Sleep-Wake Disorders Flashcards
Sleeping too little?
Insomnia
Sleeping too much?
Hypersomnolence
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
Insomnia Disorder
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
Hypersomnolence Disorder
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
Narcolepsy
Apnea versus Hypopnea
absence of breathing; shallow or infrequent breathing
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
Obstructive Sleep Apnea Hypopnea
For each hour of sleep, the patient’s polysomnography shows 5+ central sleep apneas
Central Sleep Apnea
A patient’s polysomnography shows periods of reduced breathing and high CO2 levels.
Sleep-Related Hypoventilation
A recurring mismatch between the patient’s sleep-wake pattern and environmental demands causes insomnia or hypersomnolence.
Circadian Rhythm Sleep-Wake Disorder
The patient has trouble falling asleep and awakening on time
Circadian rhythm sleep-wake disorder, delayed sleep phase type
The patient has trouble remaining awake until the desired bedtime and awakens before time to arise.
Circadian rhythm sleep-wake disorder, advanced sleep phase type
The patient sleep and wake periods vary irregularly throughout the 24-hour period
Circadian rhythm sleep-wake disorder, irregular sleep-wake type
Times of sleep onset and wakefulness are not entrained to the 24-hour period, and each day gradually drifts (usually later)
Circadian rhythm sleep-wake disorder, non-24-hour sleep-wake type
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)
Circadian rhythm sleep-wake disorder, shift work type
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.
Non-Rapid Eye Movement Sleep Arousal Disorder
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
Sleepwalking type
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
Sleep terror type
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
Restless legs syndrome
The patient repeatedly awakens, instantly and completely, from terrible dreams that are recalled in frightening detail.
Nightmare disorder
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.
Rapid eye movement sleep behavior disorder
The use of some substance appears to have caused a patient to have a serious sleep problem.
Substance/medication induced sleep disorder
Insomnia lasting less than 3 months
Brief insomnia disorder
The person doesn’t feel refreshed by sleep that is otherwise unremarkable
Restricted to nonrestorative sleep
When a patient’s insomnia symptoms don’t meet full criteria for insomnia disorder and you decide not to be specific about the reasons.
Unspecified insomnia disorder
