Wat kan er fout gaan tijdens onze slaap? Neurologie van de slaap Maarten Dewil, MD, PhD Neuroloog Imeldaziekenhuis Bonheiden

Overzicht Inleiding Waarom slapen we? Wat kan er fout gaan in de slaap? Dokter, ik snurk Dokter, ik kan niet slapen Dokter, ik val overal in slaap Dokter, ik doe vreemde dingen in mijn slaap Besluit

Inleiding

Inleiding “Zeitgebers” 4

Waarom slapen?

Waarom slapen we?

Waarom slapen we?

Waarom slapen we?

Waarom slapen we? Slaapbehoefte wordt opgebouwd in de loop van de dag

Waarom slapen we? Onze biologische klok bepaalt mee wanneer we gaan slapen Alertheid Reactiesnelheid Hoogste lichaamstemperatuur bloeddruk Melatonine productie Diepe slaap Laagste Beste coördinatie Cortisol Snelle bloeddruk stijging “Zeitgebers”

Waarom slapen we? Vandaar ...

Waarom slapen we?

Waarom slapen we?

Waarom slapen we? Fysiologische veranderingen tijdens het leven

Wat kan er fout gaan in de slaap?

4 patiënten ...

“Dokter, ik snurk”

“Dokter, ik kan niet slapen”

“Dokter, ik kan niet slapen” “Aangeleerde slapeloosheid” Slapeloosheid als gevolg Slaapmisperceptie Slapeloosheid door erfelijke aandoening

“Dokter, ik kan niet slapen” Slapeloosheid als gevolg Internistische/chirurgische pathologie Slaapstoornis Psychiatrische aandoening Omgevingsfactoren “Spelen met de klok”

“Dokter, ik val overal in slaap”

“Dokter, ik val overal in slaap” Klachten Overdreven slaperigheid overdag Niet-verfrissende slaap Automatisch gedrag Concentratieproblemen Geassocieerde depressiviteit This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik val overal in slaap” Diagnose Klachtenpatroon ESS Slaaponderzoek EEG Beeldvorming Bloedname This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik val overal in slaap” Mogelijke oorzaken Onvoldoende slaap This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik val overal in slaap” Mogelijke oorzaken Onvoldoende slaap Sociale omstandigheden Langslapers Ploegenarbeid Slaapapnee Periodische beenbewegingen This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik val overal in slaap” Mogelijke oorzaken Onvoldoende slaap Als gevolg van andere aandoeningen Medicatie Hoofdtrauma Depressie Neurologische aandoeningen: Parkinson, Alzheimer, MS This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik val overal in slaap” Mogelijke oorzaken Narcolepsie met of zonder kataplexie This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik doe vreemd ‘s nachts” This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

Doctor, I move while sleeping When lights are out, all cats are grey. Italian saying Doctor, I move while sleeping This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik doe vreemd ‘s nachts” Belang 30% van ons leven brengen we door in bed Overdreven slaperigheid vaak eerste klacht Moeilijk onderscheid tussen goedaardige bewegingsstoornis in de nacht en bepaalde vorm van epilepsie This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik doe vreemd ‘s nachts” Mogelijke oorzaken Parasomnia Nachtelijke fenomenen niet afhankelijk van slaapstadium NREM arousal disorder: tijdens diepe slaap REM associated disorder: tijdens droomslaap This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik doe vreemd ‘s nachts” Nachtelijke fenomenen niet afhankelijk van slaapstadium Praten in de slaap Inslaapschokken Nachtelijk kreunen This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik doe vreemd ‘s nachts” Nachtelijke fenomenen niet afhankelijk van slaapstadium Periodische beenbewegingen al dan niet samen met rusteloze benen This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik doe vreemd ‘s nachts” Nachtelijke fenomenen niet afhankelijk van slaapstadium Periodische beenbewegingen al dan niet samen met rusteloze benen Tandenknarsen Nachtelijke krampen This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik doe vreemd ‘s nachts” Parasomnia NREM arousal disorders Slaapwandelen Night eating Nachtelijke paniekaanval Sleep terror 15-20% kinderen, 4% volwassenen Onvoldoende ontwaken vanuit diepe slaap This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

“Dokter, ik doe vreemd ‘s nachts” Parasomnia REM arousal disorders Parkinson Voorkomen Mannen > 50 jaar This PPPmodel stands for the relative contribution of the mentioned factors during the different stages of insomnia. When you look at this figure you see the natural evolution of insomnia over time. To pass the insomnia threshold, being ‘vulnerable’ is obviously not enough. To experience acute insomnia one often needs an amount of stress, adding to our vulnerability. Quite quickly, maintaining factors start to play a role, and in the stage of chronic insomnia those maintaining factors are the ones that keep us above the threshold.

Besluit

Besluit Slaappathologie komt zeer vaak voor Vaak miskend en soms schadelijk “Doorstep”-probleem Goed luisteren naar het verhaal van de patiënt van cruciaal belang