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Sleep Disorders to Be Aware of 1 SLEEPYTIME It’s More Than Tea and Necessary for Health and Wellness Kenneth Benedik, LPC, LMFT, LAC, CCJAS, CHES Louisiana Counseling Association Conference, September 15-17, 2013 New Orleans, LA [email protected] 337-235-2304 Special Thanks I wish to acknowledge the following individuals for their assistance in preparing this presentation: Haley Garcia Jacki Benedik, Acadiana Brain MS, CHES Injury Center A LITTLE BIT OF HISTORY • Greeks –Mother Night • Hypnos Thanos (Sleep) (Death) • Alcmaecon – Sleep is caused by blood filling the brain vessels. – Waking is caused by blood leaving the brain vessels. • Plato and Aristotle – Vapors from decomposing food ran to the brain and caused sleep. A LITTLE BIT OF HISTORY continued…. th th 18 & 19 Centuries • Findings – Blood flowing to the head put pressure on the brain and caused sleep. – Falling asleep is a process imposed on a passive brain by the dark and quiet environment of the night time. • Richard Coton (1875) – Discovery of spontaneous electrical energy in the brains of animals A LITTLE BIT OF HISTORY continued…. th 20 Century • Sigmund Freud (Uncle Siggy) – 1905 – The Interpretation of Dreams • Carl Jung - 1913 – Psychology of the Unconscious • Hans Burger – 1920’s & 1930 – Human person had spontaneous electrical energy that could be recorded from the scalp. (Electroencephalogram – EEG) • Nathaniel Klutman – First to devote his professional life to studying sleep – 1920 first sleep lab at University of Chicago – Wrote Sleep and Wakefulness • Nathaniel Klutman and William Dement – 1952 – The two men meet for the first time – Nathaniel Klutman mentors and teaches William Dement William Dement, MD http://med.stanford.edu/profiles/William_Dement/ http://www.sleepquest.com/sq_dement.shtml http://www.stanford.edu/~dement/sleepless.html Dement At Stanford • Narcolepsy • Sleep Apnea • Sleep was not always good –sign of depression • Founding of the journal SLEEP How Much Sleep Do People Need? AGE AMOUNT 1-4 weeks 15 ½ - 16 ½ hrs/day 1-4 months 15 ½ hrs/day 4-12 months 13 ¾ - 14 ½ hrs/day 1-3 years old 13 ¾ hrs/day 3-6 years old 10 ¾ - 12 hrs/day 7-12 years old 10 ½ hrs /day 12-18 years old 8 ½ - 9 ½ hrs/day 19+ years old 8 hrs/day Normal Sleep • fall asleep in 5-20 minutes. • 1-2 brief awakening per night depending on age. • should dream every night, but may not remember. • 85% - 95% of time in bed should be spent sleeping. • should wake up alert, energetic and restored after 7-8 hours of sleep. Normal Sleep 3 Stages of Non REM sleep 1 Stage of REM sleep Stages • Stage 1 – Transition from wake to sleep 2-5% of the night • Stage 2 – 50% of the night • Stage 3 – 15-20% of the night – Deepest level of sleep REM Sleep • 15-20% • mostly late in the night • stage in which we dream Going To Sleep Electrical Activity in a Brain The Promise of Sleep, pg. 19 Essential Features • Sleep erects a perceptual wall between the conscious mind and the outside world. • Sleep is immediately reversible. • Sleep is characterized by electrical charges in the brain. Sleep Provides • Slow Wave Sleep– Restfulness • Rapid Eye Movement (REM) – Defragging the brain – Dream • Jung – interpretations supposed based on universal archetypes – Actually based on Western European archetypes –Paralyzed so one cannot act out one’s dreams –Fights depression –Increases brain function • Clearer thinking • Ability to complete complex tasks Hormone Function • Growth hormone is suppressed. • Melatonin – A hormone secreted by the pineal gland, a pea- size structure in the center of the brain. • At night melatonin is produced to help regulate our sleep/wake cycles • As we age, the production decreases. Melatonin Cycle Melatonin Secretion to Measure Circadian Timing /ml) picograms Salivary Melatonin ( Melatonin Salivary Time of Day Neurochemicals • Gamma-Aminobutyric Acid (GABA) – Inhibitory neurotransmitter enhanced which quiets a person • Glutamate – Excitatory neurotransmitter is supressed • Adenosine – Signals suppression – Sleep hemostat Snoring • May be a sign of sleep apnea • Use a relaxation exercise • Do not study, do heavy reading, watch stressful TV • Avoid bright light in PM • Get into bright light in AM as oon as possible! Two Sleep Disorders To Be Aware Of 1. Sleep Apnea 2. Narcolepsy Sleep Apnea • Central: Caused by neurological issues • Obstructive: Caused by blocked airway • Results – Daytime tiredness – Tachycardia (possibly leading to heart attack – Depression • Recognition – Greater than size 16 neck shirt – Snoring – Daytime fatigue – Jerking at night Obstructive Sleep Apnea Causes • Daytime fatigue • Depression • Tachycardia (which may lead to a heart attack) Narcolepsy Moving directly from AWAKE to REM SLEEP • Result – FALLING ASLEEP any time, any where • Recognition – Taking unwilling mini naps – Not remembering (similar to a blackout) • With Cataplexy – Puddling - losing muscle control DSM IV-TR (Diagnostic Criteria 12 pages) SLEEP DISORDERS • Primary –Dyssomnias • Primary Insomia • Primary Hypersomonia • Narcolepsy • Breathing Related Sleep Disorder • Circadian Rhythm Sleep Disorder • Dyssomnia NOS DSM IV™ (Diagnostic Criteria 12 pages) SLEEP DISORDERS continued… – Parasomnias • Nightmare Disorder • Sleep Terror Disorder • Sleepwalking • Parsomnias MOS – Sleep Disorders relation to Other Mental Disorders • Insomnia Related to Axis I or Axis II • Hypersomnia Related to Axix 1 or Axis II – Other Sleep Disorders • Sleep disorders due to a general medical condition • Substance Induced Sleep Disorder DSM 5 (Diagnostic Criteria 29 pages) SLEEP – SLEEP WAKE 4 Divisions – 9 Divisions • DSM 5 –More detailed –Physiological/chemistry related • NB –Sleep Medicine will be a fellowship, not just a course for MDs. DSM 5 (Diagnostic Criteria – 29 pages SLEEP DISORDERS continued…) • Sleep Wake Disorders – Insomnia Disorder – Hypersomnolence Disorder – Narcolepsy • Breathing Related Sleep Disorders – Obstructive Sleep Apnea Hypopnea – Central Sleep Apnea – Sleep Related Hypoventilation – Circadian Rhythm Sleep-Wake Disorders DSM 5 (Diagnostic Criteria – 29 pages SLEEP DISORDERS continued…) • Parasomnias – Non Rapid Eye Movement Sleep Arousal Disorders – Nightmare Disorder – Rapid Eye Movement Sleep Behavior Disorder – Restless Legs Syndrome – Substance/Medication • Other Specified Insomnia Disorder • Unspecified Insomnia Disorder • Other Specified Hypersomnolence Disorder • Unspecified Hypersomnolence Disorder • Other Specific Sleep-Wake Disorder • Unspecified Sleep Wake Disorder Essential Sleep Hygiene • Do not work out just before bed time. • Go to bed when you are sleepy. • Keep naps to a minimum – 30 minutes before 2 pm MAX! • Keep bedtime snacks very light • Do not smoke at bed time. • Keep a regular sleep schedule. – Same time to retire – SAME TIME TO RISE! • If you are sleepy, go to bed earlier. • DO NOT SLEEP LATER! Bibliography • Benedik, K, Benedik, J. Sleep Issues With Adolescents (Lafayette, LA, LCA conference, 2004) • Brown, K, Hall, JM Effects of Age and Alcoholism on Sleep (www.ncbi.nlm.nih.lgov/pmcl/articles/pmc2981610) • Dement, William C. Vaughan, Christopher The Promise of Sleep (NY. Random House, 1999) • Doghrami, Karl, The Effects of Alcohol on Sleep (www.medscape.org/view_article1497982 ) • DSM IV-TR • DSM 5 • Roehrs, T., Roth T. Sleep, Sleepiness and Alcohol Use. (http://pubs.niaaa.nih.gov/publications/arh25-2/101-109.html ) .
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