Sleep-wake Disorders Flashcards
Insomnia disorder A- c
A: A predominant complaint of dissatisfaction with sleep quality or quantity associated with one or more of the following:
1. Difficulty initiating sleep
2. Difficulty maintaining sleep
3. Early morning awakening with an ability to return to sleep
B: Causes clinically significant distress or impairment
C: Sleep difficulty occurs at least three nights per week
Insomnia disorder: how frequent is the disturbance? 
3 times per week
Insomnia disorder: how long is sleep difficulty present for? 
At least 3 months
Insomnia disorder specifiers
With mental disorder
with medical condition
with another sleep disorder
episodic — 1-3 months
persistent —sympt. 3+ mo
recurrent— 2+ episodes/year
3 types of insomnia
Initial insomnia
Middle insomnia
Late insomnia
Hyper-somnolence disorder
A. Self reported excessive sleepiness despite immense sleep. Lasting at least seven hours with one of the following symptoms:
1. Recurrent periods of sleep relapses into sleep within the day
2. Prolonged sleep episode of more than nine hours per day that is non-restorative
3. Difficulty being fully awake after abrupt awakening
B: occurs 3x/week, 3 months
C: impairments 
Hypersomnolence disorder specifier
Acute: < 1 month
Subacute: 1-3 mo
Persistent: 3+ mo
Main symptom that differentiates hypersomnolence from other sleep disorders
Sleep inertia (impaired performance following awakening, “sleep drunkenness”)
Narcolepsy a-b
A: recurrent periods of irrepressible Need to sleep, lapsing into sleep or napping occurring within the same day, 3x/week, 3 months 
B: at least one of the following:
1. Episodes of cataplexy
2. Hypocretin Deficiency (measured using CSF) 
3. Nocturnal sleep polysomnography showing REM latency =< 15 min
Narcolepsy specifiers
1 Narcolepsy with cataplexy or hypocretin deficiency
- Narcolepsy without cataplexy or without hypocretin deficiency
3.is cataplexy or hypo Kirton deficiency due to a medical condition
4. W/out cataplexy or hypocreyin due to another med condition
Cataplexy
Brief, sudden bilateral loss of muscle tone precipitated by emotions
Obstructive sleep apnea hypopnea (A)
A: either 1 or two
1. Evidence by polysomnograph of at least five obstructive apnea‘s or hypopnea per hour of sleep and either of the following symptoms
— nocturnal breathing disturbances (snoring, gasping, breathing pause)
— Daytime sleepiness fatigue or on refreshing sleep
- Evidence by polysomnograph a 15 or more obstructive apnea as per hour of sleep regardless of accompanying symptoms
Obstructive sleep apnea hypopnea specifiers
Mild: less than 15
Mod: 15-30
Severe: 30+
Central sleep apnea (A-B)
A: evidence by polysomnograph of five or more central apneas per hour of sleep
B: Not better explain by another current sleep disorder
Central sleep apnea specifiers
Idiopathic central sleep apnea: caused by respiratory effort, not airway obstruct
Cheyne-stokes breathing:
Comorbid w opiod use
Sleep related hypoventilation a
A: Polysomnograph demonstrates episode of decreased Respiration associated with elevated CO2 levels
Circadian rhythm sleep wake disorders a-c
A: A persistent pattern of sleep disruption that is primarily due to an alteration of the circadian system required by an individuals physical environment, social or professional schedule
B: The sleep disruption leads to excessive sleepiness or insomnia or both
C: distress or impairment 
Circadian rhythm sleep wake disorders specifiers
Delayed sleep phase type
— familial or overlapping
Advanced sleep phase type
— familial
Irregular sleep wake type
Non 24hr sleep wake type
Shift work type
Nonrapid eye movement sleep arousal disorder a-c
A: recurrent episodes of incomplete awakening from sleep usually during the first third of the major sleep episode accompanied by either one of the following:
1. Sleepwalking
2. Sleep terrors
B: No or a little dream imagery is recalled
C: Amnesia for the episodes is present
Nonrapid eye movement sleep arousal disorder specifiers 
Sleepwalking type
W sleep related eating
W sleep related sexual beh
Sleep terror type
Nightmare disorder a-b
A: repeated occurrences of extended extremely dysphoric and well remember 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: awakening from the dream the individual rapidly becomes oriented and alert
Rapid eye movement sleep behavior disorder a- d
a. Repeated episodes of arousal during sleep associated with vocalization and or complex motor behaviors
B. Occurs during rapid eye movement sleep usually 90 minutes after sleep at one set
C: Upon awakening the individual is a completely alert and not confused
D: Either of the following:
1. REM sleep without atonia on polysomnographic recording
2. A history suggestive of the disorder
Restless leg syndrome a-
A: an urge to move the legs, and uncomfortable sensation in the legs characterized by all of the following:
1. The urge to move the legs begins or worsens during periods of rest
2. The urge to move to legs is partially relieved by movement
3. The urge to move to legs is worse in the evening
B: Three times/week, 3 mo
C: distress
