SLEEP DISORDERS II
POR SI NO FUERA POCO SIGUE ESTO....
NO ME ODIEN Y LEAN.
ES INTERESANTE (SIC)Y TAL VEZ, SOLO CON LEERLO CONCILIEN EL SUEÑO (JAJA)
History: Insomnia may present as decreased sleep efficiency or decreased total hours of sleep, with some associated complaint of decreased productivity or well-being. Sleep quality is more important than the total number of hours slept because sleep requirements vary from person to person. Compare the total number of hours slept with each individual's lifelong normal night sleep time.
Initial insomnia is characterized by difficulty falling asleep, with increased sleep latency (time between going to bed and falling asleep). Initial insomnia frequently is related to anxiety disorders.
Middle insomnia refers to difficulty maintaining sleep. Decreased sleep efficiency is the problem, with fragmented unrestful sleep and frequent waking during the night. Middle insomnia may be associated with medical illness, pain syndromes, or depression.
In terminal insomnia, also referred to as early morning wakening, patients consistently wake up earlier than needed. This symptom frequently is associated with major depression.
Alterations of the sleep-wake cycle may be a sign of circadian rhythm disturbances, such as those caused by jet lag and shift work.
Hypersomnia, or excessive daytime sleepiness, often is attributable to ongoing sleep deprivation or poor quality sleep for reasons ranging from sleep apnea to substance abuse or medical problems.
In delayed sleep phase syndrome, the patient is unable to fall asleep until very early morning. As time progresses, the onset of sleep becomes progressively delayed.
Sleepwalking, also called somnambulism, refers to episodes of complex behaviors during NREM sleep (stages 3 and 4) of which the patient is amnestic afterward.
Nightmares are repeated awakenings from sleep caused by vivid and distressing recall of dreams. Nightmares usually occur during the second half of the sleep period. Upon wakening from the dream, the person rapidly reorients to time and place.
Night terrors are recurrent episodes of abrupt awakening from sleep characterized by a panicky scream, with intense fear and autonomic arousal. The individual usually has no recall of the details of the event and is unresponsive during the episode. These episodes occur during the first third of the night, during stages 3 and 4 of NREM sleep.
The bed partner of patients who snore may provide a history of snoring. Such a history has important implications because it may help identify obstructive sleep apnea.
Causes: The major causes of insomnia may be divided into medical conditions, psychological conditions, and environmental problems.
Medical conditions
Cardiac conditions include ischemia and congestive heart failure.
Neurologic conditions include stroke, degenerative conditions, dementia, peripheral nerve damage, myoclonic jerks, restless legs syndrome, hypnic jerk, and central sleep apnea.
Endocrine conditions affecting sleep are related to hyperthyroidism, menopause, the menstrual cycle, pregnancy, and hypogonadism in elderly men.
Pulmonary conditions include chronic obstructive pulmonary disease, asthma, central alveolar hypoventilation (the Ondine curse), and obstructive sleep apnea syndrome (associated with snoring).
Gastrointestinal conditions include gastroesophageal reflux disease.
Hematological conditions include paroxysmal nocturnal hemoglobinuria, which is a rare, acquired, hemolytic anemia associated with brownish-red morning urine.
Substances that may result in insomnia include stimulants, opioids, caffeine, and alcohol, or, withdrawal from any of these also may cause insomnia.
Medications implicated in insomnia include decongestants, corticosteroids, and bronchodilators.
Other conditions include fever, pain, and infection.
Psychiatric conditions: Bear in mind that the major psychiatric conditions now are known to have a biological basis and constitute a subset of medical conditions.
Depression may cause alterations in REM sleep. As many as 40% of people with depression have insomnia.
Anxiety disorders predispose to insomnia. The most common of these are generalized anxiety disorder, panic disorder, and anxiety disorders not otherwise specified.
Thought disorders and misperception of sleep state are other potential states that cause insomnia.
Psychotropic medications such as antidepressants may interfere with normal REM sleep patterns.
Rebound insomnia from benzodiazepines or other hypnotic agents is common.
Environmental problems
Stressful or life-threatening events (eg, bereavement) may cause insomnia.
Shift work may disturb the sleep cycle, as might jet lag or changes in altitude.
Sleep deprivation may occur as a result of environmental noise or frequent intrusions (such as in an intensive care unit setting).
