Sleep disorders

Question 1

Insomnia Disorder

Answer 1

A. A predominant complaint of dissatisfaction witli sleep quantity or quality, associated with one (or more) of the following symptoms:
1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
2. Difficulty maintaining sleep, characterized by frequent awakenings or problems re­ turning to sleep after awakenings.
(In children, this may manifest as difficulty return­ ing to sleep without caregiver intervention.)
3. Early-morning awakening with inability to return to sleep.
C. The sleep difficulty occurs at least 3 nights per week.
D. The sleep difficulty is present for at least 3 months.
E. The sleep difficulty occurs despite adequate opportunity for sleep.

Question 2

Hypersomnolence Disorder

Answer 2

A. Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms:
Recurrent periods of sleep or lapses into sleep within the same day.
A prolonged main sleep episode of more than 9 hours per day that is nonrestorative
(i.e., unrefreshing).
Difficulty being fully awake after abrupt awakening.
B. The hypersomnolence occurs at least three times per week, for at least 3 months.

Question 3

Circadian Rhythm Sleep-Wake Disorders

Answer 3

A. A persistent or recurrent pattern of sleep disruption that is primarily due to 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 excessive sleepiness or insomnia, or both.

Question 4

Obstructive Sleep Apnea Hypopnea

Answer 4

A. Either (1) or (2):

1. Evidence by polysomnography of at least five obstructive apneas or hypopneas per hour of sleep and either of the following sleep 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 (including a sleep 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.

Question 5

Narcolepsy

Answer 5

A. HYPERSOMNIA EPISODES 3 TIMES PER WEEK FOR 3 MONTHS. 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 times 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. Episodes of sudden 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. Low must not be observed in the context of acute brain injury, inflammation, or infection.
3. Rapid eye movement (REM) 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 two or more sleep-onset REM periods.