‫ حسين هليل وادعة‬.

‫د‬

- they are either difficulty in sleeping , less often or excessive sleeping .

- sleep disorder are important symptoms of mental disorder .
- depressive and anxiety disorder are the most common causes of sleep disturbance
up to 30% adults complain of insomnia . excessive sleepiness occur 5% of adult
14% of adult population complain of sleep – wake disorder .

- transient insomnia occur at times of stress as ( jet lag ) .

- short term insomnia occur in personal problems ( bereavement )
- insomnia usually secondary to other disorder like :
- painful physical syndrome .
- depression .
- anxiety .
- excessive use of alcohol , caffeine ,
- abuse of some drugs ( CNS stimulant )
- 15% of insomnia are of no causes ( primary insomnia )
- people vary in amount of sleep .
- people vary in amount of time they need to sleep .
- if insomnia secondary to another condition the later should be treated together
with general measures to promote good sleep .
 ‫ حسين هليل وادعة‬. ‫د‬

- in primary insomnia
* it is important to avoid ( tobacco , caffeine , alcohol )
* relaxation exercise .
* using hypnotic for many nights and avoid prolong use b\c withdrawl
symptoms of hypnotic lead to insomnia
* hypnotic associated impaired daily per –for many .
* dream suppression and nights emission suppression

- it is common and undiagnosed , many cases secondary to loss night –time .

Causes :

1- insuufecient night – time sleep

* unstatisfactory irregular sleep routine or circumstance .
* circadian rhythum sleep disturbance
* frequent parasomina
* psychiatric disorder .
2- pathological sleep
* obstructive sleep apnea .
* narcolepsy .
* other CNS disease .
* drug effect .
* klein –levin syndrome .
* depressive illness .
 ‫ حسين هليل وادعة‬. ‫د‬

Classification of primary sleep disorder in DSM1V

1- dys-somnias
* primary insomnia .
* primary hypersomnia .
* narcolepsy .
* breath –related sleep disorder .
* circadian rhythum sleep disorder .
* dys –somnian nos

2- parasomnia >
* night mare disorder ( dream anxiety disorder )
* sleep terror disorder .
* sleep –walking disorder .
* parsomnia nos

3- sleep disorder related to another nebtal disorder

* insomnia .
* hypersomnia .

4- other sleep disorder

* secondary sleep disorder to general medical condition .
* substance –induced sleep disorder .
Primary hypersomnia :
- the most prevalent of primary hyper-somnia .
- patient complain unable to wake complete until several hour's often getting up.
 ‫ حسين هليل وادعة‬. ‫د‬
- this time they feel confused disorder disorientated (sleep drunkenness )
- prolong and sleep night- time sleep .
- 1\2 have day time autonomic behavior
Etiology : it is obscured and most patient respond to CNS stimulant .

- usually begin between age of 10- 20 years .

- more frequent among male .
- cataplexy ( sudden temporary paralysis and loss of muscle tone )
- sleep paralysis , hypnagogic hallucination .
- +ve family history of narcolepsy .
- autosomal dominant .
- HLA type DR2 compatibility .
Psychiatric aspect of narcolepsy :
- strong emotion -------- cataplexy .
- social difficult .
- schizophrenia – like disorder .
- DDx : short period of sleep – day
* amphetamine .
* TCA

- consist of :
* day time drowsiness +
* respiratory periodic +
 ‫ حسين هليل وادعة‬. ‫د‬
* excessive snoring +
* associated airway obstruction .

Treatment :
* relieving the causes of respiratory .
* continuous positive pressure .
* using face mask .
Circadian rhythm sleep disorder ( sleep – wake schedule disorder )
- jet lag is the most familiar ( another name)
- shift –work type change .
- fatigue due to work shifts .
- impaired consciousness .

- rare secondary sleep disorder consist :

* episode of somnolence and increase appetite for weeks with period of normal
late .
* patient can arise of sleep between irritable , aggressive , dis-orientated .
* hypothalamic lesion .
Parasomnia ( dream anxiety disorder )

- awaking from REM sleep in full conscious with detail dream recall .
- children experience ( 5- 6 yrs )
- stimulated by frightening experience in day .
- usually occur in PSTDs
 ‫ حسين هليل وادعة‬. ‫د‬

Night terror disorder :

- less common than night terror .
- some time familiar .
- persist to adult life .
- non REM ( stage 3 -4 )
- no recall the dream .
- treatment by benzodiazepine .

Sleep – walking disorder :

- automatism during sleep ---- REM
- usually early part of night .
- age 5 – 12 yrs .
- child walk in their sleep .
- familial .
- most children not walk ( just fit up)
- other walk and back to bed