Sleep -Wake Disorders Flashcards
1
Q
Insomnia Disorder
A.
A
A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
2
Q
Insomnia Disorder
1.
A
Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intention.)
3
Q
Insomnia Disorder
2.
A
Difficulty maintaining sleep, characterised by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
4
Q
Insomnia Disorder
3.
A
Early-morning awakening with inability to return to sleep.
5
Q
Insomnia Disorder
B.
A
The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic behavioural, or other important areas of functioning.
6
Q
Insomnia Disorder
C.
A
The sleep difficulty occurs at least 3 nights per week.
7
Q
Insomnia Disorder
D.
A
The sleep difficulty is present for at least 3 months.
8
Q
Insomnia Disorder
E.
A
The sleep difficulty occurs despite adequate opportunity for sleep.
9
Q
Insomnia Disorder
F.
A
The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
10
Q
Insomnia Disorder
G.
A
The insomnia is not attributable to the physiological effects of a substance (e.g., drug of abuse, a medication).
11
Q
Insomnia Disorder
H.
A
Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
12
Q
Insomnia Disorder
Specify if:
A
With non-sleep disorder mental comorbidity: including substance use disorders
With other medical comorbidity
With other sleep disorder
13
Q
Specify if:
Severity
A
Episodic: Symptoms last at least 1 month but less than 3 months.
Persistent: Symptoms last 3 months or longer.
Recurrent: Two (or more) episodes within the space of 1 year.
Note: Acute and short-term insomnia (i.e., symptoms lasting less than 3 months but otherwise meeting all criteria with regard to frequency, intensity, distress, an/or impairment) should be coded as another specified insomnia disorder.
14
Q
Hypersomnolence Disorder
A.
A
Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms:
15
Q
Hypersomnolence Disorder
1.
A
Recurrent periods of sleep or lapses into sleep within the same day.
16
Q
Hypersomnolence Disorder
2.
A
A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing)
17
Q
Hypersomnolence Disorder
3.
A
Difficulty being fully awake after abrupt awakening.
18
Q
Hypersomnolence Disorder
B.
A
The hypersomnolence occurs at least three times per week, for at least 3 months.
19
Q
Hypersomnolence Disorder
C.
A
The hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning.
20
Q
Hypersomnolence Disorder
D.
A
The hypersomnolence is not better explained by and does not occur exclusively during the course of another sleep disorder (e.g., narcolepsy, breathing-related sleep disorder, circadian rhythm sleep-wake disorder, or a parasomnia).
21
Q
Hypersomnolence Disorder
E.
A
The hypersomnolence is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication)
22
Q
Hypersomnolence Disorder
F.
A
Coexisting mental and medical disorders do not adequately explain the predominant complaint of hypersomnolence.
23
Q
Hypersomnolence Disorder
Specify if:
A
With mental disorder, including substance use disorders
With medical condition
With another sleeping disorder
24
Q
Hypersomnolence Disorder
Specify if:
A
Acute: Duration of less than 1 month.
Subacute: Duration of 1-3 months.
Persistent: Duration of more than 3 months.
25
Hypersomnolence Disorder
| Specify current severity
Specify severity based on a degree of difficulty maintaining daytime alertness as manifested by the occurrence of multiple attacks or irresistible sleepiness within any given day occurring, for example, while sedentary, driving, visiting with friends, or working.
Mild: Difficulty maintaining daytime alertness 1-2 days/week.
Moderate: Difficulty maintaining daytime alertness 3-4 days/week.
Severe: Difficulty maintaining daytime alertness 5-7 days/week.
26
Narcolepsy
| A.
Recurrent periods of 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.
27
Narcolepsy
| B.
The presence of at least one of the following:
28
Narcolepsy
| 1.
Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month:
29
Narcolepsy
| a.
In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking.
30
Narcolepsy
| 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.
31
Narcolepsy
| 2.
Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less than or equal to one-third 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.
32
Narcolepsy
| 3.
Nocturnal sleep polysomnography showing 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.
33
Narcolepsy
Specify whether:
Narcolepsy without cataplexy but with hypocretin deficiency:
Criterion B requirements of low CSF hypocretin-1 levels and positive polysomnography/multiple sleep latency test are met, but no cataplexy is present (Criterion B1 not met).
34
Narcolepsy
Specify whether:
Narcolepsy without cataplexy but without hypocretin deficiency:
In this rare subtype (less than 5% of narcolepsy cases), Criterion B requirements of cataplexy and positive polysomnography/multiple sleep latency test are met, but CSF hypocretin-1 levels are normal (Criterion B2 not met).
35
Narcolepsy
Specify whether:
Autosomal dominant cerebellar ataxia, deafness and narcolepsy
This subtype is caused by exon 21 DNA (cytosine-5)-methyltransferase-1 mutations and is characterised by late-onset (age 30-40 years) narcolepsy (with low or intermediate CSF hypocretin-1 levels), deafness, cerebellar ataxia, and eventually dementia.
36
Narcolepsy
Specify whether:
Autosomal dominant narcolepsy, obesity, and type 2 diabetes:
Narcolepsy, obesity, and type 2 diabetes and low CSF hypocretin-1 levels have been described in rare cases and are associated with a mutation in the myelin oligodendrocyte glycoprotein gene.
37
Narcolepsy
Specify whether:
Narcolepsy secondary to another medical condition:
This subtype is for narcolepsy that develops secondary to medical conditions that cause infections (e.g., Wipple's disease, sarcoidosis), traumatic, or tumbrel destruction of hypocretin neutrons.
38
Narcolepsy
| Specify current severity:
Mild: Infrequent cataplexy (less than once per week), need for naps only once or twice per day, and less disturbed nocturnal sleep.
Moderate: Cataplexy once daily or every few days, disturbed nocturnal sleep, and need for multiple naps daily.
Severe: Drug-resistent cataplexy with multiple attacks daily, nearly constant sleepiness, and disturbed nocturnal sleep (i.e., movements, insomnia, and vivid dreaming).
39
Obstructive Sleep Apnea Hypopnea
A. Either (1) or (2):
1.
Evidence by polysomnography of at least five obstructive apneas or hypoapneas per hour of sleep and either of the following sleep symptoms:
40
Obstructive Sleep Apnea Hypopnea
| 1.a.
Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses during sleep.
41
Obstructive Sleep Apnea Hypopnea
| 1.b.
Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder (including sleep disorder) and is not attributable to another medical condition.
42
Obstructive Sleep Apnea Hypopnea
| 2.
Evidence by polysomnography of 15 or more obstructive apneas and/or hypopnea per hour of sleep regardless of accompanying symptoms.
43
Obstructive Sleep Apnea Hypopnea
| Specify current severity:
Mild: Apnea hypopnea index is less than 15.
Moderate: Apnea hypopnea index is 15-30.
Severe: Apnea hypopnea index is greater than 30.
44
Central Sleep Apnea
| A.
Evidence by polysomnography of five or more central apneas per hour of sleep.
45
Central Sleep Apnea
| B.
The disorder is not better explained by another current sleep disorder.
46
Central Sleep Apnea
Specify whether:
Idiopathic central sleep apnea
Characterized by repeated episodes of apneas or hypopneas during sleep caused by variability in respiratory effort but without the evidence of airway obstruction.
47
Central Sleep Apnea
Specify whether:
Cheyne-Strokes breathing
A pattern of periodic crescendo-decrescendo variation in tidal volume that results in central apneas and hypopneas at a frequency of at least five events per hour, accompanied by frequent arousal.
48
Central Sleep Apnea
Specify whether:
Central sleep apnea comorbid with opioid use
The pathogenesis of this subtype is attributed to the effects of opioids on the respiratory rhythm generators in the medulla as well as the differential effects on hypoxic versus hypercapnia respiratory drive.
49
Central Sleep Apnea
| Specify current severity:
Severity of central sleep apnea is graded according to the frequency of the breathing disturbances as well as the extent of associated oxygen desaturation and seep fragmentation that occur as a consequence of repetitive respiratory disturbances.
50
Sleep-Related Hypoventilation
| A.
Polysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels. (Note: In the absence of objective measurement of CO2, persistent low levels of haemoglobin oxygen saturation unassociated with apneic/hypopneic events may indicate hypoventilation.)
51
Sleep-Related Hypoventilation
| B.
The disturbance is not better explained by another current sleep disorder.
52
Sleep-Related Hypoventilation
Specify whether:
Idiopathic hypoventilation:
This subtype is not attributable to any readily identified condition.
53
Sleep-Related Hypoventilation
Specify whether:
Congenital central alveolar hypoventilation:
This subtype is a rare congenital disorder in which the individual typically presents in the perinatal period with shallow breathing, or cyanosis and apnea during sleep.
54
Sleep-Related Hypoventilation
Specify whether:
Comorbid sleep- related hypoventilation:
This subtype occurs as a consequence of a medical condition, such as a pulmonary disorder (e.g., interstitial lung disease, chronic obstructive pulmonary disease) or a neuromuscular or chest wall disorder (e.g., muscular dystrophies, post polio syndrome, cervical spinal cord injury, kyphoscoliosis), or medications (e.g., benzodiazepines, opiates). It also occurs with obesity (obesity hypoventilation disorder), where it reflects a combination of increased work of breathing due to reduced chest wall compliance and ventilation-perfusion mismatch and variably reduced ventilatory drive. Such individuals usually are characterized by body mass index of greater than 30 and hypercapnia during wakefulness (with a pCO2 of greater than 45), without other evidence of hypoventilation.
55
Sleep-Related Hypoventilation
| Specify current severity:
Severity is graded according to the degree of hypoxemia and hypercarbia present during the sleep and evidence of end organ impairment due to these abnormalities (e.g., right-sided heart failure). The presence of blood gas abnormalities during wakefulness is an indicator of greater severity.
56
Circadian Rhythm Sleep-Wake Disorders
| 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.
57
Circadian Rhythm Sleep-Wake Disorders
| B.
The sleep disruption leads to excessive sleepiness or insomnia, or both.
58
Circadian Rhythm Sleep-Wake Disorders
| C.
The sleep disturbance causes clinically significant distress or impairment in social, occupational, and other important areas of functioning.
59
Circadian Rhythm Sleep-Wake Disorders
Specify whether:
Delayed sleep phase type:
A pattern of delayed sleep onset and awakening times, with an inability to fall asleep and awaken at a desired or conventionally acceptable earlier time.
60
Circadian Rhythm Sleep-Wake Disorders
Specify whether:
Delayed sleep phase type:
Familial:
A family history of delayed sleep phase is present.
61
Circadian Rhythm Sleep-Wake Disorders
Specify whether:
Delayed sleep phase type:
Overlapping with non-24-hour sleep-wake type:
Delayed sleep phase type may overlap with another circadian rhythm sleep-wake disorder, non 24-hour sleep-wake type.
62
Circadian Rhythm Sleep-Wake Disorders
Specify whether:
Advanced sleep phase type:
A pattern of advanced sleep onset and awakening times, with an inability to remain awake or asleep until the desired or conventionally acceptable later sleep or wake times.
63
Circadian Rhythm Sleep-Wake Disorders
Specify whether:
Advanced sleep phase type:
Familial:
A family history of advanced sleep phase is present.
64
Circadian Rhythm Sleep-Wake Disorders
Specify whether:
Irregular sleep-wake type:
A temporally disorganized sleep-wake pattern, such that timing of sleep and wake periods is variable throughout the 24-hour period.
65
Circadian Rhythm Sleep-Wake Disorders
Specify whether:
Non-24-hour sleep-wake type:
A pattern of sleep-wake cycles that is not synchronised to the 24-hour environment, with a consistent daily drift (usually to later and later times) of sleep onset and wake times.
66
Circadian Rhythm Sleep-Wake Disorders
Specify whether:
Shift work type:
Insomnia during the major sleep period an/or excessive sleepiness (including inadvertent sleep) during the major awake period associated with a shift work schedule (i.e., requiring unconventional work hours).
67
Circadian Rhythm Sleep-Wake Disorders
| Specify if:
Episodic: Symptoms last at least 1 month but less than 3 months.
Persistent: Symptoms last 3 months or longer.
Recurrent: Two or more episodes occur within the space of 1 year.
68
Non-Rapid Eye Movement Sleep Arousal Disorders
| 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:
69
Non-Rapid Eye Movement Sleep Arousal Disorders
| A. 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 him or her; can be awakened only with great difficulty.
70
Non-Rapid Eye Movement Sleep Arousal Disorders
| A. 2.
Sleep terrors:
Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream. There is intense fear and signs of automatic 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.
71
Non-Rapid Eye Movement Sleep Arousal Disorders
| B.
No or little (e.g., only a single visual scene) dream imagery is recalled.
72
Non-Rapid Eye Movement Sleep Arousal Disorders
| C.
Amnesia for the episode is present.
73
Non-Rapid Eye Movement Sleep Arousal Disorders
| D.
The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
74
Non-Rapid Eye Movement Sleep Arousal Disorders
| E.
The disturbance is not attributable to the physiological effects of a substance (e.g., drug of abuse, a medication).
75
Non-Rapid Eye Movement Sleep Arousal Disorders
| F.
Coexisting mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors.
76
Non-Rapid Eye Movement Sleep Arousal Disorders
| Specify whether:
Sleepwalking type
77
Non-Rapid Eye Movement Sleep Arousal Disorders
| Specify if:
With sleep-related eating
With sleep-related sexual behaviour (sexsomnia)
Sleep terror type
78
Nightmare 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.
79
Nightmare Disorder
| B.
On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert.
80
Nightmare Disorder
| C.
The sleep disturbance cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
81
Nightmare Disorder
| D.
The nightmare symptoms are not attributable to the physiological effects of a substance (e.g., drug of abuse. a medication).
82
Nightmare Disorder
| E.
Coexisting mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams.
83
Nightmare Disorder
| Specify if:
During sleep onset
84
Nightmare Disorder
| Specify if:
With associated non-sleep disorder, including substance use disorders.
With associated other medical condition
With associated other sleep disorder
85
Nightmare Disorder
| Specify if:
Acute: Duration of period of nightmares is 1 month or less.
Subacute: Duration of period of nightmares is greater than 1 month but less than 6 months.
Persistent: Duration of period of nightmares is 6 months or greater.
86
Nightmare Disorder
| Specify current severity:
Severity can be related by the frequency with which the nightmares occur.
Mild: Less than one episode per week on average.
Moderate: One or more episodes per week but less than nightly.
Severe: Episodes nightly.
87
Rapid Eye Movement Sleep Behaviour Disorder
| A.
Repeated episodes of arousal during sleep associated with vocalisation and/or complex motor behaviours.
88
Rapid Eye Movement Sleep Behaviour Disorder
| B.
These behaviours arise during rapid eye movement (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.
89
Rapid Eye Movement Sleep Behaviour Disorder
| C.
Upon awakening from these periods, the individual is completely awake, alert, and not confused or disoriented.
90
Rapid Eye Movement Sleep Behaviour Disorder
| D.
Either of the following:
91
Rapid Eye Movement Sleep Behaviour Disorder
| D. 1.
REM sleep without atonia on polysomnographic recording.
92
Rapid Eye Movement Sleep Behaviour Disorder
| D. 2.
A history suggestive of REM sleep behaviour disorder and an established synucleinopathy diagnosis (e.g., Parkinson's disease, multiple system atrophy).
93
Rapid Eye Movement Sleep Behaviour Disorder
| E.
The behaviours cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (which may include injury str self or the bed partner).
94
Rapid Eye Movement Sleep Behaviour Disorder
| F.
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
95
Rapid Eye Movement Sleep Behaviour Disorder
| G.
Coexisting mental and medical disorders do not explain the episodes.
96
Restless Legs Syndrome
| A. 1.-3.
An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs, characterized by all of the following:
1. The urge to move the legs begins or worsens during periods of rest or inactivity.
2. The urge to move the legs is partially or totally relieved by movement.
3. The urge to move the legs is worse in the evening or at night than during the day, or occurs only in the evening or at night.
97
Restless Legs Syndrome
| B.
The symptoms in Criterion A occur at least three times per week and have persisted for at least 3 months.
98
Restless Legs Syndrome
| C.
The symptoms in Criterion A are accompanied by significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
99
Restless Legs Syndrome
| D.
The symptoms in Criterion A are not attributable to another mental disorder or medical condition (e.g., arthritis, leg edema, peripheral ischemia, leg cramps) and are not better explained by a behavioral condition (e.g., positional discomfort, habitual foot tapping).
100
Restless Legs Syndrome
| E.
The symptoms are not attributable to the physiological effects of a drug abuse or medication (akathisia).
101
Substance/Medication-Induced Sleep Disorder
| A.
A prominent and severe disturbance in sleep.
102
Substance/Medication-Induced Sleep Disorder
| B. 1.-2.
There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or after withdrawal from or exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.
103
Substance/Medication-Induced Sleep Disorder
| C.
The disturbance is not better explained by a sleep disorder that is not substance/medication-induced. Such evidence of an independent sleep disorder could include the following:
The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced sleep disorder (e.g., a history of recurrent non-substance/medication-related episodes).
104
Substance/Medication-Induced Sleep Disorder
| D.
The disturbance does not occur exclusively during the course of a delirium.
105
Substance/Medication-Induced Sleep Disorder
| E.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
106
Substance/Medication-Induced Sleep Disorder
| Note:
This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptom in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.
107
Substance/Medication-Induced Sleep Disorder
Specify whether:
Insomnia type:
Characterized by difficulty falling asleep or maintaining sleep, frequent nocturnal awakenings, or non restorative sleep.
108
Substance/Medication-Induced Sleep Disorder
Specify whether:
Daytime sleepiness type:
Characterized by predominant complaint of excessive sleepiness/fatigue during wakening hours or, less commonly, a long sleep period.
109
Substance/Medication-Induced Sleep Disorder
Specify whether:
Mixed type:
Characterized by a substance/medication-induced sleep problem characterized by multiple types of sleep symptoms, but no symptom clearly predominates.
110
Substance/Medication-Induced Sleep Disorder
Specify if:
With onset during intoxication:
This specifier should be used if criteria are met for intoxication with the substance/medication and symptoms developed during the intoxication period.
111
Substance/Medication-Induced Sleep Disorder
Specify if:
With onset during discontinuation/withdrawal:
This specifier should be used if criteria are met for discontinuation/withdrawal from the substance/medication and symptoms developed during, or shortly after, discontinuation of the substance/medication.
