Jennifer’s parents hear her screams on many nights

and rush to comfort her, but she does not respond.

Her heart rate is elevated during these episodes,
and her pajamas are soaked in sweat. However,
when she gets up the next day, she has no memory
of the experience.
Jack has committed seriously to his diet for
more than a month but continues gaining
weight. He has no memory of eating but
noticed that food is always missing from the
refrigerator
Maria’s mom is sometimes awakened by her
daughter’s screams. She runs to Maria’s room
to comfort her and eventually calms her down.
Maria usually explains that she was being
chased by a big, one-eyed, purple monster. The
event typically happens after watching scary
movies with friends.
 NREM-Related REM-Related Other

Includes Includes Includes

1. NREM Sleep Arousal 1. REM Sleep 1. Restless Legs

Disorders Behavior Disorder Syndrome (Willis
a. Sleep Terror (with dream Ekbom Disease)
b. Sleep Walking enacting 2. Substance-Induced
(Somnambulism) behaviors) Sleep Disorder
• Nocturnal Eating 2. Nightmare
Syndrome Disorder
• Sexsomnia
Non-Rapid Eye Movement Sleep Arousal Nightmare Disorder Rapid Eye Movement Sleep Behavior Disorder
Disorder
A. Recurrent episodes of incomplete awakening A. Repeated occurrences of extended, extremely A. Repeated episodes of arousal during sleep are associated
from sleep usually occur during the 1st third of dysphoric, and well-remembered dreams that with vocalization and /or complex motor behaviors.
the major sleep episode, accompanied by either usually involve efforts to avoid threats to survival, B. These behaviors arise during rapid eye movement (REM)
one of the ff: security, or physical integrity and that generally sleep and therefore usually occur greater than 90 minutes
1. Sleepwalking occur during the second half of the major sleep after sleep onset, are more frequent during the later portions
2. Sleep Terror episode. of the sleep period, and uncommonly occur during daytime
B. No or little dream imagery is recalled B. On awakening from the dysphoric dreams, the naps.
C. Amnesia for the episodes is present person rapidly becomes oriented and alert. C. Upon awakening from these episodes, the individual is
D. The episodes cause clinically significant distress C. The sleep disturbances cause clinically significant completely awake, alert, and not confused or disoriented.
or impairment in social, occupational, or other distress or impairment in social, occupational, or D. Either of the ff:
important areas of functioning other important areas of functioning 1. REM Sleep without atonia on polysomnographic
E. The disturbance is not attributable to the D. The nightmare symptoms are not attributable to recording
physiological effects of a substance the physiological effects of a substance 2. A history suggestive of REM sleep behavior disorder
F. Coexisting mental and medical disorders do not E. Coexisting mental and medical disorders do not and an established synucleinopathy diagnosis (e.g.
explain the episodes of sleepwalking or sleep explain the episodes of dysphoric dreams. Parkinson’s Dse. Multiple system atrophy).
terrors. E. The behaviors cause clinically significant distress or
Specify current severity: impairment in social, occupational, or other important areas
Mild-less than 1 episode per week on average of functioning
Moderate-1 or more episodes per week but less than F. The disturbance is not attributable to the physiological effects
nightly of a substance or another medical condition
Severe-Episodes nightly G. Coexisting mental and medical disorders do not explain the
episodes .
 Non-Rapid Eye Nightmare Disorder Rapid Eye Movement Sleep
Movement Sleep Arousal Behavior Disorder
Disorder
❑ Childhood ❑ Begin between 3-6 years old ❑ Gradual or rapid onset
❑ Violent or sexual activity and peaks at late adolescence ❑ More common in adult
during sleepwalking or early adulthood.
episodes is more likely to
occur in adults
 Restless Leg Syndrome Substance/Medication-
(Willis Ekbom Disease) Induced Sleep Disorder
A. An urge to move the legs, usually accompanied by or A. A prominent and severe disturbance in sleep.
Non-Rapid Eye Nightmare Disorder
in response to uncomfortable and unpleasant
sensations in the legs, is characterized by all of the ff:
B.
Rapid Eye Movement Sleep
There is evidence from the history, physical
examination, or laboratory findings of both (1) and (2):
Movement Sleep Arousal 1. The urge to move the legs begins or worsens
during periods of rest or inactivity.
Behavior Disorder
1. The symptoms in Criterion A developed during or
soon after the substance intoxication or
Disorder 2. The urge to move the legs is partially or totally withdrawal or after exposure to or withdrawal
relieved by movement. from a medication
❑ Childhood ❑ Begin between 3-6 years old
3. The urge to move the legs is worsen in the
evening or at night than during the day, or
❑ Gradual or rapid onset
2. The involved substance /medication is capable of
producing the symptoms in Criterion A.
❑ Violent or sexual activity and peaks at late adolescence
occurs only in the evening or at night. ❑ More common in adult
C. The disturbance is not better explained by a sleep
B. The symptoms in criterion A occur at least 3x per week disorder that is not substance/medication-induced. Such
during sleepwalking or early adulthood.
and have persistent for at least 3 months evidence of independent sleep disorder could include the
episodes is moreC. likely to
The symptoms in Criterion A are accompanied by following:
significant distress or impairment in social, The symptoms precede the onset of the
occur in adults occupational, or other important areas of functioning. substance/medication use;
D. Symptoms in Criterion A are not attributed to another The symptoms persist for a substantial period of time
mental disorder or medical condition. (e.g. about a month) after the cessation of acute
E. The symptoms are not attributable to the physiological withdrawal or severe intoxication;
effects of the drug of abuse or medication. There is other evidence suggesting the existence of
an independent non-substance/medication-induced
sleep disorder.
D. The disturbance does not occur exclusively in the course
of a delirium.
E. The disturbance causes clinically significant distress or
impairment in social, occupational, or other important
areas of functioning.
 Restless Leg Syndrome Substance/medication-induced
Sleep Disorder
❑ 10% -before the age of 10 ❑ Depends on the onset of the
❑ 40%-before the age of 20 substance/medication use
 Non-Rapid Eye Nightmare Disorder Rapid Eye Movement Sleep
Movement Sleep Arousal Behavior Disorder
Disorder
❑ Childhood ❑ Begin between 3-6 years old ❑ Gradual or rapid onset
❑ Violent or sexual activity and peaks at late adolescence ❑ More common in adult
during sleepwalking or early adulthood.
episodes is more likely to
occur in adults
1st Rule
Go to bed only when sleepy

2nd Rule
Use the bed only for sleeping. Do not watch tv on the bed,
do not read, eat or talk on the phone while on the bed.

3rd Rule
If unable to sleep, get up, go to another room, and do
something non-arousing until sleepiness returns.

4th Rule
Wake up at the same time every morning (regardless of
bedtime, total sleep time, or day of the week) and totally
avoid napping.
Goal: Find the optimal technique
for each patient:

▪ Progressive Muscle Relaxation

▪ Guided Imagery
▪ Breathing Exercises
▪ Biofeedback
 Restless Leg Syndrome Substance/medication-induced
Sleep Disorder
❑ 10% -before the age of 10 ❑ Depends on the onset of the
❑ 40%-before the age of 20 substance/medication use