Sleep-Wake Disorders

Question 1

Sleeping too little?

Answer 1

Insomnia

Question 2

Sleeping too much?

Answer 2

Hypersomnolence

Question 3

It’s mainly quality or amount of sleep that causes complaint: trouble getting to sleep, staying asleep, or awaking too early without again falling asleep. Occasionally, sleep is just plain not refreshing. The following day, the patient feels fatigued, grumpy, or has poor concentration or otherwise impaired functioning.

3+ nights/week for 3+ months

Answer 3

Insomnia Disorder

Question 4

The patient complains of severe daytime drowsiness ever after 7+ hours of sleep, repeatedly naps or falls asleep each day, has difficulty remaining fully awake, or sleeps long (9+ hrs a night) but doesn’t sleep well (not refreshing).

3+ times/week for 3+ months

Answer 4

Hypersomnolence Disorder

Question 5

The patient cannot resist attacks of daytime sleep, which are associated with cataplexy (immobility), low cerebrospinal fluid hypocretin, and decreased REM sleep latency on nighttime polysomnography. Cataplexy is usually associated with strong emotion (laughter).

several times a month for 3+ months

Answer 5

Narcolepsy

Question 6

Apnea versus Hypopnea

Answer 6

absence of breathing; shallow or infrequent breathing

Question 7

A patient complains of daytime sleepiness that results from nighttime breathing problems: (often long) pauses in breathing, followed by loud snores or snorts. Polysomnography reveals obstructive apneas and hypopneas

5+ apneas/hypopneas per hour, unless no nocturnal breathing symptoms or daytime sleepiness; then 15+ apnea/hypopnea ep her hour

Answer 7

Obstructive Sleep Apnea Hypopnea

Question 8

For each hour of sleep, the patient’s polysomnography shows 5+ central sleep apneas

Answer 8

Central Sleep Apnea

Question 9

A patient’s polysomnography shows periods of reduced breathing and high CO2 levels.

Answer 9

Sleep-Related Hypoventilation

Question 10

A recurring mismatch between the patient’s sleep-wake pattern and environmental demands causes insomnia or hypersomnolence.

Answer 10

Circadian Rhythm Sleep-Wake Disorder

Question 11

The patient has trouble falling asleep and awakening on time

Answer 11

Circadian rhythm sleep-wake disorder, delayed sleep phase type

Question 12

The patient has trouble remaining awake until the desired bedtime and awakens before time to arise.

Answer 12

Circadian rhythm sleep-wake disorder, advanced sleep phase type

Question 13

The patient sleep and wake periods vary irregularly throughout the 24-hour period

Answer 13

Circadian rhythm sleep-wake disorder, irregular sleep-wake type

Question 14

Times of sleep onset and wakefulness are not entrained to the 24-hour period, and each day gradually drifts (usually later)

Answer 14

Circadian rhythm sleep-wake disorder, non-24-hour sleep-wake type

Question 15

Because of night shift work or frequently changing job shifts, during the main sleep period, the patient experiences hypersomnia during the major period of wakefulness or insomnia (or both)

Answer 15

Circadian rhythm sleep-wake disorder, shift work type

Question 16

The patient repeatedly awakens incompletely from sleep with sleepwalking or sleep terror. The attempts of others to communicate or console don’t help much. The patient has little if any dream imagery at the time and tends not to remember the episode the next morning.

Answer 16

Non-Rapid Eye Movement Sleep Arousal Disorder

Question 17

Without awakening, the patient rises from bed and walks. The patient stares blankly, can be awakened only with difficulty, and responds poorly to others’ attempts at communication

Answer 17

Sleepwalking type

Question 18

Beginning with a scream of panic, the patient abruptly arouses from sleep and shows intense fear and signs of autonomic arousal, such as dilated pupils, rapid breathing, and sweating

Answer 18

Sleep terror type

Question 19

Unpleasant leg sensations cause an impulse to move them, which tends to relieve the symptoms. Legs are most restless in the evening or later.

3+ times a week for 3+ months

Answer 19

Restless legs syndrome

Question 20

The patient repeatedly awakens, instantly and completely, from terrible dreams that are recalled in frightening detail.

Answer 20

Nightmare disorder

Question 21

The patient has recurrent episodes of arousing from sleep accompanied by shouting or speech, or by physical actions that can injure the patient or bed partner. These symptoms often correlate with dream content. Subsequent awakenings tend to be complete. Because they occur during REM sleep, these episodes tend to take place after the person has been asleep quite a while, and not during naps.

Answer 21

Rapid eye movement sleep behavior disorder

Question 22

The use of some substance appears to have caused a patient to have a serious sleep problem.

Answer 22

Substance/medication induced sleep disorder

Question 23

Insomnia lasting less than 3 months

Answer 23

Brief insomnia disorder

Question 24

The person doesn’t feel refreshed by sleep that is otherwise unremarkable

Answer 24

Restricted to nonrestorative sleep

Question 25

When a patient’s insomnia symptoms don’t meet full criteria for insomnia disorder and you decide not to be specific about the reasons.

Answer 25

Unspecified insomnia disorder