Sleep disorders - DSM criteria Flashcards
What are the main criteria for Insomnia Disorder?
Dissatisfaction with sleep quality or quantity, with at least one of:
1. Trouble falling asleep.
2. Trouble staying asleep.
3. Waking up too early and unable to fall back asleep.
How often must insomnia symptoms occur for a diagnosis?
- At least 3 nights per week.
- For at least 3 months.
What are the exclusion criteria for Insomnia Disorder?
- Cannot be better explained by another sleep disorder.
- Not caused by substance use or medication.
- Not due to a mental or medical condition.
What are the specifier categories for Insomnia Disorder?
- With Mental Disorder (including Substance Use Disorders).
- With Medical Condition.
- With Another Sleep Disorder.
What are the duration specifiers for Insomnia Disorder?
- Episodic: Symptoms last 1-3 months.
- Persistent: Symptoms last over 3 months.
- Recurrent: 2+ episodes within a year.
What are some common behaviors in individuals with Insomnia Disorder?
- Over-focusing on sleep (worrying about not sleeping).
- Clock-watching.
- Spending too much time in bed.
- Frequent naps that interfere with night sleep.
How does insomnia affect daily life?
- Fatigue, mood changes, irritability.
- Impaired concentration and attention.
- Higher levels of anxiety and depression.
Who is most at risk for Insomnia Disorder?
- Women (especially around childbirth or menopause).
- Middle-aged & older adults (due to medical issues).
- Adolescents with irregular sleep schedules.
What are the different types of Insomnia?
- Situational Insomnia: Short-term, due to life events or travel.
- Episodic Insomnia: Recurrent sleep difficulties with stressful events.
What are some risk factors for Insomnia?
- Anxiety, worry, and personality traits that increase arousal.
- Environmental factors (noise, light, temperature).
- Being female (3x more likely).
- Genetic factors (higher risk in identical twins).
What are some conditions that can mimic insomnia?
- Delayed sleep phase disorder (trouble sleeping at normal times).
- Restless leg syndrome (uncomfortable leg sensations).
- Breathing disorders (sleep apnea).
- Narcolepsy (daytime sleepiness, hallucinations).
- Parasomnias (sleepwalking, night terrors).
How does insomnia affect sleep structure?
- More Stage 1 sleep (lighter sleep).
- Less Stage 3 & 4 sleep (deep sleep).
- Underestimation of total sleep duration.
What are the comorbid conditions with Insomnia Disorder?
- Medical conditions: diabetes, heart disease, chronic pain
- Mental disorders: depression, anxiety, bipolar disorder
- Substance use: alcohol, caffeine, sleeping pills
What are some common coping mechanisms people use for insomnia?
- Alcohol or medication to fall asleep.
- Caffeine or stimulants to counteract tiredness.
- Avoiding bedtime or over-sleeping to compensate.
How is insomnia diagnosed?
- Sleep diary (7-14 days).
- Insomnia Severity Index (ISI).
- Polysomnography (PSG) if other disorders are suspected.
What is the most common treatment for Insomnia Disorder?
- Cognitive Behavioral Therapy for Insomnia (CBT-I).
- Sleep hygiene education.
- Relaxation techniques.
What is the main symptom of Hypersomnolence Disorder?
Excessive sleepiness despite getting at least 7 hours of sleep, along with at least one of the following:
1. Frequent napping or falling asleep during the day.
2. Sleeping 9+ hours but not feeling refreshed.
3. Trouble fully waking up after an abrupt awakening.
How often must excessive sleepiness occur for a Hypersomnolence Disorder diagnosis?
At least 3 times per week for 3 months.
What impairments must be present for a Hypersomnolence Disorder diagnosis?
Sleepiness must cause significant problems with thinking, socializing, work, or other important areas of daily life.
What exclusion criteria must be ruled out for a Hypersomnolence Disorder diagnosis?
- Not due to another sleep disorder (e.g., narcolepsy, sleep apnea).
- Not caused by substances (e.g., drugs, medication).
- Not fully explained by another mental or medical condition.
What are the duration specifiers for Hypersomnolence Disorder?
- Acute: Less than 1 month.
- Subacute: 1-3 months.
- Persistent: More than 3 months.
What are the specifier categories for Hypersomnolence Disorder?
- With Mental Disorder (e.g., substance use, depression).
- With Medical Condition (e.g., neurological or metabolic disorders).
- With Another Sleep Disorder (e.g., sleep apnea).
What is the primary symptom of Narcolepsy?
Sudden, uncontrollable urges to sleep or frequent sleep lapses or napping, happening at least 3 times per week for 3 months.
What additional criteria (B) must be present in Narcolepsy?
At least one of the following:
1. Cataplexy: Sudden muscle weakness triggered by laughter or emotions.
2. Hypocretin deficiency: Low levels of hypocretin-1 in cerebrospinal fluid (CSF).
3. Abnormal REM latency: REM sleep within 15 minutes on nocturnal PSG or multiple REM episodes in sleep tests.
What are the subtypes of Narcolepsy?
- Without Cataplexy: Low hypocretin-1 & abnormal sleep tests, but no cataplexy.
- With Cataplexy, Without Hypocretin Deficiency: Cataplexy & abnormal sleep tests, but normal hypocretin-1 (very rare, ~5%).
- Autosomal Dominant Cerebellar Ataxia, Deafness, and Narcolepsy: Rare genetic disorder with narcolepsy, deafness, & ataxia.
- Autosomal Dominant Narcolepsy, Obesity, and Type 2 Diabetes: Narcolepsy linked to genetic mutation, obesity, & diabetes.
- Secondary to Other Medical Conditions: Caused by brain injury, infection, or tumors affecting sleep-related neurons.
How is Narcolepsy severity classified?
- Mild: Cataplexy <1x per week, occasional naps, mild nighttime sleep disturbances.
- Moderate: Cataplexy once per day or every few days, frequent naps, moderate sleep disturbances.
- Severe: Frequent, untreatable cataplexy, multiple sleep attacks per day, and severe nocturnal sleep problems.
What is the main feature of Obstructive Sleep Apnea Hypopnea?
Repeated episodes of apnea (complete airflow blockage) and/or hypopnea (reduced airflow) during sleep, leading to poor sleep quality and daytime fatigue.
What are the two main diagnostic criteria (A) for Obstructive Sleep Apnea Hypopnea?
- Sleep study shows at least 5 apnea/hypopnea episodes per hour + either:
- Noisy breathing (snoring, gasping, choking);
- Excessive daytime sleepiness or fatigue despite enough sleep.
- Sleep study shows 15+ apnea/hypopnea episodes per hour, regardless of symptoms.
What are the severity levels of Obstructive Sleep Apnea Hypopnea?
- Mild: 5-15 episodes per hour.
- Moderate: 15-30 episodes per hour.
- Severe: 30+ episodes per hour.
What are common associated features of Obstructive Sleep Apnea Hypopnea?
- Snoring, choking, gasping during sleep.
- Daytime fatigue, poor concentration, morning headaches.
- Dry mouth, erectile dysfunction, decreased libido.
- Hypertension is common (~50% of cases).
How common is Obstructive Sleep Apnea Hypopnea, and who is most affected?
- Very common, but often undiagnosed, especially in older adults.
- More common in males but differences decrease after menopause.
- Obesity is a major risk factor.
- No gender difference in prepubescent children.
What is the typical development and course of Obstructive Sleep Apnea Hypopnea?
J-shaped age curve:
* Peak at ages 3-8 (often due to enlarged tonsils).
* Decline after childhood, then increase again around 40-60 years due to obesity & menopause.
* May decrease after age 65.
Gradual progression with persistent symptoms.
Can improve with weight loss.
What are the biggest risk factors for Obstructive Sleep Apnea Hypopnea?
Obesity and male sex are the strongest risk factors.
Other risks:
* Family history of sleep apnea.
* Menopause.
* Genetic syndromes affecting the airway.
* Endocrine conditions.
What disorders must be differentiated from Obstructive Sleep Apnea Hypopnea?
- Primary snoring: Some snorers have no airflow blockages.
- Insomnia disorder: No snoring or history of airway issues.
- Panic attacks: Gasping during nocturnal panic attacks can resemble sleep apnea but lacks daytime sleepiness.
- ADHD: Can co-occur; look for tonsil enlargement, obesity, or family history.
- Substance/medication-induced sleep issues: Rule out drug effects.
What medical conditions are commonly comorbid with Obstructive Sleep Apnea Hypopnea?
- Hypertension, heart disease, stroke, diabetes.
- Higher risk of mortality if untreated.
- Stronger link to depression in males.
What is the main diagnostic feature of Central Sleep Apnea?
Repeated episodes of apnea (complete breathing pauses) during sleep, detected by a sleep study (polysomnography) showing 5+ central apneas per hour.
What are the three subtypes of Central Sleep Apnea?
- Idiopathic Central Sleep Apnea: Breathing stops due to irregular respiratory effort, without airway obstruction.
- Cheyne-Stokes Breathing: A periodic breathing pattern with waxing and waning respiration, causing central apneas and shallow breathing.
- Central Sleep Apnea Comorbid with Opioid Use: Caused by opioid-induced suppression of breathing regulation.
How is Central Sleep Apnea severity determined?
By evaluating the frequency of apneas, level of oxygen desaturation, and the extent of sleep disruption caused by breathing irregularities.
What is the main diagnostic feature of Sleep-Related Hypoventilation?
A sleep study (polysomnography) shows episodes of reduced breathing associated with increased CO2 levels.
What are the three subtypes of Sleep-Related Hypoventilation?
- Idiopathic Hypoventilation: No clear medical cause.
- Congenital Central Alveolar Hypoventilation: A rare condition from birth, often leading to shallow breathing, cyanosis, and sleep apnea.
- Comorbid Sleep-Related Hypoventilation: Associated with lung diseases, neuromuscular disorders, or medication effects.
How is Sleep-Related Hypoventilation severity determined?
By the degree of low oxygen (hypoxia) and high CO2 levels (hypercapnia), and signs of organ damage, such as right-sided heart failure.
What is the main diagnostic feature of Circadian Rhythm Sleep-Wake Disorders?
A misalignment between the person’s internal sleep rhythm and their social, work, or environmental schedule, leading to insomnia or excessive sleepiness.
What are the six main types of Circadian Rhythm Sleep-Wake Disorders?
- Delayed Sleep Phase Type: Consistently going to bed too late and waking up too late.
- Advanced Sleep Phase Type: Sleeping and waking too early.
- Irregular Sleep-Wake Type: No stable sleep-wake cycle, leading to fragmented sleep.
- Non-24-Hour Sleep-Wake Type: Sleep schedule shifts forward each day, common in blind individuals.
- Shift Work Type: Sleep problems caused by night shifts or rotating work schedules.
- Unspecified Type: Doesn’t fit into a specific category.
What are the three course/duration specifiers for Circadian Rhythm Sleep-Wake Disorders?
- Episodic: Lasts 1-3 months.
- Persistent: Lasts more than 3 months.
- Recurrent: Two or more episodes in a year.
What are the two main types of Non-REM Sleep Arousal Disorders?
- Sleepwalking: Repeated episodes of getting out of bed with a blank expression, unresponsive, and difficult to wake.
- Sleep Terror: Sudden awakenings with intense fear, often with screaming and signs of extreme arousal (e.g., rapid heartbeat, sweating).
What are the key features of Non-REM Sleep Arousal Disorders?
- Episodes happen in the first third of sleep.
- Little to no dream recall.
- Amnesia for the episode.
- Causes distress or impairment.
- Not due to substances or another disorder.
What are the specifiers for Non-REM Sleep Arousal Disorders?
- Sleepwalking type or Sleep terror type.
- With sleep-related eating or With sleep-related sexual behavior (sexsomnia).
What is the main feature of Nightmare Disorder?
Repeated distressing dreams about threats to survival, safety, or well-being.
* Occurs mostly in the second half of sleep.
* Upon waking, the person becomes fully alert and oriented.
What are the severity levels of Nightmare Disorder?
- Mild: Less than 1 episode per week.
- Moderate: 1 or more episodes per week, but not every night.
- Severe: Nightmares occur nightly.
What are the specifiers for Nightmare Disorder?
During Sleep Onset.
With Mental Disorder, Medical Condition, or Another Sleep Disorder.
* Acute: Lasts 1 month or less.
* Subacute: Lasts 1-6 months.
* Persistent: Lasts 6+ months.
What is the main feature of REM Sleep Behavior Disorder?
Vocalizations and complex movements during REM sleep.
* Happens 90+ minutes after falling asleep.
* More frequent in the later part of sleep.
* After waking, the person is fully alert and not confused.
How is REM Sleep Behavior Disorder diagnosed?
- Polysomnography shows REM sleep without muscle paralysis (atonia).
- History of symptoms plus a confirmed synucleinopathy diagnosis (e.g., Parkinson’s disease).
What are the consequences of REM Sleep Behavior Disorder?
- Can lead to self-injury or harm to a bed partner.
- Causes distress or significant impairment.
- Not due to substances, medical conditions, or another disorder.
What is the main feature of Restless Legs Syndrome?
- A strong urge to move the legs, usually with uncomfortable sensations.
- Symptoms worsen at rest and improve with movement.
- Happens mostly in the evening or at night.
What are the diagnostic criteria for Restless Legs Syndrome?
- Symptoms occur 3+ times per week for at least 3 months.
- Causes distress or impairment.
- Not due to another medical or mental disorder.
- Not caused by substances or medication.
What is the main feature of Substance/Medication-Induced Sleep Disorder?
- Severe sleep disturbance that starts during or shortly after substance use, withdrawal, or exposure.
- The substance is capable of causing the sleep disturbance.
What are the types of Substance/Medication-Induced Sleep Disorder?
- Insomnia Type: Trouble falling or staying asleep.
- Daytime Sleepy Type: Excessive sleepiness or long sleep periods.
- Parasomnia Type: Abnormal behaviors during sleep.
- Mixed Type: A combination of symptoms without one dominant type.
What are the specifiers for Substance/Medication-Induced Sleep Disorder?
- With Onset During Intoxication (develops during substance use).
- With Onset During Discontinuation/Withdrawal (develops after stopping the substance).
What is Other Specified Sleep Disorder?
- When a sleep disorder causes impairment but doesn’t meet full criteria for a specific disorder.
- The reason why criteria aren’t met is specified.
What is Unspecified Sleep Disorder?
- When a sleep disorder causes impairment but doesn’t meet full criteria for a specific disorder.
- The reason why criteria aren’t met is NOT specified
