Quiz 9 Flashcards
A) A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one or more of the following:
1) difficulty initiating sleep
2) Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings
3) Early-morning awakening with inability to return to sleep.
B) The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning
C) The sleep difficulty occurs at least 3 nights/week
D) The sleep difficulty is present for at least 3 months
E) The sleep difficulty occurs despite adequate opportunity for sleep
F) The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder
G) The insomnia is not attributable to the physiological effects of a substance
H) Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
Essential Feature: Dissatisfaction with sleep quantity or quality with complaints of difficulty initiating or maintaining sleep. Also involves daytime impairments like fatigue, daytime sleepiness, impairment in cognitive performance may include difficulties with attention, concentration, and memory. Mood disturbance includes irritability.
Insomnia disorder
A) Self-reported excessive sleepiness despite a main sleep period lasting at least 7 hours with at least one of the following:
1) Recurrent periods of sleep or lapses into sleep within the same day
2) A prolonged main sleep episode of more than 9 hours/day
3) Difficulty being fully awake after abrupt awakening.
B) The hypersomnolence occurs at least 3x/week for 3 months
C) Hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning
D) The hypersomnolence is not better explained by and does not occur exclusively during the course of another sleep disorder
E) The hypersomnolence is not attributable to the physiological effects of a substance
F) Coexisting mental and medical disorders do not adequately explain the predominant complaint of hypersomnolence.
Essential feature: Broad; includes symptoms of excessive quantity or sleep, deteriorated quality of wakefulness, and sleep inertia. Individuals fall asleep quickly and have a good sleep efficiency. They may have difficulty waking up in the morning, sometimes appearing confused, combative, or ataxic. Decline in motor dexterity, behavior may be very inappropriate, and memory deficits, disorientation in time and space, and feelings of grogginess may occur.
Hypersomnolence Disorder
A) Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three time per week over the past 3 months.
B) The presence of at least one of the following:
1) Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month:
a) Individuals with long-standing disease, brief episodes of bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking.
b) In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers.
2) Hypocretin deficiency, as measured using cerebrospinal fluid hypocretin-1 immunoreactivity values (less than or equal to 1/3 of values obtained in healthy subjects tested using the same assay, or less than or equal to 110 pg/mL) Low CSF levels of hypocretin-1 must not be observed in the context of acute brain injury, inflammation, or infection.
3) Nocturnal sleep polysomnography showing rapid eye movement sleep latency less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep latency less than or equal to 8 minutes and 2 or more sleep-onset REM periods.
Essential Feature: recurrent daytime naps or lapses into sleep. Sleepiness typically occurs daily but must occur at minimum three times/week for at least 3 months.
Narcolepsy
A) Either 1 or 2
1) Evidence by polysomnography of at least 5 obstructed apneas or hypopneas per hour of sleep and either of the following symptoms:
a) Nocturnal breathing disturbances: snoring, snorting/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.
2) Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms.
Essential Feature: Most common breathing-related sleep disorder. Characterized by repeated episodes of upper airway obstruction during sleep. Each apnea or hypopnea represents a reduction in breathing for at least 10 seconds in duration in adults or 2 missed breaths in children and is typically associated with drops in oxygen saturation of 3% or greater and//or an electroencephalographic arousal. Cardinal symptoms are snoring and daytime sleepiness.
Obstructive Sleep Apnea Hypopnea
A) Evidenced by polysomnography of 5 or more central apneas per hour of sleep
B) The disorder is not better explained by another current sleep disorder.
Essential Features: Repeated episodes of apneas and hypopneas during sleep cause by variability in respiratory effort. These are disorders of ventilatory control in which respiratory events occur in a periodic or intermittent pattern. Central and obstructive sleep apneas may coexist. Characterized by sleepiness, insomnia, and awakenings due to dyspnea in associated with five or more central apneas per hour of sleep.
Central Sleep Apnea
A) Polysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels
B) The disturbance is not better explained by another current sleep disorder.
Features: Can occur independently, but more frequently, comorbid with medical or neurological disorders, medication use, or substance use disorder. Although symptoms are not mandatory to make this diagnosis, individuals often report excessive daytime sleepiness, frequent arousals and awakenings during sleep, morning headaches, and insomnia complaints.
Sleep Related Hypoventilation
A) A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule.
B) The sleep disruption leads to an excessive sleepiness or insomnia, or both
C) The sleep disturbance causes clinically significant distress or impairment in social, occupational, and other important areas of functioning.
Circadian Rhythm Sleep-Wake disorder
A) 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:
1) Sleepwalking: repeated episodes of rising from bed during sleep and walking about. While sleepwalking, the individual has a blank, staring face; is relatively unresponsive to the efforts of others to communicate with them, and can be awakened only with great difficulty.
2) Sleep Terrors: Recurrent episodes of abrupt terror arousals 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. There is relative unresponsiveness to efforts of others to comfort the individual during the episodes.
B) No or little dream imagery is recalled
C) Amnesia for the episodes is present
D) The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
E) The disturbance is not attributable to the physiological effects of a substance
F) Coexisting mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors.
Essential Feature: Repeated occurrence of incomplete arousals, usually beginning during the first third of the major sleep episode that typically are brief (lasting 1-10 minutes), with maximum duration of an event being unknown. Eyes are typically open during the events.
Non-Rapid Eye Movement Sleep Arousal Disorder
A) 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.
B) On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert
C) The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D) The nightmare symptoms are not attributable to the physiological effects of a substance
E) Coexisting mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams
Nightmare Disorder
A) Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.
B) These behaviors arise during REM sleep and therefore usually occur more than 90 minutes after sleep onset, are more frequent during the later portions of the sleep period, and uncommonly occur during daytime naps.
C) Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented.
D) Either of the following:
1) REM sleep without atonia on polysomnographic recording
2) A history suggestive of REM sleep behavior disorder and an established synucleinopathy diagnosis
E) The behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
F) The disturbance is not attributable to the physiological effects of a substance or another medical condition
G) Coexisting mental and medical disorders do not explain the episodes.
Essential Feature: Repeated episodes of arousal, often associated with vocalizations and/or complex motor behaviors arising from REM sleep. These behaviors often reflect motor responses to the content of action-filled or violent dreams of being attacked or trying to escape from a threatening situation, which may be termed dream enacting behaviors. Vocalizations are often loud, emotion-filled, and profane.
Rapid Eye Movement Sleep Behavior Disorder
