Sleep Disorders

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Sleep Disorders
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Two Major Categories

• Dyssomnias
• Parasomnias
• This classification system is similar to that
  used by the American Sleep Disorders Association.
  

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Dyssomnias

• The sleep itself is pretty normal.
• But the client sleeps too little, too much, or at
  the wrong time.
• So, the problem is with the amount (quantity), or
  with its timing, and sometimes with the quality
  of sleep.

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Parasomnias

• Something abnormal occurs during sleep itself, or
  during the times when the client is falling
  asleep or waking up (e.g., bad dreams.
• The quality, quantity, and timing of the sleep
  are essentially normal.

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The Sleep Disorders chapter has four major
sections

• I. Primary Sleep Disorders include all
• sleep disorders, except
• II. Sleep Disorder Related to Another Mental
  Disorder
• III. Sleep Disorder Due to a General
• Medical Condition (GMC)
• IV. Substance-Induced Sleep Disorder

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I. Primary Sleep Disorders

• Dyssomnias
• A. Primary Insomnia - too little sleep (criteria
  listed on p. 604)
• Characteristics
• Difficulty initiating or maintaining sleep
• Persists for 1 month or longer
• This diagnosis is rarely independent of an Axis I
  or II disorder or a GMC or substance use.

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I. Primary Sleep Disorders (cont.)

• A. Primary Insomnia (too little sleep)
• Often due to
• Major Depressive Episode, Manic Episode, or
  anxiety disorder
• Commonly misused substances, as well as some
  prescription medicines.
• Breathing-related problems
• The cause sometimes can not be identified.

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I. Primary Sleep Disorders (cont.)

• A. Primary Insomnia (too little sleep)
• Treatment
• Vigorous daytime exercise, not exercising before
  sleep
• Sexual intercourse, if pleasurable
• Metronome or ticking clock- slow, 60 beats per
  minute or slower, beat of human heart
• Relaxation exercises, practice regularly but
  condensed to 5 minutes
• Decrease stimulation and increase soothing
  environments, such as ear plugs or calm reading
• Practice good sleep habits
• Read How to Become an Insomniac

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I. Primary Sleep Disorders

• Dyssomnias
• B. Primary Hypersomnia (sleeping too much, as
  well as being drowsy at times when client should
  be alert) (criteria listed on p. 609)
• Characteristics
• Excessive sleepiness
• Persists for 1 month or longer
• Rarely a diagnosis independent of an Axis I or II
  disorder or a GMC or substance use.
• Specify if Recurrent.

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I. Primary Sleep Disorders (cont.)

• B. Primary Hypersomnia (too much sleep) (cont.)
• Often due to
• Major Depressive Episode, Dysthymic Disorder with
  atypical features
• Use of substances is less likely to produce
  hyersomnia than insomnia, but it can happen
  (e.g., sleeping pills overdose)
• The cause sometimes can not be identified.
• Treatment Exercise when becoming sleepy

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I. Primary Sleep Disorders

• Dyssomnias
• C. Narcolepsy (Sleeping at the wrong time)
• (criteria listed on pg. 615)
• Characteristics
• Sleep intrudes into wakefulness, causing clients
  to fall asleep almost instantly
• Sleep is brief but refreshing
• May also have sleep paralysis, sudden loss of
  strength, and hallucinations as fall asleep or
  awaken.
• Treatment Stimulants, sometimes antidepressants,
  with less success.

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I. Primary Sleep Disorders

• Dyssomnias
• D. Breathing-Related Sleep Disorder
• (criteria listed on p. 622)
• Characteristics
• Sleep disruption (excessive sleepiness or
  insomnia)
• Due to sleep-related breathing condition (e.g.,
  Obstructive Sleep Apnea Syndrome)

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I. Primary Sleep Disorders

• Dyssomnias
• D. Breathing-Related Sleep Disorder
• Treatment (Criteria on p. 622)
• In mild cases weight loss, sleeping on ones
  side, and avoiding hypnotics and alcohol
• (To sleep on side, a tennis ball can be sewn
  into back of clients sleep wear)
• In more serious cases a machine that provides
  continuous positive airway pressure
• Surgery Few benefits

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I. Primary Sleep Disorders

• Dyssomnias
• E. Circadian Rhythm Sleep Disorder (criteria on
  p. 629)
• Characteristics
• Persistent or recurrent pattern of sleep
  disruption leading to excessive sleepiness or
  insomnia, due to mismatch between sleep-wake
  schedule required by a persons environment and
  his/her circadian sleep-wake pattern (e.g., shift
  work, jet lag).

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I. Primary Sleep Disorders

• Dyssomnias
• E. Circadian Rhythm Sleep Disorder
• Treatment Difficult to treat, because it has
  to involve the entire family
• Darken bedroom and use soundproofing
• Limit caffeine and hard to digest food.
• Ensure all family members learns shift
• To help jet lag, exposure to sun helps
• Specify type Delayed Sleep Phase Type, Jet Lag
  Type, Shift Work Type, and Unspecified Type

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I. Primary Sleep Disorders

• Dyssomnias
• F. Dyssomnia NOS (listed on p. 629)
• This category is for insomnias,
• hypersomnias, or circadian rhythm disturbances
  that do not meet criteria for any specific
  Dyssomnia.

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I. Primary Sleep Disorders

• Parasomnias
• A. Nightmare Disorder (Criteria listed on p. 634)
  
• Characteristics
• (1) Repeated awakenings from bad dreams
• (2) When awakened client becomes oriented
  and alert

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I. Primary Sleep Disorders

• Parasomnias
• A. Information about Nightmare Disorder
• Usually occurs in early morning when REM sleep
  dominates.
• The same nightmare may recur repeatedly or
  different ones may pop up three times a week.
• Stress may induce 60 of nightmares.
• Half of the cases of nightmare disorder appear
  before age 10 2/3 before age 20.
• Dreams are clearly remembered
• Drugs can trigger nightmares.
• Suddenly withdrawing REM-suppressant medications
  and drugs can cause REM rebound.

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I. Primary Sleep Disorders

• Parasomnias
• B. Sleep Terror Disorder (criteria listed on pg.
  639)
• Characteristics
• (1) Abrupt awakening from sleep, usually
  beginning with a panicky scream or cry.
• (2) Intense fear and signs of autonomic
• arousal
• (3) Unresponsive to efforts from other to calm
• client
• (4) No detailed dream recalled
• (5) Amnesia for episode

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I. Primary Sleep Disorders

• Parasomnias
• B. Sleep Terror Disorder
• Usually only children have sleep terror
  disorder.
• The client is not having a nightmare.
• The eyes are open, screams erupt.
• Usually happens in early evening.
• In contrast to nightmares, sleep terrors do not
  respond to psychotherapy.
• Probably due to brain wave upset, fever, or
  medications
• However, some medications may help.

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I. Primary Sleep Disorders

• Parasomnias
• C. Sleepwalking Disorder (criteria listed on pg.
  644)
• Characteristics
• (1) Rising from bed during sleep and walking
  about.
• (2) Usually occurs early in the night.
• (3) On awakening, the person has amnesia for
  episode

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I. Primary Sleep Disorders

• Parasomnias
• C. Sleepwalking Disorder
• Most sleepwalking children are psychologically
  normal.
• Runs in families.
• Begins between ages 6 and 12 and may be
  stress-related.
• Customarily sleepwalkers exhibit other
  delta-sleep interruptions.
• At some time 1-6 of children sleepwalk of
  these, 15 do
• so occasionally.
• Adult sleepwalking is far less common, usually
  worse and more chronic.

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I. Primary Sleep Disorders

• Parasomnias
• C. Sleepwalking Disorder
• Treatment
• Relaxation techniques
• Biofeedback training
• Hypnosis.
• May need to sleep on the ground floor, have
  outside doors securely locked, and have car keys
  unavailable.

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I. Primary Sleep Disorders

• Parasomnias
• D. Parasomnia NOS (listed on p. 644)
• Characteristics
• Abnormal behavioral or physiological events
  during sleep or sleep-wake transitions, but that
  do not meet criteria for a more specific
  Parasomnia

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I. Primary Sleep Disorders

• Parasomnias
• D. Parasomnia NOS (listed on p. 644)
• Examples
• Sleep-Talking Often more annoying to partner
  than to sleeper. Has no memory in morning. Can
  be during REM or delta sleep. In REM sleep,
  pronunciation is clear and understandable in
  deep sleep (delta) apt to be mumbled and
  unintelligible
• Sleep paralysis inability to perform voluntary
  movement during the transition between waking and
  sleep. Usually associated with extreme anxiety,
  and sometimes fear of impending death.
• REM sleep behavior disorder characterized by
  agitated and violent behavior.
• Parasomnia is present but unable to determine
  whether it is primary, due to GMC, or substance
  induced.

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The Sleep Disorders chapter has four major
sections

• I. Primary Sleep Disorders include all
• sleep disorders, except
• II. Sleep Disorder Related to Another Mental
  Disorder
• III. Sleep Disorder Due to a General
• Medical Condition (GMC)
• IV. Substance-Induced Sleep Disorder

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Sleep Disorder Related toAnother Mental Disorder

• Two Diagnoses
• 1. Insomnia Related to Another Mental
• Disorder (criteria listed on p. 650)
• 2. Hypersomnia Related to Another
• Mental Disorder (criteria listed on p. 650)

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Sleep Disorder Related toAnother Mental Disorder

• 1. Insomnia Related to Another Mental
• Disorder
• Characteristics
• Difficulty in initiating or maintaining sleep
• Persists for at least 1 month
• 2. Hypersomnia Related to Another
• Mental Disorder
• Characteristics
• Excessive sleepiness
• Persists for at least 1 month

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Sleep Disorder Related toAnother Mental Disorder

• Two Diagnoses
• 1. Insomnia Related to another mental
• disorder indicate the Axis I or II disorder
• (criteria listed on p. 650)
• 2. Hypersomnia Related toanother
• mental disorder indicate the Axis I or II
• disorder (criteria listed on p. 650)

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III. 327.xx Sleep Disorder Due to a General
Medical Condition (list the GMC) (criteria on p.
654)Also GMC on Axis III

• Prominent disturbance in sleep that is
  sufficiently
• severe to warrant independent clinical attention.
• Evidence has to be present that the sleep
  disturbance is a direct physiological consequence
  of a general medical condition.
• Specify Type
• (1) .52 Insomnia Type
• (2) .54 Hypersomnia Type
• (3) .59 Parasomnia Type
• (4) .59 Mixed Type

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IV. Substance-Induced Sleep Disorder (Indicate
Substance) (criteria is on p. 660)

• Characteristics
• Evidence must be present that the sleep
  disturbance is a direct physiological consequence
  of substance use.
• Substance use that produces a sleep disorder
  severe enough to warrant independent clinical
  attention
• Code
• 291.8 Alcohol 292.89 Amphetamine 292.89
  Caffeine 292.89 Cocaine 292.89 Opioid 292.89
  Sedative, Hypnotic, or Anxiolytic 292.89 Other
  (or unknown) Substance

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IV. Substance-Induced Sleep Disorder (Indicate
Substance) (criteria is on p. 660)

• Types
• Insomnia Type
• Hypersomnia Type
• Parasomnia Type
• Mixed Type
• Specify if
• With Onset During Intoxication
• With Onset During Withdrawal