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

I. Primary Sleep Disorders (cont.) A. Primary Insomnia (too little sleep) 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.

I. Primary Sleep Disorders (cont.) A. Primary Insomnia (too little sleep) 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

I. Primary Sleep Disorders Dyssomnias 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

I. Primary Sleep Disorders (cont.) B. Primary Hypersomnia (too much sleep) (cont.) 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

I. Primary Sleep Disorders Dyssomnias 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.

I. Primary Sleep Disorders Dyssomnias D. Breathing-Related Sleep Disorderss Characteristics Sleep disruption (excessive sleepiness or insomnia) Due to sleep-related breathing condition (e.g., Obstructive Sleep Apnea Syndrome)

I. Primary Sleep Disorders Dyssomnias D. Breathing-Related Sleep Disorder 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

I. Primary Sleep Disorders Dyssomnias 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,

I. Primary Sleep Disorders Dyssomnias E. Circadian Rhythm Sleep Disorder 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

I. Primary Sleep Disorders Parasomnias A. Nightmare Disorder Characteristics: (1) Repeated awakenings from bad dreams (2) When awakened client becomes oriented and alert

I. Primary Sleep Disorders Parasomnias A. 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.

I. Primary Sleep Disorders Parasomnias 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

I. Primary Sleep Disorders Parasomnias B. Sleep Terror Disorder 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.

I. Primary Sleep Disorders Parasomnias 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

I. Primary Sleep Disorders Parasomnias C. Sleepwalking Disorder 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.

I. Primary Sleep Disorders Parasomnias C. Sleepwalking Disorder Treatment: Relaxation techniques Biofeedback training Hypnosis. May need to sleep on the ground floor, have outside doors securely locked, and have car keys unavailable.

I. Primary Sleep Disorders Parasomnias 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: I. Primary Sleep Disorders include all sleep disorders, except: II. Sleep Disorder Related to Another Mental Disorder III. Sleep Disorder Due to a General Medical Condition (GMC) IV. Substance-Induced Sleep Disorder

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