2010 psy course Insomnia - dr lau.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * Approaches To Insomnia Dr. Lau Kim Kah Psychiatrist Hospital Sentosa Sleep Disorders Insomnias Disorders associated with complaints of insufficient, disturbed, or nonrestorative sleep Hypersomnias Disorders associated with excessive sleepiness Parasomnias Disorders associated with abnormal behaviors or abnormal physiologic events during sleep Circadian disturbances Alterations of the sleep-wake cycle Modified from Gillin JC, et al.[9] Insomnia Latin in (no) and somnus (sleep) Characterised by difficulty initiating or maintaining sleep and by finding sleep nonrestorative Sleep latency Sleep maintenance (nocturnal awakenings, early awakening) Quality of sleep Frequency and duration of sleep disturbance Diurnal residual effects Impact on family and on social and occupational life Quality of life Insomnia – The Most Common Sleep Disorder Prevalence chronic insomnia ~ 10 – 15% adult 34% - chronic transient insomnia combined Female:Male = 1.5-2:1 Risk factors* Age – combination of medical disorders and partial decline in functionality of sleep control Sex – women, associated with onset menses menopause Medical disorders and their treatment Psychiatric disorders Shift workers Only 5% chronic insomniac seek specific treatment * these factors do not independently cause insomnia; but precipitants in individuals predisposed to insomnia Types of Insomnia Pattern Duration Causative Groupings Transient 4 wks Acute illness, social stress, jet lag, shift work Short-term 4 wks - 6 mths Grief, stress, substance or medicinal exposures Chronic 6 mths Medical illnesses (eg, COPD) Psychiatric conditions (eg, depression) Psychophysiologic insomnia Chronic stress, bereavement Behavioral reasons (eg, caffeine) Primary sleep disorders Long-term Sleep apneas (central or obstructive) Periodic limb movement disorder Restless legs syndrome Narcolepsy How Much Sleep is Enough Average 7.5 hours (range 5 to 9 hrs) Age-related changes in sleep