SLEEP-WAKE DISORDERS -Circadian Rhythm Sleep-Wake Disorder

Four Stages of Sleep -Delayed Sleep Phase Type

Awake- low-voltage, high-frequency beta waves -Advanced Sleep Phase Type

Drowsy- alpha waves are more prominent -Irregular Sleep Wake Type

Stage 1 Sleep- prominent theta waves -Non-24-Hours Sleep-Wake Type

-experience hypnic jerks -Shift Work Type

Stage 2 Sleep- sleep spindles and mixed EEG activity -Parasomnias

Slow-wave Sleep (Stage 3 & 4)- progressively more -nREM Sleep Arousal Disorders
delta waves
-Sleepwalking Type
REM Sleep- low-voltage high-frequency waves
-Sleep Terror Type
-in a 90 minute sleep-duration, there is a transition
-Nightmare Disorder
between stage 3, 4, and REM sleep
-Rem Sleep Behavior Disorder
DSM Sleep Disturbances: DEVELOPMENT
-Restless Leg Syndrome
DSM I:
Insomnia Disorder
-only Somnambulism (sleep-waking
disorder) was included -it is the inability to fall asleep or remain asleep
DSM II: -in its Latin origin, “Insomnia” meant “no
sleep”
-Disorder of Sleep
-in insomnia disorder, the person wakes up not
DSM III:
feeling restored/refreshed
Sleep-walking Disorder and Sleep Terror
-it is the most common sleep complaint
-Sleep Disorders
-it can be acute or chronic
DSM IV:
-it may be termed depending on when it happens:
-Narcolepsy and Breathing-Related Sleep
Onset Insomnia- the difficulty in sleeping is
Disorder was included
during the start of sleep (mostly found in
International Classification of Sleep Disorders children)
(ICSD-2):
Maintenance Insomnia- difficulty in staying
-Insomnia, Breathing-related Sleep asleep
Disorders, Hypersomnias of central origin,
Terminal Insomnia- sleeping and waking up
Circadian Rhythm Sleep Disorders,
early, and having difficulty returning to
Parasomnias, Sleep-related movement
sleep
disorders, isolated symptoms and normal
variants, other sleep disorders Insomnia Disorder: BEFORE DIAGNOSIS
DSM 5: -before a diagnosis for any Sleep-wake Disorder,
one has to make sure that the client has any
-Insomnia Disorder
medical condition or if they’re taking medication
-Hypersomnolence Disorder
-in insomnia disorder, it is sometimes associated
-Narcolepsy with:

-Breathing-related sleep Disorder -Sleep-Stage Physiology

-obstructive sleep apnea hypopnea -Stress and worry

-central sleep apnea -Jetlag, shift work, and other major

schedule changes
-sleep-related hypoventilation
-depression and anxiety
 Insomnia Disorder: CHANGES IN DSM 5
DSM IV:
-Primary Insomnia as a diagnosis
-Insomnia related to another medical
disorder
-Sleep disorder due to another medical
condition, Insomnia Type
DSM 5:
-all of those in DSM IV now fall under one
classification: Insomnia Disorder
Insomnia Disorder: CRITERIA
Criterion A: A predominant complaint of
dissatisfaction with sleep quantity or quality,
associated with one (or more) of the following
symptoms:
Criterion B: The sleep disturbance causes clinically
significant distress or impairment in important
areas of functioning.
Criteria C & D: The sleep difficulty occurs at least 3
NIGHTS PER WEEK and is present for at least 3
MONTHS.
Criterion E: The sleep difficulty occurs despite
adequate opportunity for sleep.
-SEE DSM 5 for Criteria F-H (p. 362)-
Hypersomnolence Disorder
-it is the excessive sleepiness which:
-is not due to insufficient sleep or fatigue
-not due to difficulty falling asleep
-there is confusional arousal during
awakening
-return to normal after 30-60 mins
-there is nonrestorative sleep
Hypersomnolence Disorder: DEVELOPMENT
DSM IV:
-Primary Hypersomnia
-Hypersomnia related to another medical
disorder
-sleep disorder due to a general medical
condition, Hypersomnia Type
DSM V:
-all of those in DSM V was turned into
Hypersomnolence because there were
plenty of excessive sleepiness symptoms
that were undiagnosed in the past
-excessive sleepiness were related
to the quality of wakefulness, not
quantity of sleep
Hypersomnolence Disorder: CRITERIA
Criterion A: Self-reported excessive sleepiness
(hypersomnolence) despite a main sleep period
lasting AT LEAST 7 HOURS, with at least one of the
following symptoms:
Criterion B: The hypersomnolence occurs at least
THREE TIMES PER WEEK, for at least 3 MONTHS.
Criterion C: The hypersomnolence is accompanied
by significant distress or impairment in important
areas of functioning.
-SEE DSM 5 for Criteria D-F & Specifiers (pp. 368-369)-
Narcolepsy
-there is excessive daytime sleepiness and sudden
onsets of the REM sleep
-there is the inability to stay awake for long periods
and bouts of sleeping
-its usual onset: 15-25 years of 30-35 years (but can
begin at any age)
-the extreme drowsiness occurs every 3-4 hours and
they experience dream-like hallucinations
-there may also be sleep paralysis, cataplexy, and
sleep attacks
Narcolepsy: HISTORY
1880:
-first discovered by a French neurologist
named Gelineau
-characterized it as the syndrome of
recurrent, irresistible daytime sleep
episodes and sometimes accompanied by
sudden falls
DSM IV:
-it was first included in this version
ICSD2:
-Subtypes: Narcolepsy with Catalepsy and
Narcolepsy without Catalepsy
 Narcolepsy: ETIOLOGY
Hypocretin (Orexin)- it is the chemical in our system
that is required for us to be awake and keep our
wakeful behaviors intact
-there are five obstructive apneas or hypopneas
with symptoms
-and there are 15 obstructive apneas or hypopneas
regardless of the symptoms

Low levels of hypocretin-1 in the CSF Obstructive Sleep Apnea Hypopnea: CRITERIA

Losses of over 80% of hypocretin (Orexin)- leads to

production of neurons in the dorsolateral
hypothalamus

Autoimmune Process

Narcolepsy: CRITERIA

Criterion A: Recurrent periods of an irrepressible

need to sleep, lapsing into sleep, or napping
occurring within the same day. These must have
been occurring at least three times per week over
Obstructive Sleep Apnea Hypopnea: RISK FACTORS
the past 3 months.
-excess weight -smoking
Criterion B: The presence of at least one of the
-narrowed airway -diabetes
following:
-hypertension -asthma
-chronical nasal -family history of sleep
congestion apnea

[BRSD] Central Sleep Apnea

-occurs when the brain’s area that controls the

breathing does not function correctly during sleep

-its difference to OSAH, is that in OSAH, it is

caused by obstructions in the upper airway
that restrict oxygen to the body

-SEE DSM 5 for Specifiers (p. 373)- Central Sleep Apnea: ETIOLOGY

Breathing-Related Sleep Disorders: TYPES
[BRSD] Obstructive Sleep Apnea Hypopnea
Apnea- pause in breathing
-has ≥ 90% drop in airflow for 10 secs
-has ≥3% oxygen desaturation or an arousal
Hypopnea- abnormally slow/shallow breathing
-has ≥39% drop in airflow for 10 secs
-has ≥3% oxygen desaturation
-there is excessive daytime sleepiness
(hypersomnia)
-there is loud snoring and observed episodes of
breathing cessation during sleep
Problems that affect the brainstem- includes brain
infections, stroke, or conditions of the cervical spine
(neck)
Severe Obesity
Certain medicines- includes narcotic painkillers
Central Sleep Apnea: CRITERIA
-there are observed episodes of stopped breathing
or abnormal breathing patterns during sleep
-there are also abrupt awakenings accompanied by
shortness of breath (which are relieved by sitting
up)
-there is insomnia and hypersomnia, and difficulty
in concentrating, morning headaches, and snoring

-there is also abrupt awakenings accompanied by

shortness of breath and awakening with a dry
mouth or sore throat

-there are also morning headaches, difficulty staying

asleep, and difficult-to-control high blood pressure
 [BRSD] Sleep-Related Hypoventilation
-people with this disorder experience decreased
respiration associated with elevated carbon dioxide
levels during sleep
-there is shallow breathing lasting longer than 10
seconds during sleep
-disease, neuromuscular or chest wall disorders, or
medication used may be implicated
Criterion B: The sleep disruption leads to excessive
sleepiness or insomnia, or both.
Criterion C: The sleep disturbance causes clinically
significant distress or impairment in social,
occupational, and other important areas of
functioning.
-SEE DSM 5 for Specifiers (pp. 390-391)-
Parasomnias

DSM IV: -these are abnormal behavioral, experiential, or

physiological events occurring in association with
-it was once called Breathing-related Sleep
sleep, specific sleep stages, or sleep-wake
Disorder
transitions
[BRSD] Sleep-Related Hypoventilation: CRITERIA
Parasomnia: NREM Sleep Arousal Disorders:
Criterion A: Polysomnography demonstrates CRITERIA
episodes of decreased respiration associated with
-these are variations of the simultaneous admixture
elevated CO2 levels. (Note: In the absence of
of elements of both wakefulness and NREM sleep
objective measurement of CO2 , persistent low
levels of hemoglobin oxygen saturation -this mixture results in the appearance of
unassociated with apneic/hypopneic events may complex motor behavior without conscious
indicate hypoventilation.) awareness

Criterion B: The disturbance is not better explained
by another current sleep disorder.
-SEE DSM 5 for Specifiers (p. 387)-
Circadian Rhythm Sleep-Wake Disorders
Criterion A: Recurrent episodes of incomplete
awakening from sleep, usually occurring during the
first third of the major sleep episode, accompanied
by either one of the following:

-it is a persistent or recurring pattern of sleep

disruption resulting in either from:

-altered sleep-wake schedule

-inequality between a person’s natural
sleep-wake cycle and the sleep-related
demands placed on them
Circadian Rhythm Sleep-Wake Disorders:
DEVELOPMENT
Criterion B: No or little (e.g., only a single visual
scene) dream imagery is recalled.
Criterion C: Amnesia for the episodes is present.
-SEE DSM 5 for Criteria D-F and Specifiers (p.399-400)

DSM IV: Nightmare Disorder: CRITERIA

-it was called Circadian Rhythm Sleep -characterized by recurrent dreams that feel
Disorders threatening, frightening, or cause dysphoria

DSM V: -the person becomes fully oriented when awakened

and can usually remember the dream
-the name was changed to Circadian
Rhythm Sleep-wake Disorders -the nightmare disorder should be considered only
in cases where the nightmares are recurrent and
-certain revisions produced specifiers result in significant distress or impairment (because
Circadian Rhythm Sleep-wake Disorders: CRITERIA nightmares are relatively common in the general
population)
Criterion A: A persistent or recurrent pattern of
sleep disruption that is primarily due to an
alteration of the circadian system or to a
misalignment between the endogenous circadian
rhythm and the sleep-wake schedule required by an
individual’s physical environment or social or
professional schedule.
 REM Sleep Behavior Disorder: Criteria

Criterion A: Repeated episodes of arousal during

sleep associated with vocalization and/or complex
motor behaviors.

Criterion B: These behaviors arise during rapid eye

movement (REM) sleep and therefore usually occur
more than 90 minutes after sleep onset, are more
frequent during the later portions of the sleep
period, and uncommonly occur during daytime
naps.

Criterion C: Upon awakening from these episodes,

the individual is completely awake, alert, and not
confused or disoriented.

Criterion D: Either of the following:

-SEE DSM 5 for Criteria E-G (p. 408)-

Restless Leg Syndrome: CRITERIA

-it is a sensorimotor, neurological sleep disorder

characterized by a desire to move the legs (or arms)

-it is usually associated with uncomfortable

sensations typically described as creeping, crawling,
tingling, burning, or itching

Criterion A: An urge to move the legs, usually

accompanied by or in response to uncomfortable
and unpleasant sensations in the legs, characterized
by all of the following:

Criterion B: The symptoms in Criterion A occur at

least three times per week and have persisted for at
least 3 months.

-SEE DSM 5 for Criteria C-E (p.410)-