The document discusses stages of sleep including REM and non-REM sleep. It describes the five stages of a sleep cycle, including stage 1 and 2 non-REM sleep, stage 3 deep sleep, and REM sleep. Characteristics of each stage are provided such as brain wave patterns, muscle tone, and the occurrence of dreams in REM sleep. Common sleep disorders are also summarized such as insomnia, narcolepsy, sleep apnea, and effects of medications, medical conditions, and aging on sleep. Treatments for insomnia including sleep hygiene, therapy, and medications are outlined. The diagnostic criteria for insomnia and narcolepsy are also presented.
This document provides an overview of sleep, sleep disturbances, and sleep disorders. It discusses the physiology and stages of normal sleep, including non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. It describes factors that affect sleep such as circadian rhythms, lifestyle, environment, and medications. Common sleep disorders are explained, including insomnia, sleep apnea, narcolepsy, and parasomnias. Diagnostic tests and treatments for sleep disturbances are also summarized.
Sleep disorders encompass 10 main disorder groups including insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian rhythm sleep-wake disorders, non-REM sleep arousal disorders, nightmare disorder, REM sleep behavior disorder, restless legs syndrome, and substance/medication-induced sleep disorder. Insomnia disorder is characterized by difficulties initiating or maintaining sleep and can cause impairment. It affects up to 10% of the population and is more common in females. Treatment may include sleep hygiene, therapy, and short-term sleeping pills.
This document discusses normal sleep patterns and stages of sleep. It describes the stages of non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. It then discusses factors that can affect sleep stages and cycles, including sleep disorders, sleep deprivation, stress, and environment. The document also summarizes sleep patterns in infants, adults, and elderly persons. Finally, it discusses non-organic sleep disorders like insomnia, and treatments for insomnia including sleep hygiene, behavioral therapy, relaxation techniques, sleep restriction, stimulus control, and medications.
This document discusses sleep, sleep disorders, and their diagnosis and treatment. It covers:
- The stages and functions of normal sleep
- Tools used in sleep medicine like polysomnography
- Common sleep disorders like insomnia, hypersomnia, narcolepsy, sleep apnea
- Treatment approaches including behavioral therapies, pharmacological options, and management of specific disorders.
This document discusses concepts related to sleep and rest. It defines sleep and rest, compares their characteristics, and describes the two types of sleep - NREM and REM sleep. The document outlines objectives, functions of sleep, factors affecting sleep, common sleep disorders like insomnia and sleep apnea, and nursing interventions to promote sleep. Nursing diagnoses and safety measures for patients with sleep issues are also mentioned.
sleep disorders contains dyssomnias ,parasomnias ,and sleep disorder associated with other major medical disorders . Restless leg syndrome and PLM are also covered here. this ppt also shows how to differentiate between sleep terror and night mares . treatment of sleep disorders also included.
This document defines sleep and rest, compares their characteristics, and discusses sleep patterns and disorders. It outlines two types of sleep - NREM and REM sleep - and explains their stages and functions. Factors affecting sleep and common sleep disorders like insomnia and sleep apnea are identified. Nursing interventions to promote sleep through environmental changes, relaxation techniques, and medication administration if needed are also discussed.
Primary sleep disorders:
Primary sleep disorders are those disorders not attributable to another cause, which includes dyssomnias and parasomnias.
Dyssomnias: are primary disorders of initiating or maintaining sleep/ excessive sleepiness, characterized by abnormalities in the amount, quality, or timing of sleep.
Insomnia:
Difficulty initiating or maintaining sleep or nonrestorative sleep that lasts for 1 month and causes significant distress or impairment in social, occupational, or other important areas of functioning.
Hypersomnia:
Excessive sleepiness for atleast 1 month that involves either prolonged sleep episodes or daily daytime sleeping that causes significant distress or impairment in social, occupational or other functioning.
Narcolepsy:
A rare sleep disorder in which a person, usually under the age of 20, has recurrent sudden episodes of irresistible sleep attacks of short duration 10 - 15 minutes (directly enters into REM sleep).
Breathing related sleep disorder:
Sleep disruption leading to excessive sleepiness or, less commonly, insomnia, caused by abnormalities in ventilation during sleep. These disorders include obstructive sleep apnea (repeated episodes of upper airway obstruction), central sleep apnea (episodic cessation of sventilation without airway obstruction), and central alveolar hypoventilation (hypoventilation resulting in low arterial oxygen levels).
Circadian Rhythm Sleep Disorder:
Persistent or recurring sleep disruption resulting from altered functioning of circadian rhythm or a mismatch between circadian rhythm and external demands. Subtypes include; delayed sleep phase, jet lag, shift work and unspecified.
Delayed sleep phase: A persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time.
Jet lag: Sleepiness and alertness that occur at an inappropriate time of day relative to local time, occurring after repeated travel across more than one time zone.
Shift work: Insomnia during the major sleep period or excessive sleepiness during the major awake period associated with night shift work or frequently changing shift work.
Parasomnias: are disorders characterized by abnormal behavioral or psychological events associated with sleep, specific sleep stages, or sleep–wake transition. These disorders involve activation of physiological systems, such as the autonomic nervous system, motor system, or cognitive processes, at inappropriate times during sleep.
Nightmare disorder:
Repeated occurrence of frightening dreams that lead to waking from sleep.
Sleep terror disorder:
Repeated occurrence of abrupt awakenings from sleep associated with a panicky scream or cry.
Sleepwalking disorder (Somnambulism):
Repeated episodes of complex motor behavior initiated during sleep, including getting out of bed and walking around.
This document summarizes key aspects of sleep and sleep disorders. It discusses the physiological changes that occur during the different sleep stages of NREM and REM sleep. It also outlines different types of sleep disorders including dyssomnias like insomnia and hypersomnia, and parasomnias involving abnormal events during sleep. Specific disorders covered include sleepwalking, night terrors, sleep talking and bruxism. Nursing assessments and interventions for managing sleep disorders are also summarized.
it explain about definition of sleep, normal sleep, sleep disturbance, causes of sleep disturbance, management therapy, nursing therapy and its effect om normal life.
This PPT aims to give Knowledge and Understanding about Sleep Talking, Types of Sleep Disorder, Stages of Sleep, Factor of Effecting Sleep Talking, Causes of Sleep Talking, Risk and Concern Associated with Sleep Talking, Diagnosis of Sleep Talking, Treatment of Sleep Talking.
The document discusses sleep statistics, definitions, sleep cycles, factors affecting sleep, categories and sections of sleep disorders, sleep hygiene, and sleep assessment and management. It provides information on average sleep needs by age, sleep definitions, sleep cycles, factors influencing sleep like physical activity, stress, diet, smoking and environment. It describes categories of sleep disorders like dyssomnias involving too little or too much sleep, parasomnias involving abnormal events during sleep, and sleep disorders related to other conditions. Treatment options for different sleep disorders include lifestyle changes, medications, therapy and managing the underlying condition.
Sleep is essential for health and cognitive function. It involves NREM and REM sleep stages measured using polysomnography. Common sleep disorders include insomnia, hypersomnolence, and narcolepsy. Insomnia is difficulty initiating or maintaining sleep and is treated with sleep hygiene, relaxation, and medication. Hypersomnolence involves excessive daytime sleepiness and is treated with stimulants. Narcolepsy involves REM sleep intrusion and is diagnosed by decreased REM latency on polysomnography.
This document provides an overview of sleep and sleep disorders. It defines sleep and describes the four stages of the sleep cycle: NREM Stages 1-3 and REM Stage. Common sleep disorders like sleep apnea, insomnia, narcolepsy, sleepwalking and sleep terrors are explained, including causes, symptoms and ways to prevent each. Finally, tips are provided for falling asleep fast, such as setting the right temperature, avoiding electronics before bed, and maintaining a regular sleep schedule.
Continuum of Consciousness
- Controlled and Automatic Processes
- Altered States of Consciousness
- Psychoactive Drugs
- Sleep and Dreams
- Different Stages of Sleep (REM and N-REM)
- 4 Major Questions About Sleep
- Sleep Disorders
- The Unconscious Mind
- Unconsciousness
The document provides information on sleep disorders and sleep medicine. It discusses the history and physiology of sleep, classification of sleep disorders, and assessment and management of sleep problems. Key points include: sleep is regulated by circadian and homeostatic systems in the brain; there are three main states of consciousness - wakefulness, non-REM sleep, and REM sleep; sleep disorders are classified into dyssomnias involving sleep quantity/quality and parasomnias involving abnormal events during sleep; and treatment involves lifestyle changes, psychotherapy, and medications in some cases.
This document discusses classifications and types of sleep disorders according to diagnostic manuals like DSM-5 and ICD-10. It covers disorders like insomnia, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders including obstructive sleep apnea, and circadian rhythm sleep-wake disorders. For each type of sleep disorder, it provides diagnostic criteria, epidemiology, etiology and pathophysiology, treatment approaches and specific subtypes or related conditions. The document aims to comprehensively describe the major sleep disorders recognized in clinical practice and research according to standardized diagnostic systems.
Sleep disorders are characterized by disturbances in sleep amount, quality, or timing. There are over 70 different sleep disorders divided into two main categories - dyssomnias involving problems falling or staying asleep, and parasomnias involving abnormal behaviors during sleep. The document provides detailed descriptions of common sleep disorders like insomnia, narcolepsy, sleep apnea, circadian rhythm disorders, nightmares, and sleep terrors. Diagnostic criteria are also outlined for each disorder.
Drugs used in the management of anxiety disorders.pdfEugenMweemba
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This document provides an overview of sleep and sleep disorders from a psychological perspective. It defines sleep and describes the four stages of the sleep cycle: NREM Stages 1-3 and REM Stage. Common sleep disorders like sleep apnea, insomnia, narcolepsy, sleepwalking and sleep terrors are explained. Potential causes and symptoms of each disorder are outlined. The document concludes by listing 14 evidence-based ways to fall asleep faster, such as keeping a regular sleep schedule, avoiding screens before bed, and getting exercise in the morning. References are provided.
2-NGS 332-Substance abuse and related addictives.pptxGeofryOdhiambo
This document discusses substance and behavioral addictions. It covers the classification and diagnostic criteria for alcohol, tobacco, and other substance use disorders. It also examines non-substance addictions like gambling disorder and proposed diagnoses of internet gaming disorder. Assessment tools for detecting issues related to alcohol, internet use, and gambling are provided, along with the management of substance intoxication, withdrawal, and treatment approaches.
The document describes the Integrated Management of Childhood Illness (IMCI) strategy. IMCI relies on simple clinical signs and empirical treatment rather than exact diagnoses. It can be used by various health professionals to assess, classify, and treat sick children aged 1 week to 5 years. The assessment involves checking for general danger signs, asking questions, examining the child, and checking nutrition and immunization status. Children are then classified and given specific medical treatments, advice, or referrals depending on their conditions. The document provides details on assessing and managing common childhood illnesses like cough, diarrhea, fever, and ear problems.
This document discusses several eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and obesity. It provides diagnostic criteria and general information about each disorder. Anorexia is characterized by restricted food intake and fear of gaining weight. Bulimia involves binge eating and compensatory behaviors like purging. Binge eating disorder only involves binge eating without compensating. The document covers biological, psychological, family, and social factors that may contribute to eating disorders and discusses treatment approaches.
This document provides information on various anxiety disorders. It defines anxiety and discusses when it becomes pathological. It then outlines the physical, cognitive, behavioral, and affective impairments associated with anxiety disorders. The document discusses causes and risk factors, common types of anxiety disorders (including diagnostic criteria), treatments involving pharmacological and non-pharmacological approaches, and substance-induced anxiety disorders.
This document discusses common childhood cancers, focusing on leukemias. It provides details on the types and subtypes of leukemia, risk factors, clinical presentation, evaluation, and management. The main types discussed are acute lymphoblastic leukemia (ALL), which is the most common childhood cancer, and acute myeloid leukemia (AML). The management of ALL involves induction therapy to achieve remission, CNS prophylaxis to prevent spread to the brain, intensification therapy, and maintenance therapy to prevent relapse.
SEXUAL DYSFUNCTIONS, PARAPHILIAS AND GENDER DYSPHORIA.pptxGeofryOdhiambo
1. The document discusses several common sexual dysfunctions including female sexual interest/arousal disorder, male hypoactive sexual desire disorder, erectile dysfunction, female orgasmic disorder, and delayed ejaculation.
2. For each dysfunction, the diagnostic criteria from the DSM-5 are provided, including symptoms that must be present for a minimum of 6 months and cause significant distress.
3. The neurophysiology of sexual response and factors influencing sexuality such as identity, orientation and behavior are also examined at a high level.
Neurocognitive disorders (NCDs) include conditions involving significant cognitive decline from previous levels of functioning. Major subtypes include those due to Alzheimer's disease, vascular factors, Lewy bodies, Parkinson's disease, frontotemporal deficits, traumatic brain injury, HIV, Huntington's disease, prion disease, or multiple etiologies. Delirium is characterized by acute changes in attention and cognition. Diagnosis of major or mild NCD due to conditions like Alzheimer's disease requires evidence of cognitive impairment in multiple domains interfering with daily life. Vascular NCD results from cerebrovascular disease and impairment occurs in step-like progression following small strokes in the brain.
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In Odoo, the pivot view is a graphical representation of data that allows users to analyze and summarize large datasets quickly. It's a powerful tool for generating insights from your business data.
The pivot view in Odoo is a valuable tool for analyzing and summarizing large datasets, helping you gain insights into your business operations.
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Still I Rise by Maya Angelou
-Table of Contents
● Questions to be Addressed
● Introduction
● About the Author
● Analysis
● Key Literary Devices Used in the Poem
1. Simile
2. Metaphor
3. Repetition
4. Rhetorical Question
5. Structure and Form
6. Imagery
7. Symbolism
● Conclusion
● References
-Questions to be Addressed
1. How does the meaning of the poem evolve as we progress through each stanza?
2. How do similes and metaphors enhance the imagery in "Still I Rise"?
3. What effect does the repetition of certain phrases have on the overall tone of the poem?
4. How does Maya Angelou use symbolism to convey her message of resilience and empowerment?
Split Shifts From Gantt View in the Odoo 17Celine George
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AI Risk Management: ISO/IEC 42001, the EU AI Act, and ISO/IEC 23894PECB
As artificial intelligence continues to evolve, understanding the complexities and regulations regarding AI risk management is more crucial than ever.
Amongst others, the webinar covers:
• ISO/IEC 42001 standard, which provides guidelines for establishing, implementing, maintaining, and continually improving AI management systems within organizations
• insights into the European Union's landmark legislative proposal aimed at regulating AI
• framework and methodologies prescribed by ISO/IEC 23894 for identifying, assessing, and mitigating risks associated with AI systems
Presenters:
Miriama Podskubova - Attorney at Law
Miriama is a seasoned lawyer with over a decade of experience. She specializes in commercial law, focusing on transactions, venture capital investments, IT, digital law, and cybersecurity, areas she was drawn to through her legal practice. Alongside preparing contract and project documentation, she ensures the correct interpretation and application of European legal regulations in these fields. Beyond client projects, she frequently speaks at conferences on cybersecurity, online privacy protection, and the increasingly pertinent topic of AI regulation. As a registered advocate of Slovak bar, certified data privacy professional in the European Union (CIPP/e) and a member of the international association ELA, she helps both tech-focused startups and entrepreneurs, as well as international chains, to properly set up their business operations.
Callum Wright - Founder and Lead Consultant Founder and Lead Consultant
Callum Wright is a seasoned cybersecurity, privacy and AI governance expert. With over a decade of experience, he has dedicated his career to protecting digital assets, ensuring data privacy, and establishing ethical AI governance frameworks. His diverse background includes significant roles in security architecture, AI governance, risk consulting, and privacy management across various industries, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: June 26, 2024
Tags: ISO/IEC 42001, Artificial Intelligence, EU AI Act, ISO/IEC 23894
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Training: ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
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Webinar Innovative assessments for SOcial Emotional SkillsEduSkills OECD
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2. Stages of Sleep: REM and Non-REM
Sleep Cycles
REM- Rapid eye movement.
NREM- non –rapid eye movement.
There are five different stages of sleep including both REM (rapid eye movement) and NREM (non-
rapid eye movement) sleep. The five stages make one sleep cycle which usually repeat every 90 to 110
minutes.
Stage 1 non-REM sleep marks the transition from wakefulness to sleep. This stage typically lasts less
than 10 minutes and is marked by a slowing of your heartbeat, breathing, and eye movements , as
well as the relaxation of your muscles.
The brain transitions from alpha waves (having a frequency of 8 to 13 Hz, common to people who
are awake) to theta waves (with a frequency of 4 to 7 Hz). This stage is sometimes referred to as
somnolence, or ‘drowsy sleep`. Sudden twitches and hypnic jerks also known as positive
myoclonus are associated with this stage. Some people may also experience hypnagogic
hallucinations which can be troublesome to them. The subject loses some muscle tone and most
conscious awareness of the external environment.
3. Stage 2 non-REM sleep is a period of light sleep before you enter deeper sleep, lasts
roughly 20 minutes. Stage two is characterized by further slowing of both the
heartbeat and breathing, and the brain begins to produce bursts of rapid, rhythmic
brain wave activity known as sleep spindles.
Is characterized by `sleep spindles’ (12 to 16 Hz) and ‘K-complexes`. During
this stage, muscular activity as measured by electromyogram (EMG)
decreases and conscious awareness of the external environment disappears.
This stage occupies 45 to 55% of total sleep in adults.
Stage N3- Deep or slow-wave sleep, is characterized by delta waves,(0.5 to
4Hz), also called the delta rhythms. This is the stage in which such
parasomnias as night terrors, bedwetting, sleepwalking and sleep-talking
occur. This is the deepest period of sleep and lasts 20 to 40 minutes. Your heartbeat
and breathing slow to their lowest levels, and your muscles are so relaxed that it may
be hard to awaken you.
4. REM sleep occurs 90 minutes after sleep onset, and is a much deeper sleep than any of the three
stages of non-REM sleep. REM sleep is defined by rapid eye movements and an almost complete
paralysis of the body, and a tendency to dream.
.Characteristics of REM sleep:
1. Muscle atonia- a state in which the motor neurons are not stimulated and thus the body’s
muscles don’t move.
2. Heart rate and breathing rate are irregular during this sleep which is similar to waking
hours.
3. Body temperature is not well regulated.
4. Erections of the penis.
5. Clitoral enlargement, with accompanying vaginal blood flow and transudation
(lubrication).
5. 1. Dyssomnias- A broad category of sleep disorders characterized by
either hyper somnolence or insomnia. The three major subcategories include
intrinsic (arising from the body), extrinsic (secondary to environmental
conditions or various pathologic conditions), and disturbance of circadian
rhythm.
2. Parasomnias.
3. Medical or psychiatric conditions that may produce sleep disorders.
4. Sleeping sickness- A parasitic disease which can be transmitted by Tsetse
fly.
5. Snoring- Not a disorder in and of itself, but it can be a symptom of deeper
problems.
6. Sudden infant death syndrome.
6. • Physical disturbances (for example, chronic pain from arthritis, headaches, fibromyalgia)
• Medical issues (for example, sleep apnea)
• Psychiatric disorders (for example, depression and anxiety disorders)
• Environmental issues (for example, it's too bright, your partner snores)
• Genetics: Researchers have found a genetic basis for narcolepsy, a neurological disorder of sleep
regulation that affects the control of sleep and wakefulness.
• Night shift work: People who work at night often experience sleep disorders, because they cannot
sleep when they start to feel drowsy. Their activities run contrary to their biological clocks.
• Medications: Many drugs can interfere with sleep, such as certain antidepressants, blood
pressure medication, and over-the-counter cold medicine.
• Aging: About half of all adults over the age of 65 have some sort of sleep disorder. It is not clear if it
is a normal part of aging or a result of medications that older people commonly use.
7. Insomnia is the disturbance of normal sleep pattern and characterized by
an insufficient quantity or quality of sleep.
A type of dyssomnia.
8. A. A predominant complaint of dissatisfaction with sleep quantity or
quality, associated with one (or more) of the following symptoms:
1. Difficulty initiating sleep. (In children, this may manifest as difficulty
initiating sleep without caregiver intervention.)
2. Difficulty maintaining sleep, characterized by frequent awakenings or
problems returning to sleep after awakenings. (In children, this may manifes as
difficulty returning to sleep without caregiver intervention.)
3. Early-morning awakening with inability to return to sleep.
B. The sleep disturbance causes clinically significant distress or
impairment in social, occupational, educational, academic, behavioral, or
other important areas of functioning.
C. The sleep difficulty occurs at least 3 nights per week.
9. D. The sleep difficulty is present for at least 3 months.
E. The sleep difficulty occurs despite adequate opportunity for sleep.
F. The insomnia is not better explained by and does not occur exclusively
during the course of another sleep-wake disorder
10. 1. Sleep hygiene education: a moderate intake of easily digested warm food; a
comfortable bed; avoid caffeine, nicotine, alcohol, and excessive fluid intake
in the evening; keep a regular sleep schedule and regular daytime
exercise; limit time in bed; and remove clock from bedroom to avoid
excessive monitoring.
2. Sleep restriction therapy: the patient should keep a sleep log that records
the total sleep duration, bedtime, and wake-up time. The time allowed
in bed is reduced to the total sleep duration and the patient is advised to
increase the time in bed by 15 min on a weekly basis by adjusting the
bedtime.
3. Stimulus control therapy: arise at the same time every morning, avoid
daytime napping, go to bed only when sleepy, use the bed only for sleep,
leave the bed when unable to sleep, and reduce lighting and level of
noise in bedroom.
11. 4. Cognitive therapy aims at correcting cognitive distortions (e.g. being catastrophic
after insomnia) and unrealistic expectations (e.g. must have 10 h uninterrupted
sleep).
5. Behaviour therapy: progressive muscle relaxation techniques for any
associated anxiety.
6. consider nonbenzodiazepine hypnotic agents such as
a. Antihistamines: hydroxyzine.
b. Melatonin receptor agonists: agomelatine and ramelteon.
c. Sedating antidepressants: amitriptyline, mirtazapine, and trazodone.
d. Antipsychotics: low-dose quetiapine.
e. Melatonin: the Maudsley guidelines recommend the use of melatonin for the
treatment of insomnia in children and adolescents.
12. 7. Benzodiazepines are only indicated for short-term use (<4 weeks).
Benzodiazepine hypnotic agents include
a. Benzodiazepines: temazepam, oxazepam, lorazepam, and diazepam
b. Benzodiazepine receptor agonists: zaleplon, zolpidem, and zopiclone.
8. Diet that contain tryptophan such as banana, warm milk, oatmeal ,fish.
These stimulate melatonin production.
9. Bright light therapy uses artificial light to simulate the effects of sunlight on
the body’s circadian rhythms. It is generally used to treat people who have
circadian rhythm sleep disorders or sleep problems associated with jet lag or
shift work.
10. Aromatherapy involves the use of certain scents from herbs, usually
distilled into essential oils.
13. 11. Acupuncture involves the insertion of very fine needles into the body at
specific points. It can have a calming effect on your nervous system and also
stimulates the production of brain chemicals, including serotonin, which
promote sleep.
14. is a chronic neurological disorder that affects the brain’s ability to control
sleep-wake cycles.
Onset: first symptom is almost always daytime sleepiness and occurs during
adolescence.
Characterized by 5 major symptoms.
Common psychiatric comorbidity: depression, anxiety, substance misuse,
and parasomnia.
15. Hypersomnia: sleepiness in between sleep attacks.
Sleep attacks: two to five episodes of sleep attacks per day. Sleep attacks
are irresistible and last for 10–20 min with dreaming. The attacks cause
functional impairments.
Cataplexy (70%): sudden loss of muscle tone with consciousness lasting for a
few seconds to minutes. The hypotonia causes spontaneous grimaces
and jaw opening with tongue thrusting. Eye and respiratory muscles
are spared. Cataplexy can be precipitated by laughter. Cataplexy
increases the risk of fall and accident.
Hypnagogic hallucinations (20%–40%): usually visual hallucinations or
dreamlike imagery. Hypnopompic hallucinations are less common than
hypnagogic hallucinations.
16. Sleep paralysis: mainly affecting ability to speak and movement of four
limbs. Diaphragm is spared in sleep paralysis.
17. A. Recurrent periods of an irrepressible need to sleep, lapsing into
sleep, or napping occurring within the same day. These must have been
occurring at least three times per week over the past 3 months.
B. The presence of at least one of the following:
1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few
times per month:
a. In individuals with long-standing disease, brief (seconds to minutes)
episodes of sudden bilateral loss of muscle tone with maintained
consciousness that are precipitated by laughter or joking.
b. In children or in individuals within 6 months of onset, spontaneous
grimaces or jaw-opening episodes with tongue thrusting or a global
hypotonia, without any obvious emotional triggers.
18. 2. Hypocretin deficiency, as measured using cerebrospinal fluid (CSF)
hypocretin-1 immunoreactivity values (less than or equal to one-third of
values obtained in healthy subjects tested using the same assay, or less than
or equal to 110 pg/mL). Low CSF levels of hypocretin-1 must not be observed
in the context of acute brain injury, inflammation, or infection.
3. Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep
latency less than or equal to 15 minutes, or a multiple sleep latency
test showing a mean sleep latency less than or equal to 8 minutes and
two or more sleep-onset REM periods
19. Lifestyle modifications- avoid triggers such as emotions.
Scheduled napping.
Stimulants such as methylphenidate.
Antidepressants such as SSRIs e.g setraline.
20. A. Self-reported excessive sleepiness (hypersomnolence) despite a main
sleep period lasting at least 7 hours, with at least one of the following
symptoms:
1. Recurrent periods of sleep or lapses into sleep within the same day.
2. A prolonged main sleep episode of more than 9 hours per day that
is nonrestorative (i.e., unrefreshing).
3. Difficulty being fully awake after abrupt awakening.
B. The hypersomnolence occurs at least three times per week, for at
least 3 months.
C. The hypersomnolence is accompanied by significant distress or
impairment in cognitive, social, occupational, or other important areas of
functioning.
21. D. The hypersomnolence is not better explained by and does not occur
exclusively during the course of another sleep disorder (e.g., narcolepsy,
breathing-related sleep disorder, circadian rhythm sleep-wake disorder, or a
parasomnia).
E. The hypersomnolence is not attributable to the physiological effects of
a substance (e.g., a drug of abuse, a medication).
F. Coexisting mental and medical disorders do not adequately explain
the predominant complaint of hypersomnolence.
22. Parasomnias are a partial arousal meaning that a person exhibits symptoms
of being both asleep and awake at the same time. It involves abnormal
movements, behaviors’, emotions, perceptions, dreams. It occurs while falling
asleep, during rapid eye sleep or non rapid eye movement (slow wave sleep)
stages of sleep, or arousal from sleep.
They include;
23. A) Nightmares: Also called dream anxiety attacks. These vivid events happen
when a person is awakened suddenly from REM sleep by a long frightening
dream that is causing fear or anxiety. They are also associated with
tachycardia, tachypnea, diaphoresis and arousal. It can occur at any time of
the night.
B) Sleep terror disorder; also known as night terrors. It is the most disruptive
arousal disorder that primarily occurs during stages 3 and 4 of non rapid eye
movement sleep. This occurs when a person is suddenly awakened and feels
terrified and confused with intense anxiety. It may also involve loud screams
and extreme panic during sleep followed by motor activities which such as
hitting object or moving in and out of the bedroom. It usually within the first
hours of sleep and only lasts for 15 minutes and then the person returns to
sleep. It’s especially common in children. Most people who experience sleep
terrors don’t remember the event the following morning (amnesia after the
episode)
24. C) Sleep walking; it is also called somnambulism. It arises from slow wave stages of
NREM sleep. It occurs when a person moves around, wanders aimlessly carrying
objects, going outdoors while they are sleeping.
d) Sleep bruxism; also called teeth grinding. It is a common disorder where the
sufferers grind their teeth during sleep. It primarily occurs in stages 1 and 2
or during partial arousal or transitions .This disorder leads to sleep disruption
to the sufferer and the bed partner, wear and fracture of teeth and jaw pain.
Treatment consists of bite plates to prevent dental damage.
e) Sleep talking; Also known as somniloquy. It refers to talking aloud in ones sleep.
It can be quite loud, ranging from simple sounds to long speeches and can occur
many times during sleep.
It usually occurs during transitory arousals from NREM sleep, which is when the
body does not move smoothly from one sleep stage in NREM sleep to another. It
can also occur during REM sleep.
25. F) Sleep paralysis; It occurs when the brain awakes from the REM state but the
body paralysis persists. This leaves the person fully conscious but unable to
move any body part, and has only minimal control over blinking, breathing and
very rarely movement of the jaw. It occurs after waking up or shortly before
falling asleep the state may be accompanied by terrifying hallucinations
and acute sense of danger.
G) Rem sleep behavior disorder; it is a chronic and progressive disease,
common in elderly men.
It involves loss of muscle atonia during the REM sleep with emergence of
complex and violent behaviors hence potential for serious injury, bruises,
lacerations and fractures.
26. H) Confusional arousals, it involves waking during a very deep stage of
sleep. They are occasional thrashings or inconsolable crying among
children and are characterized by movements in bed. Are not common in
adults.
I) Restless leg syndrome: is a disorder in which the sufferers reports
itching, burning, or otherwise uncomfortable sensations in their legs usually
exuberated when resting or asleep. This causes sleep disruption as they wake
to move or scratch their legs. It is relieved by movement. Benzodiazepines e.g.
clonazepam are the treatment of choice, in severe cases levodopa or
uploads may be used.
J) Rhythmic movement disorder; Rhythmic head or body rocking just before or
during sleep and may extend into light sleep. It is usually limited in childhood
and observed in period before sleep. No treatments required in most infants
and young children. Crib padding or helmets may be used. Behaviour
modification, benzodiazepines and tricyclic antidepressants may be effective.
27. k) Sleep enuresis; It is also called bedwetting. It occurs when a person urinates
by accident in his or her sleep. It results from failure to wake up from sleep
when the bladder is full or failure to prevent bladder contraction. Bedwetting is
not a sleep disorder unless it occurs at least twice a week in a person at least
five years of age.
29. A. Either (1) or (2):
1. Evidence by polysomnography of at least five obstructive apneas or
hypopneas per hour of sleep and either of the following sleep symptoms:
a. Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing
pauses during sleep.
b. Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient
opportunities to sleep that is not better explained by another mental
disorder (including a sleep disorder) and is not attributable to another
medical condition.
2. Evidence by polysomnography of 15 or more obstructive apneas
and/or hypopneas per hour of sleep regardless of accompanying symptoms.
30. A. Evidence by polysomnography of five or more central apneas per hour of
sleep.
B. The disorder is not better explained by another current sleep disorder.
31. (1) behavior modification aimed at improving sleep hygiene and avoiding additional sleep deprivation.
(2) avoidance of supine positioning during sleep
(3) avoidance of ethanol and sedative medications.
(4) Appropriate weight management strategies and compliance with positive airway
support.
(5) Surgical treatment options for breathing-related sleep disorders include (1)
procedures designed to increase upper airway size, (2) procedures designed to
bypass the upper airway, and (3) procedures that ensure weight loss.