Sleep Disorders  Insomnias • Dyssomnias also include disorders of initiating or        maintaining sleep – also known as Insomnia • Two broad types:  ◦ Problem with sleep onset – can't fall asleep  ◦ Problems with sleep maintenance – can't stay asleep • Must first tease out medical problems (e.g.,hyperthyroidism), psychological problems (e.g.,   anxiety, perhaps surrounding sleep), environmental factors (e.g., bed, temperature), and potential   medication issues Diagnosis & Treatment Insomnia is often diagnosed based on patient report (especially in case of problems with sleep initiation). Insomnia is an inability to initiate or maintain sleep, often coupled with decreased daytime functioning. It is usually long-standing condition, and often perseveres through emotional states. In other words, a person may have insomnia whether they are stressed or not. Insomnia is more common in females and in older adult population. It seems the ability to sleep (rather than need to sleep, as was previously thought) often decreases with age Must differentiate between Insomnia and other Dyssomnias, such as:               • Sleep State Misperception             ◦ Subjective complaint of insomnia & decreased functioning   ◦ Normal sleep latency and normal PSG                • Delayed Sleep Phase Syndrome (Circadian Rhythm Disorder)    ◦  Phase delay of sleep in relation to desired time of sleep    ◦ "Night owls"    ◦ Results in complaints of sleep onset insomnia                   or difficulty awakening at the desired time EDS frequent    ◦ Sleep log (chart to track sleep pattern) helps to diagnose    ◦ Often treated with light therapy (bright light box                   used for a certain amount of time each day)                   Insomnia is often treated with medications.                   Behavioral treatment of insomnia also used;                   involves making changes in sleep habits,                   aimed at being long-standing. Focus on                   reducing anxiety surrounding sleep. Stress                   management, relaxation training. Sleep                   restriction. Main focus is on Sleep Hygiene –                   healthy sleep habits for healthier sleep. Sleep Hygiene • Establish a regular routine that includes going                to bed and getting up at the same time every day. • Get an adequate amount of sleep every night.                Determine the amount of sleep you need by                keeping track of how long you sleep without                using an alarm clock for a week. Maintain this                "personal" sleep requirement. • Go to bed when you are sleepy. If you have                difficulty falling asleep or wake up shortly after                going to sleep, leave the bedroom and read                quietly or do some other relaxing activity. • Develop sleep rituals before going to bed. Do                the same things to cue your body to relax. • Avoid stress and worries at bedtime. Allow a                "worry time." • Use your bed for sleeping and sex only. Often,                doing other activities in bed like watching TV,                paying bills, or working only serve to initiate                worries and concerns. Let your mind associate                the bed with sleeping. • Avoid heavy meals late in the evening; similarly,               avoid going to bed hungry. A light snack,               especially dairy foods, can help you sleep (e.g.,               warm milk). • Reduce your intake of caffeine and nicotine 4-6                hours before going to sleep. • Avoid alcohol 4-6 hours before bedtime. As a                depressant that slows brain activity, alcohol                                              may initially make you tired, but you will end up                having fragmented sleep. Alcohol also                aggravates snoring and sleep apnea. • Exercise regularly. Regular exercise, even for                20 minutes, 3 times a week, promotes deep sleep. • Don't nap for more than 30 minutes or after 3                p.m. Avoiding naps all together will ensure that                you are tired at night. Longer naps disrupt the                body's ability to stay asleep. • Maintain a dark, quiet, and cool room to sleep in. • Use sleeping aids conservatively, and avoid                using them for more than one or two nights per                           month. Avoid sleeping pills altogether if you                have obstructive sleep apnea; it can be a deadly                 combination.