Sleep Disorders

Fifth stage

Psychiatry
Lec-11
د. الهام

17/4/2016

Sleep Disorders
Two Major Categories*
Dyssomnias
Parasomnias
*This classification system is similar to that used by the American Sleep Disorders Association.

Dyssomnias:

The sleep itself is pretty normal.
But the client sleeps too little, too much, or at the wrong time.
So, the problem is with the amount (quantity), or with its timing, and sometimes with the quality of sleep.

Parasomnias:
Something abnormal occurs during sleep itself, or during the times when the client is falling asleep or waking up (e.g., bad dreams.
The quality, quantity, and timing of the sleep are essentially normal.


I. Primary Sleep Disorders:
Dyssomnias
A. Primary Insomnia - too little sleep
Characteristics
Difficulty initiating or maintaining sleep
Persists for 1 month or longer
Often due to:
Major Depressive Episode, Manic Episode, or anxiety disorder
Commonly misused substances, as well as some prescription medicines.
Breathing-related problems
The cause sometimes can not be identified.
Treatment
Vigorous daytime exercise, not exercising before sleep
Relaxation exercises, practice regularly but condensed to 5 minutes
Decrease stimulation and increase soothing environments, such as ear plugs or calm reading
Practice good sleep habits

B. Primary Hypersomnia (sleeping too much, as well as being drowsy at times when client should be alert)
Characteristics
Excessive sleepiness
Persists for 1 month or longer
Often due to:
Major Depressive Episode, Dysthymic Disorder with atypical features
Use of substances is less likely to produce hyersomnia than insomnia, but it can happen (e.g., sleeping pills overdose)
The cause sometimes can not be identified.
Treatment: Exercise when becoming sleepy


C. Narcolepsy (Sleeping at the wrong time)
Characteristics
Sleep intrudes into wakefulness, causing clients to fall asleep almost instantly
Sleep is brief but refreshing
May also have sleep paralysis, sudden loss of strength, and hallucinations as fall asleep or awaken.
Treatment: Stimulants, sometimes antidepressants, with less success.

D. Breathing-Related Sleep Disorderss

Characteristics
Sleep disruption (excessive sleepiness or insomnia)
Due to sleep-related breathing condition (e.g., Obstructive Sleep Apnea Syndrome)
Treatment
In mild cases: weight loss, sleeping on one’s side, and avoiding hypnotics and alcohol
In more serious cases: a machine that provides continuous positive airway pressure
Surgery: Few benefits

E. Circadian Rhythm Sleep Disorder

Characteristics
Persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia, due to mismatch between sleep-wake schedule required by a person’s environment and his/her circadian sleep-wake pattern (e.g., shift work,
Treatment: Difficult to treat, because it has to involve the entire family
Darken bedroom and use soundproofing
Limit caffeine and hard to digest food.
Ensure all family members learns shift


Parasomnias
A. Nightmare Disorder
Characteristics:
(1) Repeated awakenings from bad dreams
(2) When awakened client becomes oriented and alert
Information about Nightmare Disorder
Usually occurs in early morning when REM sleep dominates.
The same nightmare may recur repeatedly or different ones may pop up three times a week.
Stress may induce 60% of nightmares.
Half of the cases of nightmare disorder appear before age 10; 2/3 before age 20.
Dreams are clearly remembered
Drugs can trigger nightmares.
Suddenly withdrawing REM-suppressant medications and drugs can cause REM rebound.

B. Sleep Terror Disorder

Characteristics:
(1) Abrupt awakening from sleep, usually beginning with a panicky scream or cry.
(2) Intense fear and signs of autonomic arousal
(3) Unresponsive to efforts from other to calm client
(4) No detailed dream recalled
(5) Amnesia for episode
Usually only children have sleep terror disorder.
The client is not having a nightmare.
The eyes are open, screams erupt.
Usually happens in early evening.
In contrast to nightmares, sleep terrors do not respond to psychotherapy.
Probably due to brain wave upset, fever, or medications
However, some medications may help.


C. Sleepwalking Disorder
Characteristics:
(1) Rising from bed during sleep and walking about.
(2) Usually occurs early in the night.
(3) On awakening, the person has amnesia for episode
Most sleepwalking children are psychologically normal.
Runs in families.
Begins between ages 6 and 12 and may be stress-related.
Customarily sleepwalkers exhibit other delta-sleep interruptions.
At some time 1-6% of children sleepwalk; of these, 15% do so occasionally.
Adult sleepwalking is far less common, usually worse and more chronic.

Treatment:
Relaxation techniques
Biofeedback training
Hypnosis.
May need to sleep on the ground floor, have outside doors securely locked, and have car keys unavailable.

D. Parasomnia NOS (listed on p. 644)

Examples:
Sleep-Talking: Often more annoying to partner than to sleeper. Has no memory in morning. Can be during REM or delta sleep. In REM sleep, pronunciation is clear and understandable; in deep sleep (delta) apt to be mumbled and unintelligible
Sleep paralysis: inability to perform voluntary movement during the transition between waking and sleep. Usually associated with extreme anxiety, and sometimes fear of impending death.
REM sleep behavior disorder: characterized by agitated and violent behavior.
Parasomnia is present but unable to determine whether it is primary, due to GMC, or substance induced.


The Sleep Disorders chapter has four major sections:
Primary Sleep Disorders include all sleep disorders, except:
Sleep Disorder Related to Another Mental Disorder
Sleep Disorder Due to a General Medical Condition (GMC)
Substance-Induced Sleep Disorder

II. Sleep Disorder Related to Another Mental Disorder:

Two Diagnoses
1. Insomnia Related to Another Mental Disorder
2. Hypersomnia Related to Another Mental Disorder