Important truths ___________________________ Sleep issue are regular Sleep issue are not kidding Sleep issue are treatable Sleep issue are under analyzedSlide 3
Important realities ___________________________ Sleep grievances are generally not because of psychiatric conditions or character blemishes Most rest issue are promptly diagnosable and treatable The reviews incorporate Polysomnography (PSG) Multiple rest inertness test (MSLT) ActigraphySlide 4
Wake System ___________________________Slide 5
Sleep System ___________________________Slide 6
Sleep Wake Cycle ___________________________Slide 7
Changes in lay down with age ___________________________Slide 8
Stages of rest ___________________________ NREM Sleep A. Organize 1 B. Arrange 2 C. Arrange 3 D. Arrange 4 2. REM SleepSlide 9
Wake 2/3 of life REM Sleep ~20% of night NREM Sleep ~80% of night Sleep Stages ___________________________Slide 10
Sleep issue (ICSD 2) ___________________________ Insomnia. Rest Related Breathing Disorders. Hypersomnia. Cicadian Rhythm Sleep Disorder. Parasomnia. Rest related Movement Disorder.Slide 11
Insomnia - definition ___________________________ Insomnia and over the top daytime tiredness are essential protestations paying little mind to the phase of the illness Insomnia incorporates trouble nodding off, trouble staying unconscious, and early morning arousingSlide 12
Insomnia - definition ___________________________ Insomnia is not characterized by the quantity of hours of rest, but instead, by an individual\'s capacity to rest sufficiently long to feel solid and alarm amid the day. The typical necessity for rest goes somewhere around 4 and 10 hours Insomnia is a manifestation, not a turmoil without anyone else\'s inputSlide 13
Insomnia - appraisal ___________________________ Determine the example of rest issue (recurrence, related occasions, to what extent it takes to go to rest, and to what extent the patient can stay unconscious) Include a full history of liquor and caffeine admission and different variables that may influence rest Review current solutions that patient is taking to dispose of these as conceivable causes Take a history to discount physical cause as well as psychosocial causeSlide 14
Cognitive Model of InsomniaSlide 15
Evolution of InsomniaSlide 16
Possible reasons for a sleeping disorder ___________________________Slide 17
Insomnia ___________________________ An objection of trouble in starting, keeping up or awakening too soon or rest that is non-therapeutic or poor in quality. The above rest trouble happens in spite of satisfactory open door and condition for rest. A sleeping disorder is a manifestation – not an ailment in essenceSlide 18
Insomnia – related elements ___________________________ At slightest (at least one) of the accompanying Fatigue or discomfort Attention, fixation hindrance Social/professional brokenness/poor work Mood unsettling influence or touchiness Daytime drowsinessSlide 19
Insomnia – resultant issues ___________________________ Reduction in inspiration, vitality or activity Proneness for mistakes or mishaps at work or while driving Tension, migraines or gastrointestinal indications because of rest misfortune Concerns or stresses over rest Secondary psychiatric issuesSlide 20
Insomnia - subdivisions ___________________________ Sleep onset a sleeping disorder Sleep support a sleeping disorder Sleep counterbalance a sleeping disorder Non remedial restSlide 21
Types of a sleeping disorder ________________________ Transient a sleeping disorder < 4 weeks activated by fervor or stress, happens when far from home Short-term 4 wks to 6 mons , continuous worry at home or work, therapeutic issues, psychiatric ailment Chronic Poor rest each night or most evenings for > 6 months, mental elements (pervasiveness 9%)Slide 22
Medical issues __________________________ Depression Hyperthyroidism Arthritis, interminable torment Benign prostatic hypertrophy Headaches; Sleep apnoea Periodic leg development, Restless leg disorder (RLS)Slide 23
Other issues __________________________ Caffeine Nicotine Alcohol Exercise Noise Light HungerSlide 24
Management of a sleeping disorder ____________________________ Good Sleep History Rule out essential psychiatric issue Rule out antagonistic impacts of drugs Sleep Diary Good Sleep Hygiene Measures Interventions – CB treatment, medicinesSlide 25
Management of a sleeping disorder ___________________________ Treat basic causes at whatever point conceivable Advise patient to maintain a strategic distance from work out, substantial dinners, liquor, or struggle circumstances just before bed Plain ibuprofen or paracetamol in low dosages might be useful; or give short-acting hypnotics or a calming Treat fundamental discouragementSlide 26
Management of a sleeping disorder ___________________________ Treat basic Medical Condition Treat basic Psychiatric Condition Improve rest cleanliness Change environment CBT: \'essential sleep deprivations\', transient a sleeping disorder Pharmacological Light, melatonin, or " chronotherapy " for circadian issueSlide 27
Medications and a sleeping disorder ___________________________Slide 28
Cognitive Behavior Therapy (CBT) ____________________________Slide 29
Non pharmacological medicationsSlide 30
Bed room __________________________ Temperature Fresh air S&S Comfortable bedSlide 31
Stimulus control __________________________ Go to bed when tired Only S & S in room Get up a similar time each morning Get up when rest onset does not happen in 20 min, and go to another room No daytime snoozingSlide 32
Sleep cleanliness __________________________ Behaviors that meddle with rest Caffeine Alcohol Nicotine Daytime resting Exercise < 4hrs preceding bedSlide 33
Relaxation preparing __________________________ Progressive muscle unwinding Diaphragmatic breathing Autogenic preparing Biofeedback Meditation, Yoga Hypnosis to ↓ nervousness & pressure at sleep timeSlide 34
Thought ceasing __________________________ Interrupt undesirable pre-rest intellectual movement by educating patient to rehash sub-vocally "the" each 3 sec (articulatory concealment) To holler sub-vocally "stop" (thought halting)Slide 35
Behavioral treatments __________________________ Explicit direction to remain wakeful when they go to bed; Aim is to decrease uneasiness connected with attempting to nod off – Paradoxical aim Alter unreasonable convictions about rest, give precise data that balances false convictions – Cognitive rebuilding Patient envisions 6 basic items (flame, kite, organic product, hourglass, writing board, light) accentuation on envisioning shape, shading, surface – Imagery preparingSlide 36
Benzodiazepine receptor agonists __________________________ Non Benzodiazepines Zolpidem CR Zeleplon Eszopiclone Both these classes follow up on the GABA A receptors ( BzRA ) in PCN Benzodiazepines Lorazepam Clonezepam Temazepam Flurazepam Quazepam Alprazolam Triazolam EstazolamSlide 37
Other classes of meds __________________________ Melatonin Receptor Agonists Melatonin Ramelteon Miscellaneous Valerian Diphenhydramine Cyclobenzaprine Hydroxyzine Alcohol Antidepressants Trazadone Mirtazapine Doxepin Amitryptyline Antipsychotics Olanzapine QuitiepineSlide 38
BzRAs – reactions and security __________________________ Anterograde amnesia Residual sedation – longer acting BzRAs Rebound Insomnia? Mishandle and reliance? Generally utilized short term (2 weeks) When utilized as a tranquilizer dosage acceleration uncommon No physical reliance with evening time utilize Low mental reliance with evening use Increased fall hazard, psychological impacts in the elderlySlide 39
Benzodiazepines ____________________________ Benzodiazepines (GABA receptor agonist) Transient a sleeping disorder, (max 2 wks, preferably 2-3/wk) Long ½ life - nitrazepam Medium ½ life - temazepam Short ½ life - diazepam Poor practical day time status, intellectual hindrance, daytime languor, falls and mishaps, wretchedness Acute withdrawal, perplexity, psychosis, fits - may happen up to 3/52 from haltingSlide 40
Benzodiazepine utilize ____________________________ Benzodiazepines are the medications of decision for the treatment of a sleeping disorder. Flurazepam can be utilized for up to one month with little resistance. Temazepam can be utilized for up to three months with little resistance. Irregular utilize suggested (at regular intervals). Use for no longer than 3 – 6 months.Slide 41
Benzodiazepine utilize ____________________________ Half-life is an essential element Benzodiazepines with long half lives (e.g., flurazepam) deliver supported rest, however expanded danger of daytime drowsiness Benzodiazepines with short half lives might be best for patients with trouble nodding off, yet can create bounce back a sleeping disorder Development of resistance can deliver bounce back a sleeping disorder in mixes with short half livesSlide 42
Benzodiazepine manhandle ____________________________ Benzodiazepines have generally low mishandle potential. Drawn out utilize can prompt to withdrawal side effects: cerebral pain, peevishness, discombobulation, irregular rest Rebound a sleeping disorder - triazolamSlide 43
Benzodiazepine poisonous quality ____________________________ Low lethality when taken alone In blend can be deadly Flumanzenil is a benzodiazepine foe that can be utilized to square antagonistic impacts of benzodiazepines Stomach pump, charcoal, hemodialysisSlide 44
Non benzodiazepines ____________________________ Act at the benzodiazepine receptor Less danger of reliance Zaleplon short ½ life Zolipidem, Zopiclone somewhat longer ½ life No distinction in viability & wellbeing More costly Only to be utilized if unfriendly impacts to BZPSlide 45
Zolpidem ____________________________ Short half life Does not create bounce back a sleeping disorder Low manhandle potential Less prone to deliver withdrawal indications Rebound a sleeping disorder after first night of withdrawal, yet soon settle .:tslid
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