sleepdisorderTwo Major Categories

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

 

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

 

 

Dyssomnias

  1. Primery Insomnia
  2. Primary Hypersomnia
  3. Narcolepsy
  4. Breath thing-related Sleep Disorder
  5. Circadian Rhythm Sleep Disorder
  6. Dismomnia NOS

 

  • Primery Insomnia

Characteristics

  1. Difficulty initiating or maintaining sleep
  2. Persists for 1 month or longer
  3. This diagnosis is rarely independent of an Axis I or II disorder or a GMC or substance use.

Often due to:

  1. Major Depressive Episode, Manic Episode, or anxiety disorder
  2. Commonly misused substances, as well as some prescription medicines.
  3. Breathing-related problems
  4. The cause sometimes cannot be identified.

Treatment

  1. Vigorous daytime exercise, not exercising before sleep
  2. Sexual intercourse, if pleasurable
  3. Metronome or ticking clock- slow, 60 beats per minute or slower, beat of human heart
  4. Relaxation exercises, practice regularly but condensed to 5 minutes
  5. Decrease stimulation and increase soothing environments, such as ear plugs or calm reading
  6. Practice good sleep habits
  7. Read “How to Become an Insomniac”
  • Primary Hypersomnia (sleeping too much, as well as being drowsy at times when client should be alert)

Characteristics

  1. Excessive sleepiness
  2. Persists for 1 month or longer
  3. Rarely a diagnosis independent of an Axis I or II disorder or a GMC or substance uses.
  4. Specify if: Recurrent.

Often due to:

  1. Major Depressive Episode, Dysthymic Disorder with atypical features
  2. Use of substances is less likely to produce hyersomnia than insomnia, but it can happen (e.g., sleeping pills overdose)
  3. The cause sometimes cannot be identified.

Treatment:   Exercise when becoming sleepy.

  • Narcolepsy (Sleeping at the wrong time)

Characteristics

  1. Sleep intrudes into wakefulness, causing clients to fall asleep almost instantly
  2. Sleep is brief but refreshing
  3. May also have sleep paralysis, sudden loss of strength, and hallucinations as fall asleep or awaken.

Treatment: Stimulants, sometimes antidepressants, with less success.

  • Breathing-Related Sleep Disorder

Characteristics

  1. Sleep disruption (excessive sleepiness or insomnia)
  2. Due to sleep-related breathing condition (e.g., Obstructive Sleep Apnea Syndrome)

Treatment

  1. Surgery: Few benefits .
  2. In more serious cases: a machine that provides continuous positive airway pressure
  3. (To sleep on side, a tennis ball can be sewn into back of client’s sleep wear)
  4. In mild cases: weight loss, sleeping on one’s side, and avoiding hypnotics and alcohol

 

  • Circadian Rhythm Sleep Disorder

Characteristics

  1. Persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia, due to mismatch between sleep-wake schedules required by a person’s environment and his/her circadian sleep-wake pattern (e.g., shift work, jet lag).

Treatment: Difficult to treat, because it has to involve the entire family

  1. Darken bedroom and use soundproofing Limit caffeine and hard to digest food.
  2. Ensure all family members learns shift
  3. To help jet lag, exposure to sun helps

Specify type: Delayed Sleep Phase Type, Jet Lag Type, Shift Work Type, and Unspecified Type.

  • Dyssomnia NOS

This category is for insomnias, hypersomnias, or circadian rhythm disturbances that do not meet criteria for any specific Dyssomnia.

Second Type:

Para-somnia

  1. Nightmare Disorder
  2. Sleep Terror Disorder
  3. Sleep Walking Disorder
  4. Para-somnia NOS
  5. Nightmare Disorder

Characteristics:

  1. Repeated awakenings from bad dreams
  2. When awakened client becomes oriented and alert

Information about Nightmare Disorder

  1. Usually occurs in early morning when REM sleep dominates.
  2. The same nightmare may recur repeatedly or different ones may pop up three times a week.
  3. Stress may induce 60% of nightmares.
  4. Half of the cases of nightmare disorder appear before age 10; 2/3 before age 20.
  5. Dreams are clearly remembered
  6. Drugs can trigger nightmares.
  7. Suddenly withdrawing REM-suppressant medications and drugs can cause REM rebound.
  8. Sleep Terror Disorder

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
  6. Sleep Terror Disorder
  7. Usually only children have sleep terror disorder.
  8. The client is not having a nightmare.
  9. The eyes are open, screams erupt.
  10. 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.

  1. Sleepwalking Disorder

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
  4. Most sleepwalking children are psychologically normal.
  5. Begins between ages 6 and 12 and may be stress-related.
  6. Customarily sleepwalkers exhibit other delta-sleep interruptions.
  7. At some time 1-6% of children sleepwalk; of these, 15% do so occasionally.
  8. Adult sleepwalking is far less common, usually worse and more chronic.

Treatment:

  1. Relaxation techniques
  2. Biofeedback training

May need to sleep on the ground floor, have outside doors securely locked, and have car keys unavailable.

  • Parasomnia NOS

Characteristics:

Abnormal behavioral or physiological events during sleep or sleep-wake transitions, but that do not meet criteria for a more specific Parasomnia.

  • Parasomnia NOS

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.

Umar Raza
Clinical Psychologist

 

 

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