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A Case Study of Various Sleep Disorders

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Sleep Disorders

Dyssomnias are characterized by the amount, quality and/or timing of sleep. The five specific types of dyssomnias are: primary insomnia, primary hypersomnia, narcolepsy, breathing-related sleep disorder, and circadian rhythm sleep-wake disorder. People with insomnia have an ongoing difficulty with falling asleep, remaining asleep, or achieving restorative sleep for a month or longer. The sleep disturbance causes levels of personal distress and difficulties performing usual, social, occupational and other roles. There is a link between insomnia and other psychological problem like anxiety and depression. Insomnia is the most common form of sleep disturbance although the prevalence is unknown. People with insomnia have a tendency of bring their anxieties and worries to bed with them, which raises their bodily arousal to a level that prevents natural sleep. Individuals with hypersomnia have a pattern of excessive sleepiness during the day that continues for a month or longer. Hypersomnia makes it difficult to wake up after a prolonged sleep period and may cause a pattern in daytime sleep episodes that occur daily. Although the person may take naps during the day they will not feel refreshed upon awakening. This disorder is considered primary because it cannot be accounted for by inadequate amounts of sleep due to insomnia, psychological or physiological disorders, drug/medication use and other factors such as loud neighbours. A person with primary hypersomnia had more persistent and severe periods of sleepiness that leads to a difficulty in daily functioning. People with narcolepsy experience sleep attacks in which they suddenly fall asleep without any warning throughout the day. The person remains asleep for about fifteen minutes and can be having a conversation one moment and fast asleep the next. This diagnosis is made when sleep attacks happen daily for three months or longer and is combined with the conditions such as: cataplexy, intrusions of rapid eye movement sleep and hypocretin deficiency. People with narcolepsy may also experience sleep paralysis which is a temporary state following awakening in which the person feels incapable to move or talk. The person may also experience terrifying hallucinations called, hypnagogic hallucinations. Individuals with breathing-related sleep disorders experience frequent disruptions during sleep due to respiratory issues. These disruptions eventually result in insomnia and daytime sleepiness. Frequent disruptions during sleep will make the individual very sleep the follow day, which makes it difficult to function. People with this disorder gasp for air during sleep many times and are unaware of it. Breathing-related sleep disorder may also cause high blood pressure, heart attacks, strokes and even sudden death. Circadian rhythm sleep-wake disorder is characterized by disruption of sleep due to mismatch of sleep schedules between the bodies internal sleep-wake cycle. The disruptions in the sleep pattern can lead to insomnia and hypersomnia. Frequent changes in time zones and work shifts can cause more persistent issues to adjust sleep pattern scheduling which will cause Circadian rhythm sleep-wake disorder.

Parasomnias are abnormal behaviours or physiological events taking place during sleep or at the threshold between wakefulness and sleep. Common parasomnias include nightmare disorder, sleep terror disorder and sleepwalking disorder. People diagnosed with a nightmare disorder experience recurrent awakenings from sleep because of nightmares. These nightmares are long, story-like dreams that include threats of physical danger i.e being chased, injured or attacked. When people awake they remember their nightmare and may experience anxiety and fear, making it difficult to fall back asleep. Nightmares are associated with traumatic experiences and tend to occur more when the person is feeling stressed. Sleep terror disorder is highly common with children. When experiencing a sleep terror children may be sitting up, frightened, and profusely sweating. Sleep terror disorder involves episodes of sleep terrors that result in abrupt awakenings and begin with a loud scream. If awakenings occur during a sleep terror the individual will appear confused and disoriented for a few minutes. The person may feel a vague sense of terror and will be able to report some parts of their dream, but not the sort of detailed dreams typical of nightmares. The individual does fall back asleep and remembers nothing of the experience in the morning. Sleep terror disorder in children is usually outgrown during adolescence. In adults, the disorder tends to follow a chronic course during which the frequency and intensity of the episodes waxes and wanes over time. The cause of sleep terror disorder remains a mystery. Individuals with sleepwalking disorders have episodes in which they arise out of bed and walk around the house while remaining fully asleep. These episodes tend to happen during deeper stages of sleep where there is an absence in dreaming. The repeated episodes of sleepwalking may cause significant levels of personal distress or impaired functioning. The causes of sleepwalking are still unknown, however genetic and environmental factors are believed to be involved. Although sleepwalkers usually avoid walking into things, accidents may still occur. When an individual awakens, they usually have little if any recall of the experience. If they are awakened during the episode, they may feel disoriented or confused for a while but full alertness is soon restored. Sexsomnia is distinct from pure sleepwalking and involves sexual behaviour, which can include sexual activity with other people, while asleep.

The most common pharmacological method for treating sleep-wake disorders in Canada is the use of sleep medications called anxiolytics. However, there are many issues that come with using these drugs. Many different anti-anxiety drugs are frequently used to treat insomnia, including a class of minor tranquilizers called benzodiazepines (halcion, restoril and dalmane). When used for the short-term treatment of insomnia, anxiolytics are effective in reducing the amount of time it takes to get to sleep. There are many negative effects of these drugs such as adverse side effects and dependence if used regularly. Problems with using drugs to combat insomnia is that it tends to suppress REM sleep, which may interfere with some of the restorative functions of sleep. They may also lead to a carryover, which is associated with daytime sleepiness and reduced performance. Rebound insomnia can follow discontinuation of the drug, which causes worse insomnia than before. Rebound insomnia can be lessened by tapering off the drug instead of abruptly discontinuing it. High doses of these drugs can be dangerous, especially if they are mixed with alcohol. Regular use can also lead to physical dependence. Once dependence is established, withdrawal symptoms include agitation, tremors, nausea, headaches and in severe cases delusions. Individuals may also become psychologically dependent on sleeping pills. People can develop a psychological need for the medication and will assume that without it, they will not be able to sleep. These drugs should only be used for a brief amount of time and tend to have no long-term benefits after withdrawal. Cognitive-behavioural interventions have produced many benefits in treating chronic insomnia, measured by both reductions in sleep latency and improvement of sleep quality.

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