Sleep Disorders

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International Classification of Sleep Disorders

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Dysomnias
Parasomnias
Disorders Associated with Medical/Psychiatric Disorders
Proposed Sleep Disorders

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Dysomnias

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A primary disorder of initiating and maintaining sleep or of excessive sleepiness. The dysomnias are disorders of wakefulness
ex. intrinsic, extrinsic, circadian rhythm sleep disorders.

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Intrinsic Sleep Disorders

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Disorders that originate develop or arise from causes within the body. Subgroup of Dysomnias. ex insomnia, sleep apnea, narcolepsy, plmd, rls, sleep state misperception, hypersomnia

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Extrinsic Sleep Disorders

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Disorders that originate, develop or arise from causes outside of the body. Subgroup of Dysomnias.

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Circadian Rhythm Sleep Disorders

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Relates to the timing of sleep within a 24 hour day.
Intrinsic- advanced sleep phase syndrome
Extrinsic-shift work sleep disorders.

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Insomnia

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The most common sleep disorder. The inability to fall asleep or remain asleep. Classifications: mild, moderate, severe

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Transient Insomnia

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Inability to sleep well over a period of a few nights

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Short-term Insomnia

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Periods of 2-3 weeks of poor sleep. Brought on by a project or prolonged stress.

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Chronic Insomnia

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Poor sleep every night or most nights. Affects more than 35million Americans. Physical ailments such as sleep apnea actually account for more than half of the complaints

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Idiopathic Insomnia

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Neurochemical imbalance that affects the arousal system or sleep inducing and maintainance system

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Idiopathic Insomnia
PSG indications

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Long sleep latencies
Poor sleep efficiency
Increased number and duration of awakenings
Long periods of REM without eye movements
Poorly formed sleep spindles
Stages are intermixed-difficult to score.

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Symptoms of OSA

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Snoring
EDS
Irritibility
Morning Headaches
Restless Sleep
Job Problems
Drowsy Driving
Arrythmias
HTN
GERD
Obesity
Diabetes
Heart Disease

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Central Apnea

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Absence of airflow and inspiratory effort; apnea caused by irregularity in the brains control of breathing.

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3 Classifications of Sleep Apnea

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Obstructive-apnea with cont efforts.
Central-apnea with no efforts to breathe
Mixed-apnea usually begins with central component, ends with obstructive components of effort.

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Narcolepsy

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Sleep attacks

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Nacolepsy Tetrad of symptoms

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EDS
Cataplexy
Sleep Paralysis
Hypnogogic Hallucinations

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EDS

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Excessive Daytime Sleepiness

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Cataplexy

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Sudden brief loss of muscle control

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Sleep Paralysis

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Brief loss of muscle control upon falling asleep or waking up

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Hypnogogic Hallucinations

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vivid, dreamlike experiences that occur when a person is drowsy

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PLMD Periodic Limb Movement Disorder

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Very rhythmic twitches, lasting from .5-5 seconds each, within 5-90 seconds of each other. Must be atleast 4 for an episode.

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PLMD

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Appear a the onset of stage 1
Occur frequently during stages 1 and 2
Reduced during SWS
Generally absent during REM

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RLS Restless Leg Syndrome

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Occurs while awake- often prevents sleep onset.
Patient complaints include unpleasant or creepy crawly sensations in legs. causes iron deficiency, caffeine, smoking, alcoholism

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Sleep State Misperception

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Complaint of disturbed sleep but no objective evidence of sleep disturbance.
Complaint of difficulty falling asleep or staying asleep
Associated with anxiety or depression or the use of hypnotics.

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Hypersomnia Recurrent

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Relatively uncommon
Hypersomnia lasting several days
occurs 2-3 times per year

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Nacolepsy Tetrad of symptoms

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EDS
Cataplexy
Sleep Paralysis
Hypnogogic Hallucinations

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EDS

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Excessive Daytime Sleepiness

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Cataplexy

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Sudden brief loss of muscle control

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Sleep Paralysis

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Brief loss of muscle control upon falling asleep or waking up

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Hypnogogic Hallucinations

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vivid, dreamlike experiences that occur when a person is drowsy

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PLMD Periodic Limb Movement Disorder

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Very rhythmic twitches, lasting from .5-5 seconds each, within 5-90 seconds of each other. Must be atleast 4 for an episode.

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PLMD

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Appear a the onset of stage 1
Occur frequently during stages 1 and 2
Reduced during SWS
Generally absent during REM

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RLS Restless Leg Syndrome

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Occurs while awake- often prevents sleep onset.
Patient complaints include unpleasant or creepy crawly sensations in legs. causes iron deficiency, caffeine, smoking, alcoholism

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Sleep State Misperception

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Complaint of disturbed sleep but no objective evidence of sleep disturbance.
Complaint of difficulty falling asleep or staying asleep
Associated with anxiety or depression or the use of hypnotics.

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Hypersomnia Recurrent

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Relatively uncommon
Hypersomnia lasting several days
occurs 2-3 times per year

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Nacolepsy Tetrad of symptoms

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EDS
Cataplexy
Sleep Paralysis
Hypnogogic Hallucinations

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EDS

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Excessive Daytime Sleepiness

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Cataplexy

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Sudden brief loss of muscle control

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Sleep Paralysis

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Brief loss of muscle control upon falling asleep or waking up

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Hypnogogic Hallucinations

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vivid, dreamlike experiences that occur when a person is drowsy

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PLMD Periodic Limb Movement Disorder

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Very rhythmic twitches, lasting from .5-5 seconds each, within 5-90 seconds of each other. Must be atleast 4 for an episode.

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PLMD

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Appear a the onset of stage 1
Occur frequently during stages 1 and 2
Reduced during SWS
Generally absent during REM

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RLS Restless Leg Syndrome

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Occurs while awake- often prevents sleep onset.
Patient complaints include unpleasant or creepy crawly sensations in legs. causes iron deficiency, caffeine, smoking, alcoholism

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Sleep State Misperception

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Complaint of disturbed sleep but no objective evidence of sleep disturbance.
Complaint of difficulty falling asleep or staying asleep
Associated with anxiety or depression or the use of hypnotics.

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Hypersomnia Recurrent

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Relatively uncommon
Hypersomnia lasting several days
occurs 2-3 times per year

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Klein-Levin Syndrome

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Episodes of binge eating and hypersexuality.
Most common in adolescent males
Behavioral changes including aggression depression and disorientation

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Idiopathic Hypersomnia

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Associated with normal or prolonged duration of sleep followed by EDS.
Presumed to be caused by central nervousl system
Mimics Narcolepsy
stimulants do no work

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Idiopathic Hypersomnia
Diagnosis

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Onset of symptoms must be prior to age 25 and not within 18 months of a head trauma
Symptoms need to be present for at least 6 months
all other sleep disorders have been ruled out.

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Central Alveolar Ventilation Syndrome

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Ventilatory impairment resuting in decreased SA02 worsened by sleep, and occurs in patients with normal lung function
also called obesity hypoventilation syndrome

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Inadequate Sleep Hygiene

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Extrinsic Dysomnia, establish routine and good bedtime habits

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Environmental Sleep Disorder

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Extrinsic Dysomnia, environmental disturbance present for 3 weeks causing insomnia and EDS

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Adjustment Sleep Disorder

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Extrinsic Dysomnia Sleep disturbance related to acute stress or environmental change

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Insufficient Sleep Disorder

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Extrinsic Dysomnia Failure to obtain sufficient sleep to maintain wakefulness

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Limit Setting Disorder

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Extrinsic Dysomnia Inadequate parental bedtime enforcement

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Sleep Onset Association Disorder

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Extrinsic Dysomnia, sleep onset is impaired by absence of certain objects or circumstances

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Nocturnal Eating And Drinking Syndrome

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Extrinsic Dysomnia, recurrent awakenings and inablility to return to sleep without eating or drinking.

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Hypnotic Dependent Sleep Disorders

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Extrinsic Dysomnia, EDS/insomnia caused by tolerance to or withdraw from hypnotics

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Stimulant Dependant Sleep Disorder

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Extrinsic Dysomnia Decreased sleepiness or suppression of sleep due to stimulants

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Alcohol Dependant Sleep Disorder

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Extrinsic Dysomnia, Use of alcohol to initiate sleep.

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Circadian Rhythm Disorders

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Time Zone Change
Shift Work Sleep Disorder
Irregular Sleep Wake Pattern

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Delayed Sleep Phase Syndrome

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Circadian Rhythm Disorder, sleep onset and wake times later than desirable

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Advanced Sleep Phase Syndrome

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Circadian Rhythm Disorder
Evening sleepiness, early sleep onset, early awakenings more common in the elderly

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Parasomnias

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Disorder of arousal partial arousals or sleep stage transition. It represents an episodic disorder of sleep such as sleep walking. May be induced or exacerbated by sleep

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Arousal Disorders

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Parasomnia, disorders associated with impaired arousal from sleep