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SLEEP DISORDER

The DSM V classification: Sleep-wake disorders encompass 10 disorders or disordered groups. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral or other important areas of functioning. The sleep difficulty occurs at least 3 nights per week, for at least 3 months despite adequate opportunity for sleep.

A. Insomnia disorder:

A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:

  • Difficulty initiating sleep
  • Difficulty maintain sleep
  • Early-morning awakening with inability to return to sleep
B. Hypersomnolence disorder:

Self-reported excessive sleepiness despite a main sleep period lasting at least 7 hours, with one of the following symptoms:

  • Recurrent periods of sleep or lapse into sleep within the same day
  • Difficulty being fully awake after abrupt awakening
  • A prolonged main sleep episode of more than 9 hours per day that is nonrestorative
C. Narcolepsy:

Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day

  • Episodes of cataplexy: Brief episodes of sudden bilateral loss of muscle tone with maintained consciousness are precipitated by laughter or joking
  • Within 6months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers
D. Breathing related sleep disorders:

The breathing-related sleep disorders category encompasses three relatively distinct disorders, Obstructive sleep apnea hypopnea, Central sleep apnea and Sleep-related hypoventilation

  1. The symptoms are evidence of polysomnography of at least five obstructive apneas or hypopneas per hour sleep and either of the following sleep symptoms:
  • a. Nocturnal breathing disturbances: snoring, snoring/gasping, or breathing pauses during sleep
  • b. Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder and is not attributable to another medical condition
  1. Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms
E. Circadian rhythm sleep-wake disorders:

A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or a misalignment between the endogenous circadian rhythm and the sleep –wake schedule required by an individual’s physical environment or social or professional schedule. The sleep disruption leads to excessive sleepiness or insomnia, or both.

F. Non-rapid eye movement (NREM) sleep arousal disorder:

Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either one of the following

  • Sleepwalking: Repeated episodes of rising from bed during sleep and walking about. While sleep walking, the individual has a blank , staring face; relatively unresponsive to the efforts of others to communicate with him or her; and can be awakened only with great difficulty.
  • Sleep terrors: Recurrent episodes of abrupt terror arousal from sleep, usually beginning with a panicky scream. There is intense fear and signs of autonomic arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode.
G. Nightmare disorder:

Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity and that generally occur during the second half of the major sleep episode.

H. Rapid eye movement (REM) sleep behavior disorder:

Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors. These behaviors arise during REM sleep and therefore usually occur more than90 minutes after sleep onset.

I. Restless leg syndrome:

An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs, characterized by the urge to move the legs begins or worsens during periods of rest or inactivity. The urge to move the legs is partially or totally relieved by movement. The urge is worse in the evening or night.

J. Substance/Medication-induced sleep disorder:

A prominent and severe disturbance in sleep. There is evidence from the history, physical examination, and or laboratory findings. Sleep disorders are often accompanied by depression, anxiety and cognitive changes that must be addressed in treatment planning and management. Furthermore, persistent sleep disturbances are established risk factors for the subsequent development of mental illness and substance use disorders.

Diagnosis:

Psychiatrist will confirm the diagnosis after sleep study if necessary.

Management:

Medication management and alternate therapy like meditation, reiki and hypnotherapy.