Sleep Related Disorders Assessment & Diagnosis SW 593

Introduction  Diagnoses are related to disturbances in the sleep process that cause clinically significant distress and/or psychosocial impairment.  Two major categories: –Dyssomnias: person sleeps too much, too little, or at the wrong time –Parasomnias: abnormal things occur during sleep or immediately before/after sleep.

Introduction  Sleep disturbances are expected in a number of instances: –Mood and anxiety disorders –Cognitive, schizophrenic, somatization disorders  Sleep disorder is only made when that symptom is excessive or has become the primary focus of intervention.

Insomnia  Sleeping too little  Takes the form of problems falling or staying asleep.  It may be characterized by non-restorative sleep.  Insomnia must last at least one month and be causing distress or psychosocial impairment.

Insomnia  Etiology: –Primary Insomnia –Insomnia Related to Another Mental Disorder –Sleep Disorder due to a General Medical Condition, Insomnia Type –Substance-Induced Sleep Disorder, Insomnia Type

Hypersomnia  Sleeping too much.  Characterized either by prolonged sleep episodes or by daytime sleep episodes that occur daily or almost daily.  Problem must have lasted at least one month or be recurrent. –Lasting 3 days several time a year for at least 2 years.

Narcolepsy  Characterized by irresistible episodes of refreshing sleep that occur daily over at leas a 3-month period.  Client experiences episodes of cataplexy (brief episode of loss of muscle power) or recurrent intrusions of REM sleep in the transitions between being awake and sleeping (experienced as hallucinations or sleep paralysis).

Breathing-Related Sleep Disorder  Involves sleep disruption that leads to excessive sleepiness or insomnia.  Disruption is caused by a sleep-related breathing condition but not by some other general medical condition, mental disorder, or substance use.  Practitioner should list the underlying breathing-related medical condition on Axis III.

Circadian Rhythm Sleep Disorder  A persistent or recurrent pattern of sleep disruption due to disruptions in the normal sleep-wake schedule.  Origin(s) of this problem is made clearer by the specifiers used: –Shift work type –Jet lag type –Delayed Sleep Phase type

Parasomnia  Some disruptive event occurs during specific sleep periods and/or transitions.  These conditions refer to instances in which behaviors or physiological processes are activated inappropriately while the individual is asleep.

Nightmare Disorder  Usually begins in children between the age of 3 and 6.  Causes significant disruption for both the children and their parents.  It can persist into adulthood.  The individual experiences repeated awakenings with detailed recall of frightening dreams.  Upon awakening, becomes oriented.  Episodes generally occur during second half of sleep period.

Sleep Terror Disorder  Occurs both among children and adults.  Individual experiences repeated episodes of abrupt awakening during the first third of a sleep cycle.  Individual awakes with a scream and physiological symptoms similar to those of a panic attack.  Individual is generally unresponsive to attempts to be comforted and when finally awake, no memory of the dream.

Sleepwalking Disorder  Begins in childhood and ends during adolescence.  Initial onset of sleepwalking in adulthood is unusual.  Involves the client getting up and walking around, usually during the first third of the sleep cycle.  Very difficult to awake and no memory of the incident.

Assessment  Has become a technologically advanced medical procedure in recent years.  Sleep studies are conducted by having the person check in to a facility in the evening and leaves when the person awakes the following morning.

Assessment  Monitored throughout the night for: –Breathing patterns and efforts –Heart rate –Oxygen saturation –Brain activity –Muscle activity  Typically non-medical clinicians do not administer self-report sleep instruments.