0 Sleep is mainly divided into two main parts, Rapid Eye Movement (REM) and Non-REM (NREM).
0 NREM sleep is also examined in 4 different stages. Stages 3 and 4 are also called deep sleep (slow wave sleep).
0 The first REM period occurs 90-120 minutes after the onset of sleep. This period is called REM latency.
0 Afterwards, 3-5 REM periods are passed in a night with intervals of approximately 90 minutes.
0 In general, deep sleep takes place in the first 1/3 of sleep and REM sleep takes place more in the last 1/3.
NREM Period
• Stage 1: It is the stage between sleep and wakefulness.
• Stage 2: K-complex and sleep spindles are seen on EEG.
• Stages 3 and 4: It is the deep sleep period, the main resting part of sleep. These two stages can be called stage 3 together. Delta waves are evident in EEG. During this period, metabolism slows down, heart rate - blood pressure decreases. Growth hormone (GH) secretion increases.
REM Period
• Active sleep is also known as paradox sleep.
• It is characterized by rapid eye movements. There is atony to skeletal muscles other than the eye muscles.
• Irregularities (increases and decreases) occur in heart rate, blood pressure, and respiratory rate.
• Penile erection is seen in men.
• Most dreams occur during the REM period. Dreams in this period are typically abstract and surreal.
• The neurotransmitter responsible for REM sleep is acetylcholine.
Sleep periods in young adult human sleep are distributed approximately as follows.
Distribution of sleep periods in young adult humans
Non REM Stage 1 ---------------------------------------------- ---------------------► 5-10%
Non REM Stage 2 ---------------------------------------------- ---------------------► 45-60%
Non REM Stages 3 and 4 ------------------------------------------ ----------------► 20-25%
REM ------------------------------------------------- ----------------------------------►20-30%
Dyssomnias
• They are also called sleep-wake disorders.
• They are quantitative disorders of sleep. Dyssomnias go away with changes in the amount, quality and timing of sleep.
• Disorders such as not being able to fall asleep, not being able to sleep or vice versa, sleeping too much are seen.
Insomnia
Insomnia is defined as the inability to fall asleep, the inability to maintain sleep or the complaints of early termination, and non-restorative sleep.
Considering the function and structure of sleep, insomnia is defined as the situations in which people cannot rest and are not ready for a new day because they cannot sleep for a sufficient period of time.
Hypersomnia
Hypersomnic is defined as those who affect the course of daily life for more than one month and who feel compelled to sleep during the day despite getting enough sleep at night.
Narcolepsy
It is characterized by unexpected, irresistible sleep attacks.
Daytime sleep attacks are the most common complaint, although not all symptoms are present in all patients.
Sleep attacks usually occur at intervals of 1.5-2 hours, unavoidably.
Attacks typically begin with the REM period.
Hallucinations may occur during falling asleep (hypnagogic) and upon awakening (hypnopompic).
Hallucinatory experiences and sleep paralysis are short-term changes that occur during the sleep-wake transition.
Patients can feel completely rested when they sleep for 5-10 minutes.
Cataplexy is short-term striated muscle atony in response to sudden emotional stimuli.
He may suddenly be unable to speak, drop something in his hand.
This situation will disappear in a short time.
Parasomnias
Parasomnias (DSM 5)
NON-REM
Sleepwalking
sleep terror
REM
nightmare disorder
REM sleep behavior disorder
• Parasomnias include changes and deteriorations in behavior and physiological areas during sleep.
• In these disorders, CNS activation is transferred to the autonomic nervous system or skeletal muscles.
• Parasomnias are similar to each other in terms of clinical appearance and can easily be confused with epilepsy.
• Parasomnias are common in childhood and decrease in adulthood, suggesting that these disorders may be related to CNS maturation.
Sleepwalking
It is one of the disorders of the non-REM sleep stage. Occurs in the first hours of sleep.
The person exhibits behaviors that can range from getting out of bed and sitting down before fully awakening, to engaging in simple purposeful activities.
It is common in children aged four to eight years. It is very rare in adults.
sleep terror
It is one of the disorders of the non-REM sleep stage. Occurs in the first hours of sleep.
The sudden onset of intense panic and fear is accompanied by symptoms such as screaming and crying.
Unlike nightmares, there is usually no dreaming/imagery in a sleep terror attack.
Nightmare
It is a disorder of the REM sleep stage. Occurs in the second half of sleep.
Frightening, disturbing dreams occur. (The opposite of sleep terror)
Behavioral psychotherapy, benzodiazepines, prazosin can be used in its treatment.
REM Sleep Behavior Disorder
It is caused by the inability to provide the necessary muscle atony during REM sleep.
For this reason, the person acts in accordance with his dreams.
As they are not aware of the real environment and act as if they are in a dream, they may harm themselves and their spouses.
It is mostly seen in elderly male patients. It is common in neurological diseases such as Parkinson's disease, dementia and multisystem atrophy.
Clonazepam, a long-acting benzodiazepine, is used in its treatment.
|
|
Sleep Terror |
Sleepwalking |
Nightmare |
|
prevalence |
1-6% |
2.5-5% |
5% |
|
The time it appeared |
Non-REM 3 and 4 |
Non-REM 3 and 4 |
REM period |
|
Beginning |
the first hours of sleep |
the first hours of sleep |
in the second half of the night |
|
clinical feature |
vocalization, anxiety, motor and
autonomic activity |
Automatic and relatively organized
behaviors |
Less vocalization, anxiety, motor and
autonomic activity |
|
mental state |
Messy |
Messy |
detailed, careful |
|
violent behavior |
common |
it's possible |
no |
|
injury |
it's possible |
it's possible |
no |
|
Amnesia |
Generally, |
Generally, |
Rare |
|
tendency to wake up |
Hard |
Hard |
Easy |
|
when i wake up |
Confused |
Confused |
oriented |
Sleep Movement Disorders
Restless Legs Syndrome
When trying to fall asleep, burning, tingling and the urge to move develops in the lower extremities.
These complaints are relieved by getting out of bed and walking.
It is associated with a low ferritin level.
Antiepileptics such as dopaminergic agents (pramipexole, ropirinol, levodopa), benzodiazepines, opiates, and gabapentin can be used in its treatment.
Uykuda periyodik bacak hareketleri
Formerly known as noctrunal myoclonus. However, there is no epileptiform activity.
During non-REM sleep, repetitive, stereotypical movements are usually seen in the lower extremities.
The main difference from restless legs syndrome is that the symptoms occur during sleep, not when trying to fall asleep.
Movements can lead to awakening from sleep.
Folate deficiency, anemia, kidney failure and antidepressant drug use are blamed in the etiology.
Its treatment is similar to restless legs syndrome.