Behavioral Science

Sleep Science and Disorders 47
In a person with sleep problems related
to OSA, why might you avoid
benzodiazepines?
What are the three most common causes
of a circadian rhythm sleep disorder?
During which phase of sleep would
you expect nightmares to occur in?
What are the similarities between sleep
terrors and sleepwalking?
How could you clinically differentiate
sleep terror from sleepwalking?
What is the treatment of sleep terrors
and sleepwalking?
You risk further compromising the
patient’s ventilation by respiratory
depression.
1. Delayed sleep phase—“night owls,”
more common in adolescents and
tends to improve with age
2. Jet lag—typically resolves over
several days
3. Shift work—eg, working the
night shift
REM
Both are more common in children and
may involve semicomplex to complex
motor behaviors. Patients tend to be
amnestic for both and in adulthood they
are equally prevalent in men and
women (1% prevalence of sleep terrors
and 2% prevalence of sleepwalking).
Both occur in slow wave sleep.
Sleep terror has strong component of
autonomic arousal and fear, often
beginning with a terrified scream, and a
lesser element of semipurposeful motor
behaviors. Sleepwalking has minimal
autonomic arousal/fear and motor
behaviors are usually more complex.
Children will usually grow out of them.
Benzodiazepines can be helpful for
adults, as can scheduled awakenings
and environmental control.
OTHER SLEEP CHANGES
What polysomnogram (PSG) findings
are characteristic of major depression?
Reduced slow wave sleep (less delta
waves), frequent nighttime awakenings,
increased sleep latency (time until
falling asleep), short REM latency
(REM cycle starts sooner than normal
90 minutes onset), and early morning
waking.
Tip: Low serotonin is associated with
depression; therefore you would expect
reduced total sleep and slow wave sleep.