2010 psy course insomnia - dr lau

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1、ApproachesToInsomniaDr.LauKimKahPsychiatristHospitalSentosaSleepDisordersInsomniasDisordersassociatedwithcomplaintsofinsufficient,disturbed,ornonrestorativesleepHypersomniasDisordersassociatedwithexcessivesleepinessParasomniasDisordersassociatedwithabnormalbehaviorsorabnormal

2、physiologiceventsduringsleepCircadiandisturbancesAlterationsofthesleep-wakecycleModifiedfromGillinJC,etal.[9]InsomniaLatinin(no)andsomnus(sleep)CharacterisedbydifficultyinitiatingormaintainingsleepandbyfindingsleepnonrestorativeSleeplatencySleepmaintenance(nocturnalawakenings,

3、earlyawakening)QualityofsleepFrequencyanddurationofsleepdisturbanceDiurnalresidualeffectsImpactonfamilyandonsocialandoccupationallifeQualityoflifeInsomnia–TheMostCommonSleepDisorderPrevalencechronicinsomnia~10–15%adult34%-chronic&transientinsomniacombinedFemale:Male=1.5-2:1Ris

4、kfactors*Age–combinationofmedicaldisordersandpartialdeclineinfunctionalityofsleepcontrolSex–women,associatedwithonsetmenses&menopauseMedicaldisordersandtheirtreatmentPsychiatricdisordersShiftworkersOnly5%chronicinsomniacseekspecifictreatment*thesefactorsdonotindependentlycause

5、insomnia;butprecipitantsinindividualspredisposedtoinsomniaTypesofInsomniaPatternDurationCausativeGroupingsTransient<4wksAcuteillness,socialstress,jetlag,shiftworkShort-term4wks-6mthsGrief,stress,substanceormedicinalexposuresChronic>6mthsMedicalillnesses(eg,COPD)Psychiatriccond

6、itions(eg,depression)PsychophysiologicinsomniaChronicstress,bereavementBehavioralreasons(eg,caffeine)PrimarysleepdisordersLong-termSleepapneas(centralorobstructive)PeriodiclimbmovementdisorderRestlesslegssyndromeNarcolepsyHowMuchSleepisEnoughAverage7.5hours(range5to9hrs)Age-re

7、latedchangesinsleepShorter&morefragmentedFrequentarousalsandawakeningsStageIII-IVsleepreducedmoreinmenNotevidenceofreducedsleepneedReducedabilitytosleep→increasedaytimesleepiness+undesirednappingBriefAwakeningsOccurDuringNormalSleepAwakeningsarebrief,lastingsecondstoaminute–fa

8、llasleepagainimmediatelyafterthatNorecollectioninthemorningNu