Sleep-Wake Disorders Flashcards
Insomnia Disorder
A: A predominant complaint of dissatisfaction w/ sleep quantity or quality, associated with one or more of the following sx:
1. Difficulty initiating sleep (in children, may manifest as difficulty initiating sleep w/o caregiver intervention)
2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings
3. Early-morning awakening w/ inability to return to sleep
B: The sleep disturbance cause clinically significant distress or impairment
C: Difficulty occurs at least 3 nights per week
D: Difficulty is present for at least 3 mos
E: Difficulty occurs despite adequate opportunity for sleep
F: The insomnia is not better explained by and does not occur exclusively during the course another sleep-wake disorder
G: The insomnia is not due to effects of a substance
H: Co-existing mental disorders & medical conditions do not adequately explain the pre-dominant complaint of insomnia
Specify If:
W/ non-sleep disorder mental comorbidity (including substance use disorders)
W/ other medical comorbidity
W/ Other Sleep Disorder
Episodic- Sx last at least 1 month but less than 3 mos
Persistent-Sx last 3 mos or longer
Recurrent0 2 or more episodes within the space of 1 year
Hypersomnolence Disorder
A: Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, w/ at least one of the following sx:
1. Recurrent periods of sleep or lapses into sleep within the same day
2. A prolonged main sleep episode of more than 9 hours per day that is nonrestorative
3. Difficulty being fully awake after abrupt wakening
B: The hypersomnolence occurs at least 3x a week for at least 3 mos
C: The hypersomnolence is accompanied by significant distress or impairment
D: Not better explained by and does not occur exclusively during the course of another sleep-wake disorder
E: Not due to effects of a substance or another medical condition
F: Co-existing mental and medical disorders do not adequately explain the complaint of hypersomnolence
Specify If: W/ mental disorder, W/ medical condition, W/ another sleep disorder
Specify If: Acute-less than 1 month, Subacute-duration of 1-3 mos, Persistent-duration of more than 3 month
Current Severity: Mild-difficulty maintaining daytime alertness 1-2 days of the week
Moderate: difficulty maintaining daytime alertness 3-4 days of the week
Severe: difficulty maintaining daytime alertness 5-7 days of the week
Narcolepsy
A: 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 3x per week over the past 3 mos
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. Individuals w/ long standing disease, briefs (seconds to minutes) episodes of sudden bilateral loss of muscle tone w/ maintained consciousness that are precipitated by laughter or joking
b. In children or individuals within 6 mos of onset, spontaneous grimaces or jaw-opening episodes w// tongue thrusting or a global hypotonia (decreased muscle tone). w/o an emotional trigger
2. Hypocretin deficiency. Low CSF levels must not be observed in the context of acute brain, injury, inflammation or infection
3. Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency than or equal to 15 mins, or a multiple sleep latency test showing a mean sleep latency less or equal to 8 mins and two or more sleep-onset REM periods
Specify Current Severity:
Mild- Infrequent cataplexy (less than once a week), need for naps only once or twice a day and less disturbed nocturnal sleep
Moderate-Cataplexy once daily or every few days, disturbed nocturnal sleep & need for multiple naps daily
Severe: Drug resistant cataplexy w/ multiple attacks daily, nearly constant sleepiness & disturbed nocturnal sleep
Obstructive Sleep Apnea Hypopnea
A: Either (1) or (2):
1. Evidence by polysomnography of at least five obstructive apneas or hypopneas per hour of sleep & either of the following sleep sx:
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 medical condition
2. Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying sx
Mild: Apnea hypopnea index is less than 15
Moderate: apnea hypopnea index is 15-30
Severe: apnea hypopnea index is greater than 30
Central Sleep Apnea
A: Evidence by polysomnography of 5 or more central apneas per hour of sleep
B: The disorder is not better explained by another current sleep disorder
Specify Whether: Idiopathic central sleep apnea: repeated episodes of apneas & hypopneas during sleep
Cheyne-Stokes breathing
Central Sleep Apnea Comorbid W/ Opioid Use
Sleep Related Hypoventilation
A: Polysomnography demonstrates episodes of decreased respiration associated w/ elevated CO2 levels
B: The disturbance is not better explained by another current sleep disorder
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
B: The sleep disruption leads to excessive sleepiness on insomnia, or both
C: The sleep disruption causes significant distress or impairment
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:
1. Sleepwalking-repeated episodes of rising from bed during sleep & walking about.
2. Sleep terrors-Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream
B. No, or little, dream imagery is recalled
C. Amnesia for the episodes is present
D: The episodes causes significant distress or impairment
E: Disturbance not due to effects of a substance
F: Co-existing mental & medical disorders do not explain the episodes of sleepwalking or sleep terror
Nightmare Disorder
A: Repeated occurrences of extended, extremely dysphoric & well-remembered dreams that usually involve efforts to avoid threats to survival, security or physical integrity
B: On awakening from the dreams, the individual rapidly becomes oriented & alert
C: Causes significant distress & impairment
D: Sx are not due to substance
E: Co-existing mental & medical disorders don’t adequately explain the dreams
Rapid Eye Movement Sleep Behavior Disorder
A: Repeated episodes of arousal during sleep associated w/ vocalization and/or complex motor behaviors
B: Behaviors arise during REM sleep & usually occur more than 90 mins after sleep onset, uncommon during daytime naps
C: Upon awakening, the individual is completely awake, alert & not confused or disoriented
D: Either of the following:
1. REM sleep w/o atonia or PSG recording
2. A history suggestive of REM sleep behavior disorder & an established synucleinopathy dx (Parkinson’s, multiple system atrophy, ect)
E: Cause significant distress or impairment
F: Not due to substance or another medical condition
G: Co-existing mental & medical disorders don’t explain the episodes
Restless Legs Syndrome
A: An urge to move the legs, usually accompanied by or in response to uncomfortable & unpleasant sensations in the legs, characterized by all of the following:
1. Urge to move the legs begins or worsens during periods of rest or inactivity
2. Urge to move the legs is partially or totally relieved by the movement
3. Urge to move the legs is worse in the evening or at night that during the day, or only occurs at night
B: The sx in Criterion A occur at least 3x per week & have persisted for at least 3 mos
C: The sx in Criterion A are accompanied by significant distress or impairment
D: The sx in Criterion A are not due to another mental & medical condition
