Dyssomnias

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Dyssomnias

• By Jill Yaryan

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Types Of Dyssomnias

• Primary Insomnia
• Primary Hypersomnia
• Narcolepsy
• Breathing-Related Sleep Disorder
• Circadian Rhythm Sleep Disorder
• Dyssomnia Not Otherwise Specified
• Dyssomnias are disorders that pertain to the
  quality, timing, and amount of sleep due to
  disturbances in initiating and in maintaining
  sleep.

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Primary Insomnia Diagnostic Criteria

• Difficulty falling asleep, maintaining sleep, or
  non-restorative sleep for at least one month.
• Having daytime fatigue that causes significant
  distress or impairment in social, occupational,or
  functional areas
• Symptoms do not occur exclusively during course
  of any other Dyssomnia or Parasomnia.
• Disorder not better accounted for by any medical
  condition, anxiety or mood disorder.
• Disorder is not better accounted for by another
  mental disorder.

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Prevalence Rates

• Prevalence is increased with age and among women.
• Elderly usually have difficultly staying asleep
  while young individuals have difficulty falling
  asleep.
• Few data regarding general population.
• A 1-year prevalence of insomnia complaints of
  30-45 in adults.
• 25 rate in the elderly.
• 15-25 of individuals with chronic insomnia are
  diagnosed with primary insomnia.

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Types of Insomnia

• Transient Insomnia- Symptoms of insomnia last for
  only one or two nights. It is caused by a single
  stressor, and is not usually treated or diagnosed
  as a disorder.
• Short- Term Insomnia- Last for a few days to a
  few weeks. Causes are believed to be escalading
  stress and poor sleeping habits. Treatment
  consists of reducing all stress levels.
• Chronic Insomnia- Symptoms may last for years.
  The significant loss of sleep may cause other
  health problems. Most always diagnosed as Primary
  Insomnia.

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Differential Diagnosis

• Short-Sleepers- require shorter sleep time than
  usual and do not suffer from most characteristics
  of Insomnia.
• In some cases of Insomnia, less severe symptoms
  of Hypersomnia may appear.
• Circadian Rhythm Sleep Disorder is differentiated
  by the individuals recent travel experiences or
  dramatic changes in shifts at their place of
  work.
• Narcolepsy can cause Insomnia complaints but is
  distinguished by other symptoms of cataplexy,
  sleep paralysis and sleep- related hallucinations.

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Differential Diagnosis continued.

• Breathing related sleep disorder has complaints
  of chronic insomnia but is distinguished by loud
  snoring, breathing pauses while sleeping, and
  excessive daytime sleepiness.
• Primary Insomnia must be distinguished from any
  mental disorder that includes a symptom of
  Insomnia. (Schizophrenia, Major Depressive
  Disorder, etc.)
• As well as, any chronic medical condition or any
  condition that may cause stress or physical
  discomfort.
• Substance- use must be considered when diagnosing
  insomnia. Cocaine abuse can cause chronic
  insomnia with onset during use.

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Causes of Insomnia

• Many medical and psychological disorders that
  include pain and/or discomfort can cause chronic
  insomnia.
• Some individuals have a later biological clock.
• Substance use such as cocaine, caffeine, or any
  kind of stimulant.
• Major stressors ( a stressful workplace or
  household)
• Insomnia can also become a learned behavior.
• Some researchers believe that some individuals
  may have a predisposition toward light and
  disrupted sleep, but there is limited data on
  these genetic factors.

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Typical Course of Insomnia

• Onset usually begins at the time of
  psychological, medical or social stress.
• Primary insomnia will persist long after the
  original causation factors have been resolved.
• Once sleep problems have begun, negative
  associations with sleep will create the learned
  behavior of insomnia, therefore making the
  condition worse.
• Primary insomnia usually begins in young
  adulthood but can sometimes be traced back to
  childhood.
• Overall the course of Primary insomnia is
  variable.

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Demographic

• 1 in 3 adults report having had chronic insomnia
  some point in their life.
• Insomnia mostly affects women, college students,
  and medical professionals.
• There was no evidence showing a difference in
  other cultures.

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Treatments

• Most physicians recommend patients with chronic
  insomnia to a sleep clinic.
• Using a polysomnograph a clinican will measure a
  individuals sleep pattern.
• Clinicians will teach the patient to reduce their
  stresses as well as better sleep habits.
• Medications may also be prescribed for immediate
  relief.

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Medication Issues

• Most prescribed sleep medication effects only
  last for about 2 weeks.
• Medications such as Ambien can be very dangerous
  and addictive.
• When combined with alcohol, these sleep
  medications can be very dangerous and cause sleep
  walking, sleep eating, and unconscious actions.

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Hypersomnia Diagnostic Criteria

• Hypersomnia is abnormally excessive sleep.
• Predominant complaint is excessive sleepiness for
  at least one month. Patterns must be observed of
  prolonged sleep episodes or daytime sleep
  episodes that occur daily. This prolonged sleep
  is non restorative.
• The excessive sleep causes significant distress
  in social, occupational, or other areas of daily
  functioning.
• Not better accounted for by insomnia, or any
  other sleep disorder.
• The disorder is not due to substance use, and
  cannot be accounted for by a lack of sleep.

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Klein-Levin Syndrome

• Klein- Levin syndrome is a form of reoccurring
  Hypersomnia that present extreme prolonged sleep
  times. Hypersomnia must be reported lasting at
  least 3 days, several times a year for 2 years to
  be recurrent. A patient with this syndrome may
  spend 18 20 hours asleep in bed.
• Symptoms of depression, irritability, and
  impulsive behaviors may accompany this syndrome.

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Features of Primary Hypersomnia

• Patients with Hypersomnia will often appear very
  sleepy.
• Some patients will even have a automatic
  behavior, and not recall an event they had done
  while being in their extreme sleepy state.

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Prevalence Rates

• True prevalence in general population is not
  known.
• 5-10 of individuals that present daytime
  sleepiness are diagnosed with Hypersomnia
• Klein-Levin Syndrome is very rare, but is 3 times
  more likely to affect men rather than women.

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Course of Hypersomnia

• Begins between ages 15-30.
• Children with hyperactivity are likely develop
  Hypersomnia later in life.
• Gradual severity from weeks to months.
• Disorder becomes chronic and then becomes at a
  stable level.
• Klein-Levin syndrome is more likely to resolve
  during middle ages.

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Causes

• There are little facts to the causes of
  Hypersomnia.
• 39 of patients diagnosed have a family history
  of this disorder.
• Certain viral infections may be a cause of
  Hypersomnia.

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Differential Diagnosis

• Long sleepers- individuals have prolonged sleep
  episodes but the sleep is restorative.
• Inadequate nocturnal sleep can produce similar
  symptoms to Hypersomnia, but does not present
  prolonged sleep episodes.
• Primary Insomnia must be considered before
  diagnosing Hypersomnia.
• Narcolepsy has very similar symptoms as
  Hypersomnia, but does not have features of
  trouble waking, more persistent features of
  daytime sleepiness, and includes cataplexy.
• All other sleep disorders must be considered by
  patients life-style to adequately diagnose
  Hypersomnia.
• Mental Disorders such as Bipolar disorder, Major
  Depressive Episode, Substance use disorders, and
  any general medical condition must be ruled out
  as a primary cause of disorder.

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Co Morbidity

• Co morbid disorders with Hypersomnia are not
  known to mental health physicians at this time.

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Treatments

• Most clinicians prescribe medications such as
  amphetamines to stimulate brain activity.
• Anti-Depressants may be prescribed to help with
  irritability.
• Self-help is also recommended by advising a
  specific sleep schedule along with appropriate
  diet and exercise.

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Narcolepsy

• Narcolepsy is a serious neurological disorder
  that causes extreme, excessive daytime sleepiness
  with adequate amounts of nocturnal sleep.
  Paitients with Narcolepsy often have irresistible
  sleep attacks at random times during the day.
• Cataplexy is a serious symptom of Narcolepsy,
  cataplexy is the loss of muscle tone during a
  sleep attack.
• Hallucinations or distorted perception is very
  common in patients with Narcolepsy.
• Patients with Narcolepsy may have brief period of
  waking during nocturnal sleep.

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Diagnostic Criteria

• Irresistible sleep attacks that occur daily over
  3 months.
• The presence of one or both of the following
• - Cataplexy (most associated
  with intense emotion)
• - Recurrent disruptions of REM
  (deep sleep) sleep in the transition between
  sleep and wakefulness, as manifested by distorted
  perception, or sleep paralysis at beginning or
  end of sleep episode.
• The disturbance is not due to direct
  physiological effects of a substance or another
  general medical condition.

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Prevalence Rates

• Studies indicate a prevalence rate of 0.02-
  0.16 in the adult population with equal rates in
  males and females.
• Findings indicate rates between children and
  adults are similar but symptoms are harder to
  identify in children.

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Course of Narcolepsy

• The course of Narcolepsy begins mildly and builds
  up slowly over the years.
• Narcolepsy most always begins with daytime
  sleepiness and begins to become significant in
  adolescents. Onset after age 40 is very unusual.
• Cataplexy may develop concurrently with
  sleepiness but may appear months, years or
  decades after the onset of sleepiness.
• Sleep related hallucinations and sleep paralysis
  are more variable symptoms and may not even occur
  in some cases.
• Daytime sleepiness and cataplexy have a most
  stable course, but sleep- related hallucinations,
  and sleep paralysis may go into remission.
• Narcolepsy is a life- long disease and patients
  with Narcolepsy are very accident prone.
  Untreated patients with Narcolepsy are never
  symptom-free.

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Differential Diagnosis

• Narcolepsy must be differentiated from normal
  variations in sleep. Many people suffer from
  daytime sleepiness but do not have irresistible
  sleep attacks.
• Sleep deprivation may cause daytime drowsiness,or
  occasional sleep hallucinations due to lack of
  sleep, which is not associated with Narcolepsy.
• Primary Hypersomnia
• The most difficult to differentiate is
  Breathing-Related Sleep Disorder because some
  patients with Narcolepsy may experience Sleep
  Apnea, but is distinguished by history of snoring
  in BRSD patients.

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Causes

• Narcolepsy is believed to be caused by a genetic
  disposition, and a abnormal neurotransmitter
  called hypo cretin.
• Hypo cretin works in the hypothalamus of the
  brain and promotes wakefulness and inhibits REM
  sleep.
• Low levels of adrenaline, and histamine.
• The main known cause is the intrusions of REM
  sleep.
• Around 25-50 of 1st degree biological family
  develop disorders with the characteristic of
  excessive sleepiness.

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Co morbidity

• Around 40 of patients with Narcolepsy have a
  history or concurrent mental disorder.
• Mood disorders (primarily Major Depressive
  Disorders and Dysthymic Disorder) Parasomnia, and
  Generalized Anxiety Disorder.

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Demographic

• 20-25 in general population without cataplexy.
• Only other found studies were 47 individuals with
  Narcolepsy in Saudi Arabia.

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Treatment Of Narcolepsy

• There is no cure for Narcolepsy
• Primary treatment are medications that are
  nervous system stimulants.
• Other stimulants such as Ritalin control
  sleepiness.
• Controlled sleep patterns may help control
  sleepiness as well.

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Interesting Facts

• Narcolepsy may not be detected early and is
  skeptical to be diagnosed. Some patients reported
  over five years after initial symptoms of being
  diagnosed.
• Only 20 to 50 percent of the nations narcoleptics
  were not properly diagnosed.

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Misconceptions about sleep disorders

• Alcohol make cause drowsiness but creates a
  light sleep.
• Heavy smokers are more likely to develop insomnia.