Sleep Disorders

Audrea Elliott

What is sleep?
Sleep is a behavior that follows a circadian
rhythm.
Sleep is not uniform, but organized into
cycles.
Sleep is defined behaviorally into four
criteria: reduced motor activity, decreased
response to activity, stereotypic postures,
reversibility.

Sleep Cycle
There are five stages
of sleep; four stages
are considered nonREM sleep and one
stage of REM sleep

Allan & Bacon 2004

REM Sleep
Accounts for about
25% of sleep.
In humans, occurs
once every 90
minutes.
Brain activity is high
during REM.

Sleep Deprivation
Studies with humans have found that
sleep deprivation takes its greatest toll on
cognitive abilities.
When allowed to sleep again, all stages of
sleep are not made up evenly.
Studies with lab animals have shown that
with enough sleep deprivation the animals
will become sick and eventually die.

Neural Control of Arousal and

Sleep

Allan & Bacon 2004

Sleep Disorders DSM-IV-TR

Primary Sleep Disorders-Dyssomnias

- Insomnia
- Hypersomnia
- Narcolepsy
- Breathing-Related Sleeping
Disorders
- Circadian Rhythm Sleep
Disorders
- NOS

- Parasomnias
- Nightmare Disorder
- Sleep Terror Disorder
- Sleepwalking Disorder
- POS

Secondary Sleep Disorders- Sleep Disorder Related to

Another Mental Disorder
- Sleep Disorder Due to a
General Medical Condition
- Substance- Induced Sleep
Disorder

Insomnia

Difficulty initiating and

maintaining sleep; non
restorative sleep.
Clinically significant
distress/impairment in social,
occupational, or other
important areas.
Disturbance of sleep is not due
to another sleep disorder.
Disturbance of sleep is not due
to another mental disorder
Not due to direct effects of
substance use or general
medical condition.

Affects about 60 million

Americans have chronic
insomnia. About two percent
have excessive sleepiness.
Most common sleep complaint.
Affects 40% of women and
30 % of men.
# 1 cause is thought to be
sleep medication
Acute or Chronic
Treatment: medication or
behavior modification.

Hypersomnia
Excessive sleepiness with one
month as evidence by either
sleep episodes or day time sleep
episodes that occur almost daily.
Excessive sleepiness caused
clinically significant
distress/impairment in social,
occupational, or other important
areas
Excessive sleepiness not better
accounted for by insomnia, other
sleep disorder, or inadequate
sleep.
Not a result of other mental
disorder, physical condition,
substance use, or medical
condition.
Recurrent: 3 days concurrent
several times a year for at least
two years.

5-10% of sleep clinic

patients
Lifetime prevalence of
at least 16%.
Adult population
prevalence is 0.55%.
Four year prevalence
about 8%.

Narcolepsy

Sleep attack must occur daily

over period of one year over a
period of at least three months.
Must experience either
cataplexy or recurrent
intrusions of elements of REM
sleep.
Disturbance not due to
physical condition, substance
use, or medical condition.

A disorder characterized by
sudden and uncontrollable,
though often brief, attacks of
deep sleep.
Sometimes is accompanied by
paralysis and hallucinations
Chronic disease due to brains
inability to regulate sleep-wake
cycles.
Hypocretin system implicated
in development.
Treatment: keep a regular
schedule, take short daytime
naps, drug therapy
Many people go years before
seeking treatment.

Cataplexy
Neurological condition in which the person
experiences sudden bilateral loss of muscle
tone and falls, usually experienced right
after a strong emotion (anger, fear, or
excitement). Can last from seconds to
minutes.
Can be a symptom of Narcolepsy (60-100%)
Treated with antidepressants; imipramine or
desipramine

Sleep Paralysis
A condition either at on set of sleep or at
awaking when a person is aware of their
surroundings, but not able to move.
Often associated with Narcolepsy.
Treated with antidepressants and SSRIs

Sleep Apnea
Sleep disruption leading
to excessive sleepiness
or less commonly
insomnia due to
abnormalities of
ventilation during sleep.
Sleep disruption not
accounted for by another
sleep disorder, mental
disorder, physical
condition, substance use,
or medical condition.

Physiological disorder in which

reduced muscle tone results in
blocked air passages.
Apnea is the cessation of
breath for ten or more
seconds. This leads to frequent
brief arousals from sleep.
May be caused by decreased
levels of Serotonin in the
hypoglossal nucleus.
Treatment: Continual Positive
Airway Pressure (CPAP),
Lifestyle Changes, and
Surgery.
A new medicine modafinil
(Provigil) is some times given
to prevent day time sleepiness
along with CPAP

Circadian Rhythm Sleep Disorder

Persistent or recurrent pattern of

sleep disruption leading to
excessive sleepiness or insomnia
due to mismatch between sleepwake schedule.
Clinically significant
distress/impairment in social,
occupational, or other important
areas.
Disturbance of sleep is not due to
another sleep disorder.
Disturbance of sleep is not due to
another mental disorder
Not due to direct effects of
substance use or general medical
condition.

Delayed Sleep Phase Type

- A persistent pattern of late sleep
onset and late awakening times
with an inability to fall asleep and
awaken at a desired earlier time.
Shift Work Type
- Night shift or shift changes
- Can start in adolescence and last
for years or decades without
intervention.
- shift work: sleep back to normal
within 2 weeks after shift change.
- Jet Lag: one day per time zone

Nightmares

Repeated awakening from the

major sleep period or naps with
detailed recall of extended and
extremely frightening dreams,
usually involving threats of
survival, security, or self-esteem.
On awakening from frightening
dreams, person rapidly becomes
oriented and alert.
Dream experience or sleep
disturbance resulting from the
awakening results in clinically
significant distress/impairment in
social, occupational, or other
important areas.
Nightmares not due to another
sleep disorder, mental disorder,
physical condition, substance use,
or medical condition.

Dreams that occur in REM

sleep, less intense then
sleep terrors.
Awakening usually occurs
in second half of sleep
period.
Prevalence 10-50% kids 35 years old; 3% young
adults; 50% adults suffer
occasional nightmares.
Likely to reoccur in children
that are exposed to severe
psychosocial stressors

Sleep Terrors

Recurrent episodes of abrupt

awaking from sleep.
Intense fear and signs of autonomic
arousal such as tachycardia, rapid
breathing, & sweating.
Relative unresponsiveness to
efforts of others to comfort the
person during the episode.
No detailed dreams are recalled
and there is amnesia for the
episode.
The episode causes clinically
significant distress/impairment in
social, occupational, or other
important areas.
Not due to another sleep disorder,
mental disorder, physical condition,
substance use, or medical
condition.

Abrupt autonomic arousal in Stage

3-4 sleep that is interpreted as fear.
Often occurs between 4-12 years or
20-30 years.
Often resolves in adolescence.
Chronic sleep terrors waxes and
wanes.
Psychopathology is likely to be
associated with PTSD and general
anxiety.
Prevalence 1-6% children; less then
1% adults.
No treatment in children, usually go
away. Can give sleep medication.

Sleep Walking
(somnambulism)

Repeated episodes of rising from

bed during sleep and walking about.
While sleep walking person has a
blank staring face; is relatively
unresponsive of others to
communicate with him/her, and can
be awakened only with great
difficulty.
On waking the person has amnesia.
Within several minutes after
awakening from sleep walking
episode. There is no impairment,
mental activity, or behavior. (May be
a period of confusion disorientation.)
Sleep walking causes clinically
significant distress.
Not due to another sleep disorder,
mental disorder, physical condition,
substance use, or medical condition.

Stage 3 and 4 sleep

Prevalence 10-30% of
children at least once; 23% often. Occurs 1-7% of
adults and 0.5%-0.7%
have weekly or monthly
attacks
Gender differences occurs
more often in females
during childhood. Occurs
mostly in males in
adulthood.

REM Behavior Disorder

A neurological disorder in which a
person does not become paralyzed
during REM sleep, and acts out dreams
his/her dreams.
Degenerative neurological illness in
50% of affected persons.
Often give Clonazepam

Restless Leg Syndrome

Neurological disorder that is characterized by
unpleasant sensations of legs and an urge to
move them when at the rest.
Sleep movements can be so severe that causes
chronic sleep disturbances and sleep deprivation
Effects about 12 million Americans.
Causes: Mostly unknown (idiopathic)
Treatment: underlying cause, some meds, and
exercise.

Reference
Abad, V.C. & Guilleminault, C.(2004). Emerging
drugs for narcolepsy. Expert Opinion Emerging
Drugs, 9(2), 281-291.
Erman, M.K. (2005). Therapeutic options in the
treatment of insomnia. The journal of clinical
psychiatry, 66(9), 18-23.
Lemon, M.D. (2006). New medication choices for
the treatment of insomnia. South Dakota journal
of medicine, 59(2), 66-67.
Roth, T. (2005). Prevalence, associated risks,
and treatment patterns of insomnia. The journal
of clinical psychiatry, 66(9), 10-13.