Psy3032 - Abnormal Psychology Week 5 Sleep

Front 1

What are the five characteristics of normal sleep?

Back 1

1. A period of crescence common to all species
2. It involves stereotypical body posture
3. It is an active dynamic state
4. It is cyclical
5. It has a recovery role for optimal functioning

Front 2

What proportion of our life do we spend sleeping?

Back 2

One third

Front 3

What are the two major processes in the 2 process model of sleep that govern our sleep quality and quantity?

Back 3

1. Homeostatic regulation
2. Circadian rhythms

Front 4

Does the homeostatic sleep drive increase or decrease throughout the day? at night?

Back 4

Increases during the day when we are awake
Decreases during the night when we are asleep

Front 5

What is the homeostatic sleep drive?

Back 5

the propensity to sleep

Front 6

What is the circadian rhythm?

Back 6

the wake propensity

Front 7

What four aspects of sleep as we age?

Back 7

1. Fall asleep earlier
2. More awaking during night
3. Less slow wave sleep
4. Less quantity of sleep

Front 8

What three main measures used in polysomnography? and hat do they measure?

Back 8

1. EEG: electroencephalography - brain activity
2. EOG: electrooculography - eye movement
3. EMG: electromyography - muscle activity

Front 9

What happens to muscle activity during REM?

Back 9

The brain sends a descending signal during REM to inhibit muscle movement

Front 10

What are the three diagnostic criteria used to categorise sleep disorders? Who are the primary users of each?

Back 10

1. ICD-10 (Physicians & Medics)
2. ICSD (Sleep scientists & sleep psychologists)
3. DSM-IV-TR (Psychologists)

Front 11

What are the two main categories of sleep disorders in the DSM-IV-TR?

Back 11

1. Dyssomnias
2. Parasomnias

Front 12

What are the potential changes proposed for sleep disorders in the DSM-5?

Back 12

1. change in terminology
2. change in organisation
3. inclusion of disorder of arousal

Front 13

What term is used to describe disorders of initiating or maintaining sleep or of excessive daytime sleepiness, and are characterised by a disturbance in the amount, quality, or timing of sleep?

Back 13

Dyssomnias

Front 14

What are the three major groups of dyssomnias?

Back 14

1. Intrinsic sleep disorders - internal stressors
2. Extrinsic sleep disorders - external stressors
3. Circadian rhythm disorders - circadian disruption

Front 15

In the UK study what were the two most commonly reported psychological problems? and what gender differences were found?

Back 15

sleep and fatigue
women were overrepresented

Front 16

What are the 5 criteria in the DSM-IV-TR for primary insomnia?

Back 16

1. Problems with initiation/maintenance of sleep (1 month)
2. Clinically significant distress/impairment in social/cognitive functioning
3. Disturbance is not due to another sleep disorder
4. Disturbance is not due to a mental disorder
5. Disturbance not associated with a general medical condition

Front 17

What four disturbances may people with primary insomnia have repeated difficulty with?

Back 17

1. Sleep initiation

2. Sleep consolidation

3. Sleep quality

4. Daytime impairment

Front 18

What is the prevalence rate of primary insomnia?

Back 18

5 to 15% of the population

Front 19

What is the prevalence rate of transient insomnia over the lifetime in the general population?

Back 19

25 to 35%

Front 20

What was found in the study by Ohayon (2002) that suggests insomnia is under-diagnosed?

Back 20

30% reported insomnia symptoms
9-15% reported insomnia symptoms with daytime sleepiness
8-18% reported sleep dissatisfaction
only 6% diagnosed with insomnia

Front 21

What are the six main types of primary insomnia?

Back 21

1. Psychophysiologic Insomnia
2. Sleep State misperception (paradoxical insomnia)
3. Idiopathic Insomnia
4. Inadequate Sleep Hygiene
5. Adjustment Sleep Disorder
6. BEhavioural insomnia of childhood

Front 22

What is the most common form of insomnia that is characterised by a heightened level of arousal with learned sleep-preventing associations, along with overconcern with the inability to sleep. ie checking email at 3am

Back 22

Psychophysiologic Insomnia

Front 23

What sleep disorder is the complaint of severe insomnia that occurs without evidence of objective sleep disturbance and without daytime impairment to the extent that would be suggested by the amount of sleep disturbance reported?

Back 23

Sleep State Misperception (Paradoxical Insomnia)

Front 24

What is the insomnia that is associated with a specific psychological, physiologic, environmental or physical stressor that usually resolves when the stressor is no longer present?

Back 24

Adjustment Sleep Disorder

Front 25

What is the sleep disorder associated with common daily activities that are inconsistent with good-quality sleep and full daytime alertness such as irregular sleep onset and wake times, stimulating and alerting activities before bedtime, and substances ingested around sleep time?

Back 25

Inadequate Sleep Hygiene

Front 26

What is the long standing form of insomnia that appears to date from childhood and has and insidious onset with typically no factors associated with the onset, and is persistent and without periods of remission?

Back 26

Idiopathic Insomnia

Front 27

Which type of primary insomnia includes limit setting disorder and sleep-onset association disorder?

Back 27

Behavioural insomnia of childhood

Front 28

What sleep disorder is the stalling or refusing to go to sleep that is eliminated once a caretaker enforces limits on sleep times and other sleep-related behaviours?

Back 28

Limit-setting sleep disorder

Front 29

What sleep disorder occurs when there is a reliance on inappropriate sleep associations, such as rocking, watching V, holding a bottle or other object, or requiring environmental conditions such as a lighted room or an alternative place to sleep?

Back 29

Sleep onset association disorder

Front 30

What are some possible reasons that woman are overrepresented in sleep statistics

Back 30

1. Men under report sleep problems
2. Anxiety and mood disorders affecting sleep more prevalent in woman
3. Woman may be lighter sleepers
4. Woman are usually the main caretaker of young children who wake during the night

Front 31

What are the three types of risk factors for insomnia outlined in Spielman et al's (1987) model?

Back 31

Predisposing, Precipitating and Perpetuating

Front 32

According to Spielman et al, what effect fo predisposing factors have on insomnia? provide examples

Back 32

Individual differences, psychological and biological characteristics within a individual that make them vulnerable to insomnia
e.g. anxiety & hyperarousal

Front 33

According to Spielman et al, what effect do precipitating risk factors have on insomnia? provide examples

Back 33

Precipitating risk factors are the triggers that trigger insomnia
e.g. life event, divorce, medical, exams, environmental events, grief, illness, pain etc

Front 34

According to Spielman et al, what effect do perpetuating risk factors have on insomnia? provide examples

Back 34

Maintain or exacerbate insomnia
e.g. extending time in bed, nap during the day, excessively worry about their sleep.

Front 35

Which combinations three types of risk factors for insomnia outlined in Spielman et al's (1987) model result in acute versus chronic insomnia?

Back 35

Predisposing + precipitating = Acute transient insomnia

Chronic insomnia involves all three factors

Front 36

What are 5 main consequences of insomnia?

Back 36

1. increases in reported pain, emotional effects, and mental health
2. Increased risk of occupational accident risk
3. Decreased work productivity
4. Mood disorder relapse
5. Changes in brain function

Front 37

What reported differences were found in the study by Katz et al (2002) between people with insomnia and people with congestive heart failure?

Back 37

People with insomnia reported more pain, emotional effects and mental health issues than people with congestive heart failure

Front 38

How much more likely are people with insomnia to have a accident?

Back 38

2.5 to 4.5 times more likely

Front 39

What percentage of people who relapse into mood disorder have insomnia?

Back 39

56.2%

Front 40

What changes in brain functioning has been found in insomniacs on PET scans?

Back 40

hyperarousal and enhanced metabolic rates in both sleep and wake cycles

Front 41

What are the two main insomnia sub-types?

Back 41

Primary & Secondary Insomnia

Front 42

What is primary insomnia?

Back 42

insomnia not associated with a known physical or psychological disorder

Front 43

What is secondary insomnia?

Back 43

insomnia caused by 'co-morbid' physical or psychological state

Front 44

What is the difference in the way you treat primary versus secondary insomnia?

Back 44

Primary treat the insomnia. Secondary treat the underlying issue

Front 45

What are treatment options for primary insomnia?

Back 45

1. CBT
2. Sleep restriction - increase sleep drive throughout the day
3. Stimulus control - remove all objects in the bedroom that impact on sleep
4. Relaxation techniques - progressive muscles relaxation
5. Sleep hygiene education

Front 46

What is the most prevalent symptom in more than 60% of people with major depression?

Back 46

insomnia

Front 47

What are the five main types of dyssomnias?

Back 47

1. Primary Insomnia
2. Primary Hyper-insomnia
3. Narcolepsy
4. Breathing related sleep disorder
5. Circadian Rhythm Sleep Disorder

Front 48

Which disorders are those in which the primary complaint is daytime sleepiness and the cause of the primary symptom is not disturbed nocturnal sleep or misaligned circadian rhythm?

Back 48

Primary Hypersomnia

Front 49

Which rare neurological sleep disorder involves excessive daytime sleepiness, hypersomnolence, food cravings, and hypersexuality?

Back 49

Kleine-Levin Syndrome

Front 50

Bouts of sleeping for up to 20 hours a day is known as what?

Back 50

hypersomnolence

Front 51

Describe idiopathic hypersomnia.

Back 51

excessive daytime sleepiness of unknown cause

Front 52

The three diagnostic criteria for Narcoplepsy?

Back 52

1. Daily sleep attacks (3 months)
2. Cataplexy and/or REM intrusion between sleep/wake
3. Not due to another sleep disorders and/or medication

Front 53

The name of the condition where muscle tone is lost.

Back 53

cataplexy

Front 54

The prevalence of Narcolepsy

Back 54

less that 1%

Front 55

When do hypnogogic hallucinations occur?

Back 55

at sleep onset

Front 56

What are hallucinations that occur at sleep onset called?

Back 56

hypnogogic hallucinations

Front 57

What are the main noticeable symptoms of narcolepsy that clinicians look for when diagnosing narcolepsy?

Back 57

1. Excessive daytime sleepiness - 2-6 episodes/day
2. Cataplexy - can develop
3. Hypnogogic hallucinations
4. Sleep paralysis

Front 58

What is the biggest risk factor of cataplexy?

Back 58

Injury to self

Front 59

What are hypnogogic hallucinations?

Back 59

vivid imagery at sleep onset

Front 60

When do hypnopompic hallucinations occur?

Back 60

at sleep offset

Front 61

What percentage of narcoleptics have hypnogogic hallucinations?

Back 61

40%

Front 62

What percentage of narcoleptics have sleep paralysis?

Back 62

30%

Front 63

What is paralysis at sleep offset called?

Back 63

sleep paralysis

Front 64

What can trigger cataplexy?

Back 64

intense emotions

Front 65

What was identified in 90% of people with narcolepsy to be low or not present?

Back 65

A neuropeptide

Front 66

What are the two main pharmacological treatments for narcolepsy?

Back 66

Stimulants such as ritalin and Xyrem (GHB- date rape drug)

Front 67

What is the psychological treatment for narcolepsy?

Back 67

Sleep hygiene measures including planned napping, regular sleep hours, avoid sleep deprivation, avoid stimulants, promote exercise and management of emotions.

Front 68

What is the sleep disorder characterised by recurrent episodes of stopped breathing or low respiration throughout sleep is called?

Back 68

Apnea or breathing related sleep disorder

Front 69

What is apnea versus hypopnea?

Back 69

Hypopnea is low respiration and apnea when breathing is stopped.

Front 70

Three types of Sleep Apnea, and their prevalence and cause

Back 70

1. Central (15%) - central nervous system
2. Obstructive (85%) - structural tongue/adnoids, excessive wight
3. Mixed (<1%)

Front 71

OSA stands for what?

Back 71

Obstructive Sleep Disorder

Front 72

What are the causes of OSA?

Back 72

Weight and structural problems

Front 73

What are the main indicators (risk factors) of OSA?

Back 73

excessive daytime sleepiness and snoring

Front 74

Explain CPAP - the main treatment for OSA

Back 74

Continuous Positive Airway Pressure

Front 75

What are sleep disorders are a persistent or recurrent misalignments between the persons sleep pattern and the pattern that is desired or regarded as the societal norm?

Back 75

Circadian Rhythm Sleep Disorders

Front 76

What are the 4 main criteria for Circadian Rhythm Sleep Disorder?

Back 76

1. Persistent sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch schedule and circadian timing
2. Sleep disturbance causes clinically significant distress or impairment
3. Does not occur exclusively during the course of another sleep disorder or other mental disorder
4. Is not sue to the direct physiological effects of a substance or a general medical condition

Front 77

What are the 6 main types of circadian rhythm sleep disorders?

Back 77

1. Time-Zone change (jet lag) syndrome
2. Shift work sleep disorder
3. Irregular sleep-wake pattern
4. Delayed sleep phase syndrome
5. Advanced sleep phase syndrome
6. Non 24-hour sleep-wake disorder (free-running type)

Front 78

What is the sleep disorder that is related to a temporal mismatch between the timing of the sleep-wake cycle generated by a rapid change in time zones?

Back 78

Time-Zone change (jet lag) syndrome

Front 79

What is the sleep disorder that is characterised by complaints of insomnia or excessive sleepiness that occur in relation to work hours that are scheduled during the usual sleep period?

Back 79

Shift work sleep disorder

Front 80

What is the sleep disorder not resulting from a known physiologic condition that involves irregular or unconventional sleep-wake patterns that can be the result of social, behavioural, or environmental factors?

Back 80

Irregular sleep-wake pattern

Front 81

What is the sleep disorder commonly seen in adolescents that is characterised by a delay in the phase of the major sleep period in relations to the desired sleep time and wake time?

Back 81

Delayed sleep phase syndrome

Front 82

What is the sleep disorder commonly seen in older adults that is characterised by a advance in the phase of the major sleep period in relations to the desired sleep time and wake time?

Back 82

Advanced sleep phase syndrome

Front 83

What is the sleep disorder occurs because there is a lack of entrainment to the 24-hour period, and the sleep pattern often follows that of an underlying free-running pacemaker with a sequential shift in daily sleep pattern?

Back 83

Non 24-hour sleep-wake disorder (free-running type)

Front 84

What type of sleep disorders are characterised by undesirable physical or experiential events that accompany sleep?

Back 84

parasomnias

Front 85

What stage of sleep are parasomnias associated with?

Back 85

any stage

Front 86

Three main categories or parasomnias?

Back 86

1. Disorders from REM
2. Disorders from Arousal/NREM
3. Other

Front 87

Prevalence of parasomnias

Back 87

4%

Front 88

MAin reasons why people with parasomnia seek a diagnosis?

Back 88

1. Harm to self or others
2. Excessive daytime sleepiness
3. Legal implications
4. Disruption to family

Front 89

The prevalence of nightmares versus Nightmare Disorder?

Back 89

85% one nightmare/year whereas 5% one nightmare/week

Front 90

The 4 diagnostic criteria for Nightmare Disorder?

Back 90

1. Repeated occurrence of frightening dreams
2. Fully alert upon awakening
3. Significant impairment
4. Not exclusive to another disorder

Front 91

What are suggested causes of Nightmare Disorder?

Back 91

stress, anxiety, PTSD, and medication

Front 92

In what stage of sleep does Nightmare Disorder occur?

Back 92

REM

Front 93

What are the treatment options for Nightmare Disorder?

Back 93

1. CBT
2. Re-end dream
3. medication to reduce arousal

Front 94

What sympathetic activity occurs in Nightmare Disorder?

Back 94

Increased HR, blood pressure, and sweating

Front 95

What parasomnia occurs from SWS and is associated with a cry or piercing scream accompanied by autonomic nervous system activation and behavioural manifestation of intense fear?

Back 95

Sleep terrors (night terrors)

Front 96

What are the 6 diagnostic criteria for Sleep Terrors?

Back 96

1. Abrupt awakening from sleep
2. Episodes accompanied by intense fear and autonomic response
3. Unresponsive to waking and comfort
4. No recall of dream - amnesia for episode
5. Causes significant distress
6. Not exclusive to another disorder

Front 97

In what part of the night do sleep terrors typically occur?

Back 97

first third

Front 98

In what stage of sleep do sleep terrors occur?

Back 98

stages 3 & 4 SWS

Front 99

What is often comorbid with sleep terrors?

Back 99

sleepwalking

Front 100

Prevalence of sleep terrors

Back 100

1-6% in children, <1% in adults

Front 101

Typical onset of sleep terrors

Back 101

4-12 yo in children, 20-30 yo in adults

Front 102

Treatment options for Sleep Terrors?

Back 102

- avoid excessive sleepiness
- avoid hyperarousal before bedtime
- avoid eating in the bed
- reduce the chance of injury
- avoid waking them
- scheduled waking before typical time of sleep terror

Front 103

What should you not do to people with sleep terrors?

Back 103

wake or touch them

Front 104

What is the parasomnia involving a series of complex behaviours that occur from sudden arousal from SWS and result in walking behaviour during a state of altered consciousness?

Back 104

Sleep walking

Front 105

What are the 4 diagnostic criteria for Sleep Walking?

Back 105

1. Complex motor movement during (SWS) sleep
2. Reduced alertness and responsiveness
3. Limited recall of events if awaken
4. After the episode, regain full cognition and appropriate behaviour

Front 106

Prevalence of sleep walking

Back 106

1-5% and 10-30% of children

Front 107

Between what ages does the prevalence of the sleep waling peak?

Back 107

8-12 yo

Front 108

What triggers sleep walking?

Back 108

sleep deprivation

Front 109

What are the 6 main types of Parasomnias NOS?

Back 109

1. REM sleep behaviour disorder
2. Headbanging
3. Bruxism
4. Enuresis
5. Periodic leg movements/Restless leg syndrome
6. Sleep paralysis

Front 110

Which sleep disorder involves abnormal sleep behaviours that occur in REM sleep and result in injury or sleep disruption?

Back 110

REM Sleep Behaviour Disorder

Front 111

What are two indicators fo REM Sleep Behaviour Disorder?

Back 111

1. Complex, vigorous or violent behaviours sometimes associated with dreamlike thoughts/images , occurring in pathological REM sleep
2. Muscle tone is abnormally preserved during some or all of REM sleep

Front 112

Typical onset of REM Sleep Behaviour Disorder

Back 112

middle-aged or elderly

Front 113

What is REM Sleep Behaviour Disorder associated with?

Back 113

Neurological Disorder ie Parkinsons Disease and Dementai with Lewy Bodies

Front 114

What percentage of people diagnosed with REM Sleep Behaviour Disorder develop a neurological disorder within 10 years?

Back 114

65%

Front 115

What are men typically overrepresented in REM Sleep Behaviour Disorder?

Back 115

due to the tendency of men to externalise generally

Front 116

Percentage of people with REM Sleep Behaviour disorder who injure their bbed partner

Back 116

79%

Front 117

Percentage of people with REM Sleep Behaviour Disorder that recall their dreams

Back 117

93%

Front 118

Prevalence on REM Sleep Behaviour Disorder

Back 118

0.5%

Front 119

Indicators and differential diagnosis for REM Sleep Behaviour Disorder

Back 119

1. Rule out epilepsy
2. Muscle change in lab
3. Abnormal behaviour

Front 120

What percentage of people with REM Sleep Behaviour Disorder are male?

Back 120

80%

Front 121

What sleep disorder involves teeth grinding during the night, usually diagnosed by a dentist, and may cause headaches upon waking?

Back 121

Bruxism

Front 122

What sleep disorder occurs mostly in children and involves rocking and headbanging during sleep?

Back 122

Headbanging

Front 123

What is the sleep disorder that involves bedwetting with no dry period for 6 months?

Back 123

Enuresis

Front 124

What percentage of people have enuresis at age 8 and as adults?

Back 124

20% of 8yo, and 1% of adults

Front 125

What is the sleep disorder is characterised by a complaint of a strong, usually irresistible urge to move the legs often accompanied by uncomfortable or painful symptoms?

Back 125

Restless legs syndrome

Front 126

What sleep disorder is an independent disorder of repetitive, highly stereotyped limb movements that occur during sleep?

Back 126

Periodic Limb Movement Disorder

Front 127

What sleep disorder is characterised by hypnogogic and/or hypnopompic paralysis?

Back 127

Sleep paralysis

Front 128

What sleep disorder not yet in the DSM-IV-TR but may be included in the DSM-5 that is characterised by mental confusion or confusional behaviour that occurs during or after arousal from sleep?

Back 128

Confusional Arousal

Front 129

Does confusional arousal occur in REM or NREM sleep?

Back 129

NREM

Front 130

How long is the person confused in Confusional Arousal?

Back 130

5-15 minutes

Front 131

What are some indicators of Confusional Arousal?

Back 131

disorientation, slowed speech, impaired mentation, and violence/aggression

Front 132

Are eyes open or closed in Confusional Arousal?

Back 132

open

Front 133

Is confusional arousal more common in children or adults?

Back 133

children

Front 134

What are the possible serious implications of Confusional Arousal if it doesn't remit or develops in adolescence?

Back 134

injury or legal implications

Front 135

Prevalence of Confusional Arousal

Back 135

4%

Front 136

What is sexomnia?

Back 136

Abnormal sexual behaviours during sleep

Front 137

Is Sexomnia in the DSM?

Back 137

No

Front 138

What types of abnormal behaviours to people with sexomnia engage in?

Back 138

masturbation, sexual vocalisation, exhibitionism, rape

Front 139

What sleep disorder is commonly comorbid with sexomnia?

Back 139

Sleepwalking

Front 140

What risk factors are associated with Sexomnia?

Back 140

physical proximity to bed partner, fatigue, alcohol & drug use, presence of another sleep disorder

Front 141

In what stage of sleep does Sexomnia mostly occur?

Back 141

in stage 1 and not SWS

Front 142

What are the three main warning signs of a sleep disorder? 5 other factors?

Back 142

1. Excessive daytime sleepiness
2. Morning Headaches
3. Problems Initiating/Maintaining Sleep
4. Snoring
5. Overweight
6. Bizarre imagery during sleep onset (persistent)
7. Not being able to move upon awakening
8. Partner complaints