Sleep & Sexual Disorders (psych)

What is the recommended amount of sleep the academy of sleep medicine recommends? - 7 hours What are the two normal phases of sleep? - Non-rapid eye movement and rapid eye movement Muscle atonia and dreaming occur during what phase of sleep? - REM Stage one or being drowsy in sleep will show what wave shapes - Theta Stage three, four - also known as delta sleep will show what waves - Delta waves What stages of sleep do night terrors and sleepwalking most often occur? - Stage three and four What regulates timing of sleep and wakefulness? - Circadian biological clock When do we experience both are biggest dips in circadian rhythm causing us to experience our strongest sleep drive? - Between 2:00 and 4:00 am and between 1:00 and 3:00 pm What process balances sleep and wakefulness - sleep/wake restorative process Does cortisol increase while we sleep or while we are awake? - Rises and peaks while we sleep and slowly decreases throughout the day What hormone spikes between 10pm and 2 am? - Growth hormone What sleep hormone slowly rises throughout the day? - Melatonin Does sleep efficiency increase or decrease as we age? - Decrease Effects of sleep deprivation - Decreased cognition Decreased performance Decreased perceptions Changes in leptin and ghrelin levels (appetite) Insulin resistance? Besides impairing function or having dissatisfaction with sleep quality or quantity, how long does sleep difficulty have to occur for before giving a diagnosis of insomnia disorder? - Sleep difficulty occurs at least 3 nights per week Sleep difficulty presents for at least 3 months What is somatized tension and learned sleep preventing associations known as? - Psychophysiological insomnia Polysomnography is not is not indicated for the routine evaluation of insomnia. When should you consider polysomnography? - Provider suspects sleep apnea, periodic limb movements, or parasomnias Insomnia treatment failure Pharmacologic treatments for insomnia - Antihistamines Sedating antidepressants Benzodiazepines Imidazopyridines Anticonvulsants Atypical antipsychotics Insomnia antihistamine treatment - Benadryl, doxylamine No prescription needed Probable tolerance with repeated use Melatonin and insomnia - Questionable hypnotic effect Not regulated by DEA Insomnia treatment: sedating antidepressants - Doxepin, Trazodone, mirtazapine (remeron), amitriptyline Who are sedating antidepressants good for when treating insomnia? - Beneficial for patients experiencing chronic insomnia secondary to depression Insomnia treatment benzodiazepines (just listing whats on the slide) - SHORT TERM USE ONLY Good hypnotic effect Anxiolytic effects Muscle relaxant effects Potential for abuse Reduces stage 3/4 Rebound insomnia Anterograde amnesia Cognitive and psychomotor performance reduction Insomnia treatment, Zolpidem (ambien, intermezzo) - Rapid sleep onset Has no effect on sleep architecture Minimal side effects and drug/drug interactions When should you take zolpidem? - Make sure it is taken at the time of going to bed (get into bed and take it) What insomnia treatment drug can you use if you only have four hours to sleep? - Zaleplon, half life of 1 hour Could be habit forming What drug has FDA approval for chronic insomnia? - Lunesta - Eszopiclone Narcolepsy is characterized by excessive sleepiness that typically is associated with... - Cataplexy Sleep paralysis Hypnagogic hallucinations Nocturnal sleep disruption How do we diagnose narcolepsy? - Multiple sleep latency test showing low sleeponset latency and 2+ sleep-onset REM periods Levels of ________ are low in cerebrospinal fluid analysis - Hypocretin How do we treat narcolepsy if we do not have to worry about cataplexy? - Modafinil - provigil How do we treat narcolepsy if we also need to treat cataplexy? - Sodium oxybate - xyrem What are other narcolepsy treatments we can use? - Stimulants - methylphendiate, dexedrine scheduled naps How can we treat advanced or delayed sleep phase types? - Chronotherapy Light therapy Melatonin Shift work as a lot of issues, what two were highlighted? - Sleepiness Digestive & GI problems Others: Depression, stress, anxiety, divorce, increased smoking, more errors, accidents, CVD, high cholesterol, possible carcinogen How to treat shift work sleepiness? - Keep regular sleep wake patterns as much as possible 7 days a week Napping Medication What medications can we use to treat shift work sleepiness? - Modafinil or armodafanil Other stimulants or hypnotics Parasomnia: non-REM sleep arousal disorder - Sleepwalking Sleep terrors