5.1 Background of Anxiety and Sleep/Wake


emotional state caused by real or perceived danger that threatens security of an individual
purpose is to prepare the person to fight or flight
adaptive response
transient in nature

what disease state overlaps with anxiety

SSRIs address both sx


restless or on edge
easily fatigued
difficulty concentrating or having minds go blank
muscle tension
difficulty controlling the worry
sleep problems- difficulty falling or staying asleep

panic disorder

recurrent unexpected attacks of intense fear that may include palpitations, pounding heart, accelerated heart rate, sweating, trembling, shaking, SOB, impending feeling of doom
sudden and repeated attacks of intense fear
feel out of control
intense worrie

social anxiety disorder/ social phobia

fear of social or performance situations in whcih they expect to feel embarrassed, judged, rejected, or fearful of offending others
highly anxious about being with other people and having hard time talking to them
feeling self conscious in front of other


uncontrollable and recurring thoughts (obsessions) and behaviors (compulsions) that he/she feels intense urge to repeat over and over to relieve the anxiety
obsessions: fear of germs, unwanted thoughts, symmetry
compulsions: cleaning, ordering, repeatedly


develops when people experience shocking, dangerous event
fight or flight response
symptoms occur within 3 months of trauma and last from 6 months- years afterwards

PTSD dx criteria

one reexperiencing symptom
one avoidance sx
2 arousal and reactivity sx
2 cognition and mood sx

tx anxiety disorders

behavioral therapy
psychotherapy (CBT)
pharmacotherapy- antidepressants (SSRI), BZD, other

sleep cycle

5 REMs in a night
1-2 h per cycle with 4-6 cycles per night

what is insomnia

inability to get enough sleep
delayed sleep onset
early morning wake up
unrefreshing sleep
trouble staying asleep

primary vs secondary insomnia

primary- idiopathic
secondary- from an outside factor. psych disorder, medical problems, other sleep disorders, drug abuse

acute vs chronic insomnia

acute- suffers from it less than 3 times a week for less than 1 month
chronic- more than 3 times a week for more than 1 month

full moon and sleep

full moon might give you bad sleep

what is the narcolepsy tetrad

daytime sleepiness
cataplexy= loss of muscle tone without loss of consciousness
sleep paralysis- episodic loss of voluntary muscle tone when falling asleep or waking
hypagogic hallucinations- brief hallucinations when falling asleep

nacoleptic people experience what kind of sleep

instant REM
they have impairment of onset and offset of REM and NREM sleep
causes inadequate rest

narcolepsy etiology

starts in adolescence or adulthood
hypocretin-orexin NT loses function

types of narcolepsy

type 1- most common. lack hypocretin which regulates waking state and suffer from cataplexy
type 2- do not lack hypocretin or suffer from cataplexy but still experience same sx as type 1

treating narcolepsy

treat EDS, REM sleep abnormalities

restless leg syndrome

urge to move arms and legs during rest, relieved by movement, urge is worse in evening
more than 3x week for more than 3 mo
runs in family?

what is the biological clock

suprachiasmic nucleus (SCN)
contain melatonin MT1,2
melatonin from pineal gland

shift work sleep disorder

EDS due to working during sleep time
sleep that is unrefreshing, difficulty concentrating, lack of energy

non 24 sleep wake disorder

disturbance of normal 24h synch circiadian rhythm
affecting blind
nonpharm tx- change patient routines to reset and rebalance circadian
pharmacological- melatonin and tasimelteon