Sleep and Sleep Disorders

Jessica is six years old. Her parents recently saw her pediatrician because they were concerned about the sleeping difficulties Jessica has been having. Often she would scream out loud in her sleep. Her parents would rush to her room and find her sitting upright in bed, panting heavily in a state of panic. Jessica would not respond to her parent’s words of consolation, and the next morning she would have no memory of the incident at all. Her parents were worried about the anxiety their daughter was experiencing and asked the pediatrician what they could do about her nightmares. The pediatrician explained Jessica was likely suffering from sleep terrors and carefully described what that meant.

1. What are the similarities and differences between nightmares and sleep terrors?
2. What are the characteristics of motor, sensory, and autonomic function during REM sleep? What is thought to be the importance of this stage of sleep?
3. Jessica’s pediatrician said that the careful management of sleep hygiene may help to decrease the incidence of her sleep terrors. What is included in an overview of the general features that demonstrate good sleep hygiene?

Case Study 6

Disorders of Thought, Emotion, and Memory

Ella is 88 years old and was living at home until very recently. Her children, who visited her regularly, noticed she was becoming more forgetful. At first, she mislaid objects, and then she began to forget her doctor’s appointments. With time, her personality changed and she became withdrawn. At home she would forget to turn off the stove or leave the kettle on until it boiled dry. After seeking advice from a gerontologist and social worker, Ella’s children placed her in a nursing home with a unit equipped for patients with Alzheimer disease.

1. What is dementia? Why is Alzheimer disease based on a “diagnosis of exclusion”?
2. What are the macroscopic and microscopic features of the brain that are typical in Alzheimer disease?
3. One of Ella’s children brought her a new pair of slippers to wear in the nursing home. A minute after she received them, Ella could not remember the exchange and asked what they were doing on her bed. What part of the brain has largely been affected to produce this behavior, and what is the pathophysiology involved?

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