Sleep Disorders

Question 1

Types of Sleep Disorders

Answer 1

• Primary Sleep Disturbances
• > Primary insomnia
• > Primary hypersomnolence
• > Nacrolepsy
• > Circadian rhythm sleep disorder
• Sleep disorder related to another mental condition
• Sleep disorder due to a general medical condition
• Substance-induced sleep disorder

Question 2

Define Primary Insomnia

Answer 2

• Difficulties in initiating or maintaining sleep or non-restorative sleep, for at least 1 month
• The sleep disturbance causes impairment in social or occupational functioning
• Does not occur exclusively during the course of another mental disorder (e.g. Major Depressive Disorder GAD, delirium)
• Does not occur along course of other sleep disorders
• Not due to a substance

Question 3

Define Primary Hypersomnolence

Answer 3

• Excessive sleepiness for over a month
• The sleep disturbance causes impairment in social or occupational functioning
• Does not occur exclusively during the course of another mental disorder
• Does not occur along course of other sleep disorders
• Not due to a substance

Question 4

Define Narcolepsy

Answer 4

• Irreversible attacks of refreshing sleep that occur daily over at least 3 months
• The presence of one or both of the following:
• > Cataplexy (brief episodes of sudden bilateral loss of muscle tone, most often associated with intense emotion)
• > Recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic or hypnapompic hallucinations or sleep paralysis at the beginning or end of sleep episodes.
• Not due to a substance

Question 5

Define Circadian Rhythm Sleep Disorder

Answer 5

A persistent pattern of sleep disruption leading to excessive sleepiness due to a mismatch in the circadian sleep-wake cycle.

Question 6

Define Sleep Disorder Related to Another Mental Disorder

Answer 6

Involves a prominent sleep disturbance that results from a mental disorder (often a Mood disorder or Anxiety disorder). Presumably the mechanisms responsible for the mental disorder also affect the sleep-wake system.

Question 7

Define Sleep Disorder Due to a General Medical Condition

Answer 7

Common conditions include:

• headaches
• epilepsy
• fibromyalgia
• coronary ischaemia.

Question 8

Define Substance-Induced Sleep Disorder

Answer 8

Due to a concurrent use or recent discontinuation of a substance.

Question 9

Management Subtypes

Answer 9

• Sleep Hygiene
• Stimulus Control
• Specific Therapies

Question 10

What are the Sleep Hygiene Measures

Answer 10

(10 basic rules)

• Sleep only as much as you need to feel rested and then get out of bed
• Keep a regular sleep schedule
• Exercise regularly for at least 20 minutes, preferable 4-5 hours before bedtime.
• Avoid forcing sleep
• Avoid caffeinated beverages after lunch
• Avoid alcohol near bedtime: no “night cap”
• Avoid smoking, especially in the evening
• Adjust bedroom environment
• Do no go to bed hungry
• Deal with your worries before bedtime

Question 11

What is stimulus control for promoting sleep

Answer 11

• Help the patient to associate the bed and bedroom with sleep and nothing else. Activities that do not go well with sleep (including reading, eating, using computers, watching tv and worrying) are excluded from the bedroom.

Question 12

Specific Sleep Pharmacotherapy for Insomnia

Answer 12

Two classes of drugs (BZD’s & nonBZD’s) can be used intermittently and not for more than two weeks

• Temazepam 10mg
• Zolpidem
• Zopiclone

Question 13

Specific Sleep Pharmacotherapy for Hypersomnolence or Narcolepsy

Answer 13

Any of the following stimulants can be used

• Dexamphetamine
• Methylphenidate
• Modafinil