexy: brief episodes of muscle control loss triggered by laughing/joking where muscle loses its tone and can lead to falling Hypocretin (1 and 2) deficiency is found is most cases with cataplexy; hormone associated with promoting wakefulness Short latency to REM sleep Facts and Stats Rare: 0.2-0.4% of population Affects males and females relatively equally Onset in early childhood or adolescence 20-60% experience hypnagogic hallucinations (before or upon falling asleep) or hypnopompic hallucinations (just after waking up) 20-60% experience sleep paralysis Breathing Related Sleep Disorders Sleepiness during the day or disrupted sleep at night Sleep apnea: restricted air flow and/or brief cessations of breathing Subtype of Sleep Apnea Obstructive sleep apnea (OSA): airflow stops, but respiratory system works -symptoms: breathing disturbances like snoring or snorting; daytime sleepiness/fatigue Central sleep apnea (CSA): respiratory system stops for brief periods -related to central nervous system disorders and much more severe Mixed sleep apnea: combination of OSA and CSA Facts and Stats More common in males (2 to 4:1 ratio) Occurs in 10-20% of population Associated with obesity and increasing age Associated Features Persons are usually minimally aware of apnea problems Often snore or sweat during sleep and wakeup frequently May suffer morning headaches Experience episodes of sleep during the day Circadian Rhythm Disorders Sleep-Wake Disorders -Persistent sleep disruption due to alteration of circadian rhythms or misalignment between internal system and sleep-wake schedule of patients -Causes excessive sleepiness or insomnia Types of Circadian Rhythm Disorders Delayed sleep phase types: going to bed and waking up later than ideal Advances sleep phase types: going to bed and getting up earlier than ideal Shift work type: problems due to working at night Medical Interventions for Dyssomnias Insomnia -Benzodiazepines and over-the-counter sleep medication (short acting preferred) -Prolonged use can cause rebound insomnia or dependence -Best as a short-term solution Hypersomnia and Narcolepsy -Stimulants like Ritalin -Cataplexy is usually treated with antidepressants which reduce REM sleep Breathing-Related Sleep Disorders -Include medication, weight loss and mechanical devices like Continuous Positive Air Pressure Machine Environmental Interventions for Dyssomnias Circadian Rhythm Sleep Disorders -Phase delays: moving bedtime later (best approach) -Phase advanced: moving bedtime earlier (more difficult to work into peoples’ schedules) -Use of very bright light: trick brain’s biological clock Psychological Interventions for Dyssomnias Relaxation and Stress Reduction -Reduces stress and assists with sleep (use of diaphragmatic breathing, PMR, guided imagery) -Modify unrealistic expectations about sleep Stimulus Control Procedures Improve Sleep hygiene: bedroom is place for sleep, address substance use, limit exercise before sleep, reduce caffeine 6 hours before bedtime, regular sleep schedule, reduce noise and light in bedroom, increase exposure to natural light during the day Set a regular bedtime routine for children Combined Treatments -Insomnia: short-term medicine plus psychotherapy Parasomnias Nature of Parasomnias -Problem is not with sleep itself -Abnormal events during sleep, or shortly after waking -Mixtures of wakefulness and sleep Two Types of Parasomnias -Those that occur during REM -Those that occur during non-REM Nightmare Disorder Occurs during REM sleep Involves distressing and disturbing dreams; usually remembered usually involve escape from harm or threat Dreams interfere with daily life functioning Facts and Associated Features Dreams often awaken the sleeper and disrupt sleep Dreamer is alert upon awakening Problems more common in children than adults Treatment Involved antidepressants and/or relaxation techniques Rapid Eye Movement Sleep Behavior Disorder Repeated episodes of arousal during sleep with vocalization of complex behaviors Happened during REM sleep Upon awakening, individual is alert and aware -Engaging in dream enacting behavior (punching; vocalizations are loud and profane) Restless Leg Syndrome Urge to move legs due to uncomfortable sensation in legs Non-REM Sleep Arousal Disorders Recurrent episodes of incomplete awakening from sleep accompanied by either (usually happens in first 1/3 of sleep) -Sleep walking: hard to communicate with or awakening; can be involved in eating or sexual behavior -Sleep terrors: abrupt arousal from sleep and begins with scream; accompanied by symptoms of intense fear and arousal (sweating, rapid breathing, rapid heart rate) Usually little to no dream imagery present; amnesia is present for these episodes Facts and Associated Features Problem is more common in children than adults; many have few episodes but the disorder is uncommon Difficult but not dangerous to awaken sleep walker Genetic component: 80% of patients have family members with history of behaviors Problem usually goes away on its own Treatment Often involves wait-and-see approach Severe cases are treated with antidepressants or benzo Scheduled awakenings prior to sleep terror
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