• Occupies 1/3 of our Lives (3,000 hrs /year)

• Necessary for Physical and Mental Health

• $50 Billion / Year in Lost Productivity

• Occupies 1/3 of our Lives (3,000 hrs /year)

• Necessary for Physical and Mental Health

• $50 Billion / Year in Lost Productivity

Amount Varies By Persons By Age

Problems are Common Can Become Chronic

Amount Varies By Persons By Age

Problems are Common Can Become Chronic

Biological StateBiological StateTwo Major Periods

NREM Non-Rapid Eye Movement REM Rapid Eye Movement

Two Major Periods NREM Non-Rapid Eye Movement REM Rapid Eye Movement

ActigraphSleep efficiencyPolysomnographic (PSG) Evaluation

ActigraphSleep efficiencyPolysomnographic (PSG) Evaluation

Detailed history Electrooculograph (EOG) Electroencephalograph (EEG)Electroencephalograph (EEG) Electrocardiogram (EKG)Electrocardiogram (EKG) Electromyograph (EMG)Electromyograph (EMG)

Detailed history Electrooculograph (EOG) Electroencephalograph (EEG)Electroencephalograph (EEG) Electrocardiogram (EKG)Electrocardiogram (EKG) Electromyograph (EMG)Electromyograph (EMG)

Compensation & ReboundCompensation & Rebound

Dyssomnias Difficulties Getting Enough Sleep Amount, Quality, Timing

Parasomnias Abnormal Behavior During Sleep

Dyssomnias Difficulties Getting Enough Sleep Amount, Quality, Timing

Parasomnias Abnormal Behavior During Sleep

Two Major CategoriesTwo Major Categories

I have difficulty falling asleep Thoughts race through my mind and

prevent me from getting to sleep I anticipate a problem with sleep

several times a week I often wake up and have trouble going

back to sleep

I worry about things and have trouble relaxing

I wake up earlier in the morning than I would like to

I lie awake for a half an hour or more before I fall asleep

I often feel sad or depressed because I can’t sleep

I worry about things and have trouble relaxing

I wake up earlier in the morning than I would like to

I lie awake for a half an hour or more before I fall asleep

I often feel sad or depressed because I can’t sleep

ADD ALL TRUES SCORE > 3, you have symptoms of

INSOMNIA INSOMNIA is a persistent inability to

fall asleep or stay asleep

ADD ALL TRUES SCORE > 3, you have symptoms of

INSOMNIA INSOMNIA is a persistent inability to

fall asleep or stay asleep

Most Common Sleep Disorder Trouble Initiating Sleep Trouble Maintaining Sleep Have Nonrestorative Sleep

Most Common Sleep Disorder Trouble Initiating Sleep Trouble Maintaining Sleep Have Nonrestorative Sleep

“Primary” Insomnia“Primary” Insomnia

Primary InsomniaPrimary Insomnia Facts and Statistics

Common (1/3 Population) 17% Have it in Severe Form Females Report Problem > Males Common in Older Populations

Facts and Statistics Common (1/3 Population) 17% Have it in Severe Form Females Report Problem > Males Common in Older Populations

Primary InsomniaPrimary Insomnia Causes

Higher Body Temperature Drug Use and Poor Sleep Hygiene Unrealistic Views About Sleep Stress and Trying to Sleep Use of Sleep Medications

Causes Higher Body Temperature Drug Use and Poor Sleep Hygiene Unrealistic Views About Sleep Stress and Trying to Sleep Use of Sleep Medications

Hypersomnolence DisorderHypersomnolence Disorder Problem of Sleeping Too Much

Excessive Sleepiness Person Experiences it as a Problem Appear to Have Enough Sleep Little is Known About Causes Appears to Run in Families

Problem of Sleeping Too Much Excessive Sleepiness Person Experiences it as a Problem Appear to Have Enough Sleep Little is Known About Causes Appears to Run in Families

NarcolepsyNarcolepsy The “Sleep Attack”

Excessive Sleepiness & Cataplexy– Triggered by Strong Emotion– Go Right Into REM

Sleep Paralysis Hypnagogic Hallucinations

The “Sleep Attack” Excessive Sleepiness & Cataplexy

– Triggered by Strong Emotion– Go Right Into REM

Sleep Paralysis Hypnagogic Hallucinations

NarcolepsyNarcolepsy Facts and Statistics

Rare Condition: Prevalence = .03% to .16%

Affects Males and Females Equally Often Begins in Adolescence Seems to Improve Over Time Behavior Also Seen in Dogs

Facts and Statistics Rare Condition: Prevalence

= .03% to .16% Affects Males and Females Equally Often Begins in Adolescence Seems to Improve Over Time Behavior Also Seen in Dogs

Breathing-Related Sleep DisordersBreathing-Related Sleep Disorders Sleep Apnea

Breathing is Constrained or Ceases Snoring and Night Sweats Person Often Unaware of Problem Several Types of Sleep Apnea

Sleep Apnea Breathing is Constrained or Ceases Snoring and Night Sweats Person Often Unaware of Problem Several Types of Sleep Apnea

Breathing-Related Sleep DisordersBreathing-Related Sleep Disorders Types Sleep Apnea

Obstructive (OSA)– Airflow Stops; Related to Obesity Central (CSA)– Cessation of Respiratory Activity Sleep-related hypoventilation

Types Sleep Apnea Obstructive (OSA)– Airflow Stops; Related to Obesity Central (CSA)– Cessation of Respiratory Activity Sleep-related hypoventilation

Circadian Rhythm Sleep DisordersCircadian Rhythm Sleep Disorders Problem With Circadian Clock

Disturbed Sleep– Insomnia or Excessive Sleepiness

The Biological Clock– Suprachiasmatic Nucleus– Melatonin May Help Set the Clock

Jet Lag & Shift Work Types

Problem With Circadian Clock Disturbed Sleep

– Insomnia or Excessive Sleepiness The Biological Clock

– Suprachiasmatic Nucleus– Melatonin May Help Set the Clock

Jet Lag & Shift Work Types

Statistics Obstructive sleep

apnea = 10-20% Female < Male Associated with

Obesity Increasing age

Medical Treatments Prescription and Over-the-Counter

– Poor Sleep: – Hypersomnia & Narcolepsy:

Stimulants (e.g., Ritalin) Breathing-Related Disorders– Medications and Devices

Medical Treatments Prescription and Over-the-Counter

– Poor Sleep: – Hypersomnia & Narcolepsy:

Stimulants (e.g., Ritalin) Breathing-Related Disorders– Medications and Devices

Cognitive-Behavioral Treatments Modifying Timing of Sleep– moving bedtime earlier or later Improving Sleep Hygiene Addressing Beliefs About Sleep Stress and Relaxation Training

Cognitive-Behavioral Treatments Modifying Timing of Sleep– moving bedtime earlier or later Improving Sleep Hygiene Addressing Beliefs About Sleep Stress and Relaxation Training

Sleep HygieneSleep Hygiene ExerciseExercise Don’t FDon’t Force Sleep Sleep 15 Minute Limit Getting to Sleep15 Minute Limit Getting to Sleep Avoid NapsAvoid Naps Optimal Sleep ConditionsOptimal Sleep Conditions No SnackingNo Snacking Avoid Alcohol & StimulantsAvoid Alcohol & Stimulants Set Wake-Up TimeSet Wake-Up Time Relax Before BedRelax Before Bed Bed = SleepBed = Sleep

Sleep HygieneSleep Hygiene ExerciseExercise Don’t FDon’t Force Sleep Sleep 15 Minute Limit Getting to Sleep15 Minute Limit Getting to Sleep Avoid NapsAvoid Naps Optimal Sleep ConditionsOptimal Sleep Conditions No SnackingNo Snacking Avoid Alcohol & StimulantsAvoid Alcohol & Stimulants Set Wake-Up TimeSet Wake-Up Time Relax Before BedRelax Before Bed Bed = SleepBed = Sleep

During REM Nightmares

During NREM Sleep Terrors Sleep Walking (somnambulism)

During REM Nightmares

During NREM Sleep Terrors Sleep Walking (somnambulism)

Two Main TypesTwo Main Types

REM sleep Involves dreams:

Distressing & disturbing Disrupt sleep, cause awakening Interfere with functioning

More common in children Treatment

Antidepressants Relaxation training

More common in children

Piercing scream

Signs of elevated arousal (e.g., sweating)

Person looks extremely upset

Difficult to awaken

Little memory of the event

Prevalence

Children 6%

Adults 2%

More boys than girls

Treatment

“Wait-and-see” posture

Scheduled awakenings

Somnambulism Non-REM sleep

Usually during first few hours of deep sleep

Person must leave the bed More common in children 15-30% Difficult (not dangerous) to wake

Related Conditions Sexomnia Nocturnal eating syndrome

Person eats while asleep