sleep wake disorders for ncmhce study
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Insomnia Disorder Hypersomnolence Disorder Narcolepsy Breathing-Related Sleep
Disorders Circadian Rhythm Sleep-
Wake Disorders
Non-REM Sleep Arousal Disorders
Parasomnias Nightmare Disorder Restless Legs Syndrome Substance/Medication-
Induced Sleep Disorder
Comorbidity Depressive disorders Anxiety disorders Autism ADHD OCD Adjustment disorder Dissociative disorders Feeding & Eating disorders Somatic Symptom disorders Neurocognitive disorders
Rule Out Depressive
disorders
S2. Assess & Refer IEvaluations Polysomnography
Expensive and to be avoided if possible
Sleep diaries Lab tests for neurotransmitter deficiencies, breathing
difficulties, etc.
S2. Assess & Refer IITests STQ Sleep Timing Questionnaire SII Sleep Impairment Index ISI Insomnia Severity Index PSQI Pittsburgh Sleep Quality
Index RBDSQ REM Sleep Behavior
Disorder Screening REM Sleep Behavior
Questionnaires – Hong-Kong GAD-7 PHQ-9
PROMIS Level 2 Sleep Disturbance Patient Reported Outcome Measurement Information System
Epworth Sleepiness Scale SCQ Sleep Disorders
Questionnaire SCI Sleep Condition
Indicator CSM Composite Scale of
Morningingness
S4. TreatmentTherapy CBT-Insomnia Relaxation Therapy Cognitive Thought Stopping Bright Light Therapy Neurostimulation
Medication Melatonin Amphetamines Antidepressants Monoamine Oxidase
Inhibitors (MOIs)
S1. Diagnosis I Difficulty initiating or
maintaining sleep, or poor quality sleep
At least 3 nights per week for at least 3 months, despite adequate opportunity for sleep
Not part of another Sleep Wake disorder
Not due to substance effects
Types1. Psychological Worries about insomnia
so they cannot sleep2. Sleep State Misperception Believes they sleep poorly
but sleep quality is good3. Hypnotic Dependent
Sleep Disorder Due to withdrawal of
sleeping pills
S1. Diagnosis IICo-occurring: Depression or other
mental disorder Chronic pain
Rule Outs: Breathing related disorders Circadian Rhythm Sleep
Disorder Periodic limb movement
disorder
S4. Treatments CBT EEG feedback Stimulus control Relaxation Therapy Psychoeducation Sleep-restriction Therapy Behavioral Therapy, such
as regulating the circadian clock
Lifestyle changes Reduced stress Exercise Restricted caffeineMedication Melatonin Brief use of hypnotics
Diagnosis I Recurrent episodes of
excessive daytime sleepiness or prolonged nighttime sleep
At least 3 times weekly Naps repeatedly
throughout the day, with no relief from symptoms
Common among adolescents and young adults
Often disoriented when
waking and may experience:
Anxiety
Increased irritation
Decreased energy
Restlessness
Slow thinking
Slow speech
Loss of appetite
Hallucinations
Memory difficulty
Diagnosis IICo-occurring: Other mental disorders, like depression Medical conditions like head injury, multiple sclerosis,
encephalitis, epilepsy, or obesity
Diagnosis IRequires: Presence of
recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day
3x per week over the past 3 months
Also at least one of the following: Cataplexy
Brief episodes of sudden loss of muscle tone, usually with intense emotion like laughing or crying
Hypocretin neurotransmitter deficiency Recurrent intrusions of rapid eye
movement (REM) sleep into the transition between sleep and waking
With either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes
Diagnosis II Onset usually from childhood to
young adulthood, especially ages 5–25 and 30–35
Onset can be abrupt or progressive over years
Childhood onset most severe Early Symptoms:
Sleepiness
Vivid dreaming
Excessive movements during REM sleep
Co-occurring:Sleep apneaREM Sleep
Behavior Disorder
S4. TreatmentsMedications for sleepiness Central Nervous System
StimulantsMedications for sleepiness Tricyclic AntidepressantsMedication for both Sodium Oxybate
Lifestyle changes Reduced stress Exercise Restricted caffeine
Cataplexy: Brief episodes of sudden bilateral loss of muscle tone in neck, jaw, arms, legs, or whole body, resulting in head bobbing, jaw dropping, or complete falls, most often in association with intense emotion, like laughing
Apnea: No breathing airflow during sleep
Hypoapnea: Reduced airflow
S1. Diagnosis I
Nocturnal breathing
disturbances, pauses or
gasping/snorting for air
during the night
Often resulting in
daytime sleepiness
Patient unaware
Requires:
Repeated episodes, at least 5
per hour of sleep per night, of
upper airway obstruction
during sleep
Apneas (no airflow) or
hypopneas (restricted airflow)
S4. Treatments1. Physical devices Positive Airway Pressure mask over face Mouth device Higher upper body position2. Neurostimulation3. Surgery and weight loss
S1. Diagnosis IAffects timing of sleep; unable to sleep and wake at the times required Requires:1. Pattern of sleep disruption mainly due
to an alteration of the circadian system
Or misalignment between the internal circadian rhythm and the sleep-wake schedule required
2. The sleep disruption leads to excessive sleepiness or insomnia, or both
Specify:Episodic: Lasts 1 to 3 monthsPersistent: Lasts 3 months or moreRecurrent: Two or more episodes occur within 1 year
Diagnosis IllCo-occurring in children Restless Leg Syndrome Sleep Breathing Disorder Bed-wetting (Enuresis)
Co-occurring in adults: Delirium Seizure disorder Drug toxicity Schizophrenia Anxiety disorders Migraine headaches Tourette Syndrome
Diagnosis Il Most common among children and adolescentsRequires:1. Rising from bed during sleep and walking about Usually during the first third of sleep period2. While sleepwalking, they have a blank, staring face, are
relatively unresponsive to communicate efforts, and can be awakened only with great difficulty
3. No memory of the episode upon awakening4. Shortly after awakening, there is no impairment of mental
activity or behavior May be an initial short period of disorientation
S4. Treatments Avoidance of
neuroleptics or hypnotics Avoidance of alcohol
Medications Tricyclic
Antidepressants Benzodiazepine
Diagnosis IIMore likely in young peopleRequires:1. Recurrent periods where the individual
abruptly wakes from sleeping with a scream
2. Experience of intense fear and symptoms of autonomic arousal, like rapid heart rate, heavy breathing and sweating
3. Cannot be soothed during the episode 4. Unable to remember details of the
dream or episode
Co-occurring Neurological
disease Hypoglycemia Poor nutrition
S4. Treatments Psychotherapy Scheduled Awakenings
Therapy very effective Increasing quality of sleep
Medications, in extreme cases Tricyclic
Antidepressants Benzodiazepine
Diagnosis I
Requires:
Repeated awakenings with recollection of terrifying dreams,
usually involving threats to survival, or safety
During REM sleep, after 90 minutes
Awakes alert and able to recall the dream well
May be anxious and unable to fall back asleep
Onset from childhood to adolescence, improvement with age
Diagnosis IIRule out: Sleep Terrors: Cannot recall dream Side effect of illicit drugs, like cocaine
and amphetamines Side effect of prescribed drugs, for
blood pressure, depression, Parkinson’s
PTSD
Co-occurring:Dissociative
disordersBorderline
Personality disorder
S4. TreatmentsTherapy Dealing with frightening dream themes Relaxation Therapy Hypnosis Stress reductionMedications Prazosin, used in PTSD
Diagnosis I
Desire to move the
legs or arms, usually
associated with
sensations described
as creeping,
crawling, tingling,
burning or itching
Worse when at rest
Requires:
1. An urge to move the legs, related to uncomfortable sensations in the legs, characterized by all of the following:
Begins or worsens during periods of rest or inactivity
Partially or totally relieved by movement
Worse in the evening or occurs only in the evening
2. Occurs at least 3 times/week, for at least 3 months
Diagnosis IICo-occurring:Periodic Limb Movement Disorder, where limbs jerk
during sleepNeurologic conditions like Parkinsons diseaseRenal disease
S4. Treatments Stretching, walking
(temporary) Iron supplements
Medications Benzodiazepines Anticonvulsants for pain Non-dopaminergic
Gabapentin or Pregabalin Dopamine Agonists,
cautiously
Diagnosis IRequires:
Repeatedly
waking up
after REM
sleep
Movements
related to
dreams
Requires:1. Repeated episodes of arousal during sleep,
associated with vocalization and/or complex motor behaviors
2. During rapid eye movement (REM) sleep, usually 90 minutes after sleep onset and more frequent later in sleep period
3. Awakening alert and not disoriented4. Either of the following: Polysomnographic confirmation of REM sleep
without normal muscle paralysis History suggestive of this disorder and
diagnosis of Parkinson’s or related diseases
Diagnosis II Onset usually from childhood to
young adulthood, especially at ages 15–25 years and ages 30–35 years
Onset can be abrupt or progressive over years
Childhood onset most severe Early Symptoms: Sleepiness, vivid
dreaming, and excessive movements during REM sleep
Co-occurring:Other sleep
disordersParkinson’s
diseaseMultiple System
Atrophy andLewy Body
Dementia
S1. Find Out S2. Assess& ReferLab tests RBDSQ Rapid Eye
Movement (REM) Sleep Behavior Disorder Screening Questionnaire
REM Sleep BehaviourQuestionnaires – Hong-Kong
S4. Treatments Medications Clonazepam and
melatonin most effective
Avoid sleep deprivation, alcohol, and certain medications
Make bedroom safe
Cataplexy: Brief episodes of sudden bilateral loss of muscle tone in neck, jaw, arms, legs, or whole body, resulting in head bobbing, jaw dropping, or complete falls, most often in association with intense emotion, like laughing
Apnea: No breathing airflow during sleepHypoapnea: Reduced airflowAkathisia: Movement disorder characterized by a feeling of restlessness and a compelling need to be in constant motionAtonia: Muscle paralysis, as in normal sleep