PSYC 444 Lecture Notes - Lecture 11: Bruxism, Polysomnography, Sleep Disorder
14 May 2018
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PSYC 444 – LECTURE 11
There are efficient treatments for sleep disorders, which can have large, negative impact on the quality of life, yet not many are aware of this and do not seek
treatet. There are a reasos for this…
• Sleep medicine is a new field
• Lack of sleep disorder treatment training
BRUXISM
Bruxism: repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or bracing or thrusting of the mandible
Bruxism has two distinct circadian manifestations that are different in terms of symptomology and treatment approaches: it a our durig…
1. Sleep (indicated as SB)
• SB is based on self-reports
• Frequent condition affecting between 8-15% of the population
o Depending on sampling and methodology
2. Wakefulness (indicated as awake bruxism)
SYMPTOMOLOGY
• Hypersensitive teeth
• Aching jaw muscles
• Tooth wear (hypersensitive teeth throughout whole day)
• Damage to dental restorations to teeth
• Headaches (usually temporal)
DIAGNOSIS
A typical polysomnographic recording for the assessment of rhythmic masticatory muscle activity (RMMA)
• Gold standard for diagnosis: PSG with RMMA, plus audiovisual confirmation
o Audiovisual confirmation: large and frightening sound of teeth grinding (notably in children), like two rocks being crushed together
Polysomnographic recordings from electrodes placed on jaw muscles show significant muscle activity that spikes throughout the night
ETIOLOGY
Even though muscles become atonia and relax during sleep, why do the jaw muscles go berserk?
• There is general consensus that there is no single cause of SB, but that CNS and psychological factors, including stress, may contribute.
o There is no good explanation as to why this happens, but there seems to be many things going on (interplay of physiological and psychosocial
components). Bruxism is more prevalent in poverty-stricken areas.
• In severe cases, excessive sleep arousal responses are influenced by autonomic factors
TREATMENT
Pharmacological: at present, firm clinical conclusions concerning the effects of medication on SB are lacking
• Null hypothesis with side effects; something to avoid if possible
Botox injections: may be efficacious for some cases of SB; reduces amplitude of muscle activity but not its frequency nor duration
• More useful if there are certain muscles involved.
• Occurs just as much, just less severely
• Superficial solution that fails to get to root problem
Behavioral/psychosocial treatment approaches: lacks strong support for its efficacy
EMG biofeedback: promising but lacks randomized control studies
• Visualize muscle activity using technology such as sonography
• Method of eoig ore idful of our ehaior e.g. he ou’re lehig our ja usles
• Works for both day and night bruxism
• Long-term effects unknown
Mouth guards: widely used and often provides protection but not in all cases; recommended as first line treatment
• Ideally want to get an individualized set from a dentist. If not (e.g. purchased from internet), it will be uncomfortable and not fit your teeth properly
• Absorbs shock from grinding to some extent, depending on quality
Note that all of the above are relatively new approaches
RESTLESS LEGS SYNDROME
RLS: common and underdiagnosed condition with a strong genetic component
• Prevalence in European and American populations is about 7% for any RLS symptoms during a year and 2.7% for moderate to severe symptoms.
• Defined by its clinical symptoms, involving an urge to move legs while resting in the evening and night
• Less intense than other sleep disorders, in the sense that symptoms are not particularly bad (none causing bodily harm, just discomfort)
RLS is particular because it is nearly impossible to diagnose, unless patients are able to convey symptoms very well.
• Extremely underdiagnosed, though it is common (about 7% of general population, 3% for severe RLS)
• Main reason for diagnosis is the physiological phenomenon related to RLS: rhythmic bursts of activity at night seen in all patients legitimatizes disorder
find more resources at oneclass.com
find more resources at oneclass.com
Periodic limb movements during sleep is present in almost all patients
SYMPTOMS
Patients describe the sensations very differently
• Wide range of descriptions: uncomfortable, unpleasant, creepy-crawly, jittery, internal itch, shock-like feeling
• Up to 50% of RLS patients describe their sensations as painful. Some, however, describe only an urge to move and are unaware of a sensory component.
Symptoms are usually felt over large areas of the thighs or calves (or both)
• Usually experienced as coming from deep within the legs, rather than superficial
The symptoms are engendered or worsened by rest or inactivity
• Activity relieves symptoms
• Symptoms are worse in the evening or during the night
• As soon as there is inactivity, sensations return
People with RLS are affected emotionally, as it is difficult to diagnose. Often, the doctor refers them to a psychologist, who the asks, hat are ou trig to ru
aa fro? it is diffiult to oe ut er disruptie ad upleasat.
TREATMENT
Pharmacological treatments, such as dopamine agonists, are effective
• Relieves symptoms almost automatically
• Few side effects
• For most, this is a good deal
Iron deficiency engenders or exacerbates RLS
• In some patients, oral iron can lead to complete remission
• Dopamine agonists may be being taken for no reason if iron supplements were not used as first line defense.
However, the relationship between iron and the dopamine system in RLS is less clear.
SLEEP APNEA
Sleep apnea: breathing disruption during sleep, leading to low blood oxygen and sleep disruption
• Obstructive sleep apnea (OSA): breathing is interrupted by a blockage of airflow
• Central sleep apnea (CSA): breathing stops due to a lack of effort to breathe
o Automatic mechanism that makes you want to breathe is not functioning properly
o More rare
• Mixed: combination of CSA and OSA
Common symptoms include: loud snoring, restless sleep, and sleepiness during the daytime
• Patients feel tired, despite getting sufficient sleep and not consuming caffeine
• It is better to have a false alarm of sleep apnea than to miss it completely, as there are very serious consequences (some even associated with mortality).
Micro-arousals lead to disrupted sleep ot eough Delta ut does’t ause patiets to ake up due to lack of air. Most feel tired the next morning but only become
aware of their symptoms after being told by their bed-side partner.
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
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