Sleep-Wake Disorders in DSM-5
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Questions and Answers

What is a significant change from DSM-IV to DSM-5 regarding insomnia disorder classification?

  • Insomnia disorder is now classified under its own separate category.
  • Insomnia with other mental disorders has been eliminated entirely.
  • Multiple categories have been combined into a single insomnia category. (correct)
  • Insomnia disorder is exclusively for sleep disorders only.

    • What characteristic distinguishes the classification approach of DSM-5 from ICSD-3?

  • DSM-5 aggregates diagnoses under broader labels. (correct)
  • ICSD-3 does not consider sleep-related cognitive changes.
  • ICSD-3 focuses on integrating common medications into the classification.
  • DSM-5 uses more complex diagnostic criteria.

    • Which of the following is NOT one of the ten disorder groups classified in DSM-5 for sleep-wake disorders?

  • Restless legs syndrome
  • Hypersomnolence disorder
  • Sleep apnea syndrome (correct)
  • Circadian rhythm sleep-wake disorders

    • Which subtype of narcolepsy is characterized by cataplexy or hypocretin deficiency?

    <p>Narcolepsy type 1</p> Signup and view all the answers

    What common comorbid conditions must be addressed in the treatment planning of sleep disorders?

    <p>Depression and anxiety</p> Signup and view all the answers

    What does the 'lumping versus splitting' approach refer to in the context of DSM-5 classification?

    <p>Integrating subtypes into broader categories versus maintaining distinct subtypes.</p> Signup and view all the answers

    What primary audience is the DSM-5 designed for?

    <p>Mental health and general medical clinicians</p> Signup and view all the answers

    Which of the following statements about the DSM-5 classification of sleep disorders is true?

    <p>It simplifies the diagnostic process for non-sleep specialists.</p> Signup and view all the answers

    What is considered a subjective sleep latency indicative of difficulty initiating sleep?

    <blockquote> <p>20-30 minutes</p> </blockquote> Signup and view all the answers

    What percentage of adults is estimated to experience insomnia symptoms?

    <p>Approximately one-third</p> Signup and view all the answers

    What type of insomnia is typically associated with acute life events or changes in sleep patterns?

    <p>Situational insomnia</p> Signup and view all the answers

    Which symptom is more common among middle-age and older individuals concerning insomnia?

    <p>Difficulty maintaining sleep</p> Signup and view all the answers

    Which factor is associated with a higher prevalence of insomnia in women after 45 years of age?

    <p>Menopause</p> Signup and view all the answers

    What contributes to the development of insomnia according to the learned behaviors?

    <p>Excessive attention to sleep</p> Signup and view all the answers

    What range reflects the chronicity rates for insomnia follow-ups of 1-7 years?

    <p>45% to 75%</p> Signup and view all the answers

    What is a typical mood disturbance associated with insomnia disorder?

    <p>Anxiety symptoms</p> Signup and view all the answers

    What is a potential physiological factor that may increase vulnerability to insomnia?

    <p>High altitude</p> Signup and view all the answers

    What is NOT a characteristic of insomnia in individuals according to the documented symptoms?

    <p>Increased energy</p> Signup and view all the answers

    What percentage of individuals with insomnia disorder report having a family history of insomnia?

    <p>35% to 75%</p> Signup and view all the answers

    Which of the following age groups is more likely to experience insomnia due to conditioning factors?

    <p>Young children</p> Signup and view all the answers

    What type of cognitive style may increase vulnerability to insomnia?

    <p>Worry-prone personality</p> Signup and view all the answers

    What is associated with insomnia disorder as a clinical feature?

    <p>Dissatisfaction with sleep quantity or quality</p> Signup and view all the answers

    Which symptom is considered the most common manifestation of insomnia?

    <p>Difficulty maintaining sleep</p> Signup and view all the answers

    What does sleep continuity primarily refer to?

    <p>The balance of sleep and wakefulness during the night</p> Signup and view all the answers

    How long must sleep difficulties occur to meet the criteria for insomnia disorder?

    <p>At least three nights per week for three months</p> Signup and view all the answers

    In which population is the prevalence of isolated nonrestorative sleep estimated to be higher?

    <p>Younger individuals</p> Signup and view all the answers

    Which of the following is NOT a symptom associated with insomnia disorder?

    <p>Deep sleep enhancement</p> Signup and view all the answers

    When diagnosing insomnia disorder, what may influence symptom reports?

    <p>Subjective perception of sleep</p> Signup and view all the answers

    What role does persistent insomnia play in relation to other mental health conditions?

    <p>It is a risk factor for development of multiple mental disorders.</p> Signup and view all the answers

    How does polysomnography help diagnose sleep disorders?

    <p>By monitoring electrophysiological parameters during sleep.</p> Signup and view all the answers

    What is the primary purpose of the multiple sleep latency test?

    <p>To assess the physiological aspects of sleepiness</p> Signup and view all the answers

    What is typically meant by nonrestorative sleep?

    <p>Sleep that does not leave the individual feeling rested</p> Signup and view all the answers

    What are the primary components of sleep architecture?

    <p>The distribution of various sleep stages</p> Signup and view all the answers

    Which of the following is an accurate definition of insomnia disorder?

    <p>Persistent difficulty with sleep that does not occur due to other factors.</p> Signup and view all the answers

    Which factor is most closely associated with higher prevalence of insomnia?

    <p>Genetic predisposition</p> Signup and view all the answers

    What is a common misconception regarding the treatment-seeking behavior for insomnia?

    <p>Individuals prioritize biomedical treatments.</p> Signup and view all the answers

    What is one key diagnostic marker for insomnia disorder?

    <p>Impaired sleep continuity</p> Signup and view all the answers

    How should normal sleep duration be characterized in relation to insomnia disorder?

    <p>It varies significantly between individuals.</p> Signup and view all the answers

    Which of these consequences is NOT typically associated with insomnia disorder?

    <p>Improved attention and concentration</p> Signup and view all the answers

    What differentiates chronic insomnia disorder from situational insomnia?

    <p>Duration of symptoms</p> Signup and view all the answers

    Which statement accurately describes hypersomnolence disorder?

    <p>It includes recurrent lapses into sleep within the day.</p> Signup and view all the answers

    What commonly used substance may contribute to the development of insomnia disorder?

    <p>Stimulants</p> Signup and view all the answers

    Which group is identified as having a high prevalence of insomnia complaints?

    <p>Individuals with narcolepsy</p> Signup and view all the answers

    In terms of insomnia's relationship with other medical conditions, what is true?

    <p>Insomnia increases the risk of various medical conditions.</p> Signup and view all the answers

    What distinguishing factor makes short sleepers different from those with insomnia disorder?

    <p>They lack trouble falling asleep.</p> Signup and view all the answers

    Which of these is a symptom associated with hypersomnolence disorder?

    <p>Nonrestorative long sleep episodes</p> Signup and view all the answers

    What characterizes insomnia that coexists with other medical conditions?

    <p>Referred to as comorbid insomnia</p> Signup and view all the answers

    What factor is frequently misidentified as a separate type of sleep disorder?

    <p>Substance/medication-induced sleep disorder</p> Signup and view all the answers

    What distinguishes hypersomnolence disorder from narcolepsy in terms of daytime napping?

    <p>Naps in hypersomnolence disorder are often longer and unrefreshing.</p> Signup and view all the answers

    Which symptom is NOT commonly associated with hypersomnolence disorder?

    <p>Increased sleep efficiency</p> Signup and view all the answers

    What is the average age of onset for hypersomnolence disorder?

    <p>17-24 years</p> Signup and view all the answers

    Which group is least likely to experience spontaneous remission from hypersomnolence disorder?

    <p>Individuals with a chronic history of the disorder</p> Signup and view all the answers

    Which of the following statements about sleep inertia is true?

    <p>Sleep inertia can occur after both nocturnal sleep and daytime naps.</p> Signup and view all the answers

    What factor is least likely to be associated with hypersomnolence disorder?

    <p>Chronic physical activity</p> Signup and view all the answers

    Which clinical feature is most distinct in hypersomnolence disorder compared to other sleep-related disorders?

    <p>Automatic behavior without recall</p> Signup and view all the answers

    In which of the following situations would an individual with hypersomnolence disorder NOT be likely to fall asleep?

    <p>Attending a lively concert</p> Signup and view all the answers

    What differentiates hypersomnolence from tiredness due to mental disorders?

    <p>Hypersomnolence symptoms persist regardless of sleep quantity.</p> Signup and view all the answers

    Which condition is least likely to contribute to the development of hypersomnolence disorder?

    <p>Obstructive sleep apnea</p> Signup and view all the answers

    What is a common behavioral response of individuals with hypersomnolence disorder to difficulties waking in the morning?

    <p>Setting multiple alarm clocks</p> Signup and view all the answers

    Which of the following is NOT a criterion for diagnosing narcolepsy?

    <p>Lapsing into sleep occurring during the night</p> Signup and view all the answers

    How does hypersomnolence disorder typically affect social relationships?

    <p>It causes significant distress and dysfunction in relationships.</p> Signup and view all the answers

    What is a common initial symptom of narcolepsy in most individuals?

    <p>Excessive daytime sleepiness</p> Signup and view all the answers

    Which of the following is a diagnostic marker specifically for hypersomnolence disorder?

    <p>Normal to prolonged sleep duration</p> Signup and view all the answers

    Which neurological condition is most commonly associated with hypocretin deficiency?

    <p>Parkinson's disease</p> Signup and view all the answers

    Which test is considered conventional for confirming the diagnosis of both NT1 and NT2?

    <p>Multiple Sleep Latency Test (MSLT)</p> Signup and view all the answers

    Which symptom is typically reported by individuals with hypersomnolence disorder?

    <p>Difficulty in maintaining focus during waking hours</p> Signup and view all the answers

    What factor complicates the diagnosis of narcolepsy caused by infections of the central nervous system?

    <p>Transient decreases in CSF hypocretin levels can occur</p> Signup and view all the answers

    Which of the following behaviors best characterizes sleepiness in hypersomnolence disorder?

    <p>Unintentional sleep episodes in sedentary situations</p> Signup and view all the answers

    Which of the following is a feature associated with narcolepsy?

    <p>Vivid hallucinations</p> Signup and view all the answers

    What is the typical age range for the onset of narcolepsy?

    <p>15-25 years</p> Signup and view all the answers

    Which of the following statements about NT2 is true?

    <p>Diagnostic variability affects the true prevalence of NT2</p> Signup and view all the answers

    What type of disorder is narcolepsy categorized under?

    <p>Sleep disorder</p> Signup and view all the answers

    What is a primary cause of secondary narcolepsy?

    <p>Infections of the central nervous system</p> Signup and view all the answers

    The first symptom of narcolepsy often includes episodes of:

    <p>Excessive daytime sleepiness</p> Signup and view all the answers

    Which of the following statements about the diagnostic tests for narcolepsy is incorrect?

    <p>Polysomnography is solely sufficient for a narcolepsy diagnosis</p> Signup and view all the answers

    Individuals with hypersomnolence disorder are particularly at risk for what types of disorders?

    <p>Substance-related disorders</p> Signup and view all the answers

    What kind of behaviors may be associated with narcolepsy?

    <p>Automatic behaviors</p> Signup and view all the answers

    What is the main benefit of maintaining a regular sleep schedule for individuals of all ages?

    <p>It helps manage sleepiness and behavioral issues.</p> Signup and view all the answers

    Which factor is NOT considered a risk or prognostic factor in narcolepsy?

    <p>Environmental toxins</p> Signup and view all the answers

    For narcolepsy diagnosis, an MSLT result is considered positive when it shows an average sleep latency of what duration?

    <p>≤ 8 minutes</p> Signup and view all the answers

    What is the significance of measuring CSF hypocretin-1 levels in individuals suspected of having narcolepsy?

    <p>It helps identify individuals with possible treatment responses.</p> Signup and view all the answers

    What differentiates cataplexy from atonic seizures?

    <p>Cataplexy is usually triggered by emotions.</p> Signup and view all the answers

    Which comorbid condition is most relevant in considering the diagnosis of narcolepsy in adolescents?

    <p>Mood disorders</p> Signup and view all the answers

    In the diagnosis of excess daytime sleepiness, which condition can be confused with narcolepsy?

    <p>Attention-deficit/hyperactivity disorder (ADHD)</p> Signup and view all the answers

    A positive test result for narcolepsy would most likely show what characteristic during an MSLT?

    <p>SOREMPs in two or more naps</p> Signup and view all the answers

    What could potentially lead to inaccurate results during an MSLT?

    <p>Previous medication use</p> Signup and view all the answers

    Which statement about narcolepsy and its associated conditions is FALSE?

    <p>NT2 has strong associations with HLA DQB1*06:02.</p> Signup and view all the answers

    What is required for a diagnosis of obstructive sleep apnea hypopnea in adults if symptoms are absent?

    <p>Evidence of 15 or more obstructive apneas and/or hypopneas per hour of sleep</p> Signup and view all the answers

    Chronic insufficient sleep must be considered particularly when evaluating for which diagnosis?

    <p>Narcolepsy</p> Signup and view all the answers

    What percentage of individuals with NT1 are positive for the HLA DQB1*06:02 haplotype?

    <p>High – about 85-95%</p> Signup and view all the answers

    What condition is NOT associated with obstructive sleep apnea hypopnea?

    <p>Peptic ulcer disease</p> Signup and view all the answers

    The apnea hypopnea index used to measure disease severity counts which of the following?

    <p>Obstructive apneas and hypopneas per hour of sleep</p> Signup and view all the answers

    Which of the following does NOT serve as a confirmatory test in the diagnosis of narcolepsy?

    <p>Multiple wakefulness tests</p> Signup and view all the answers

    Which group is reported to have a higher prevalence of obstructive sleep apnea compared to U.S. non-Latinx Whites?

    <p>Hispanics</p> Signup and view all the answers

    What does a normal MSLT finding in a patient with major depression suggest?

    <p>Daytime sleepiness is unrelated to sleep disorder.</p> Signup and view all the answers

    What additional factor can increase the risk of obstructive sleep apnea in females?

    <p>Polycystic ovarian syndrome</p> Signup and view all the answers

    Which of the following factors is NOT typically associated with obstructive sleep apnea hypopnea?

    <p>High levels of systemic inflammation</p> Signup and view all the answers

    At what age does the prevalence of obstructive sleep apnea typically peak in children?

    <p>Ages 3-8 years</p> Signup and view all the answers

    Males are believed to be at increased risk for obstructive sleep apnea due to which of the following reasons?

    <p>Increased airway resistance due to fat distribution</p> Signup and view all the answers

    Which symptom is most commonly associated with obstructive sleep apnea in children?

    <p>Snoring and breathing pauses</p> Signup and view all the answers

    What is a significant misconception related to snoring across different cultures?

    <p>Snoring is considered a sign of normal health</p> Signup and view all the answers

    How does the apnea hypopnea index differ in its implications for first-degree relatives?

    <p>It is related to familial genetic factors</p> Signup and view all the answers

    In the context of obstructive sleep apnea, what is the significance of brain cortical arousal frequency?

    <p>It serves as a marker for sleep fragmentation</p> Signup and view all the answers

    What is a characteristic symptom that helps differentiate obstructive sleep apnea hypopnea from narcolepsy?

    <p>Loud snoring during sleep</p> Signup and view all the answers

    Which diagnostic marker is most indicative of obstructive sleep apnea hypopnea?

    <p>Primary snoring</p> Signup and view all the answers

    What functional consequence is associated with obstructive sleep apnea hypopnea?

    <p>Heightened risk of cardiovascular disease</p> Signup and view all the answers

    How can central sleep apnea be best characterized?

    <p>Arising from variability in respiratory effort</p> Signup and view all the answers

    Which statement accurately distinguishes nocturnal panic attacks from obstructive sleep apnea hypopnea?

    <p>Nocturnal panic attacks typically exhibit intense autonomic arousal</p> Signup and view all the answers

    What factor might increase the likelihood of co-occurring obstructive sleep apnea hypopnea in children with ADHD?

    <p>Adenotonsillar hypertrophy</p> Signup and view all the answers

    Which condition can negatively impact polysomnography results in individuals with suspected obstructive sleep apnea hypopnea?

    <p>Nocturnal asthma</p> Signup and view all the answers

    What is a common misconception regarding insomnia disorder in relation to obstructive sleep apnea hypopnea?

    <p>It always presents with loud snoring</p> Signup and view all the answers

    What role do risk factors such as obesity and family history play in the incidence of obstructive sleep apnea hypopnea?

    <p>They may indicate a higher likelihood of co-occurrence</p> Signup and view all the answers

    Which type of sleep apnea is primarily observed in individuals with opioid medication use?

    <p>Central sleep apnea</p> Signup and view all the answers

    What is typically absent in insomnia disorder when compared to obstructive sleep apnea hypopnea?

    <p>Symptoms of gasping or choking</p> Signup and view all the answers

    What might suggest a need for concurrent treatment between obstructive sleep apnea hypopnea and another disorder?

    <p>In co-occurrence with insomnia disorder</p> Signup and view all the answers

    What general health issue is exacerbated by obstructive sleep apnea hypopnea according to studies?

    <p>Cardiovascular disease</p> Signup and view all the answers

    What distinguishes treatment-emergent central sleep apnea?

    <p>Presence of obstructive sleep apnea treatment</p> Signup and view all the answers

    What breathing pattern is specifically associated with Cheyne-Stokes breathing?

    <p>Crescendo-decrescendo variation in tidal volume</p> Signup and view all the answers

    Which factors increase the risk for Cheyne-Stokes breathing?

    <p>Heart failure and acute stroke</p> Signup and view all the answers

    Which condition is characterized by episodes of decreased respiration associated with elevated CO2 levels?

    <p>Sleep-related hypoventilation</p> Signup and view all the answers

    How is central sleep apnea primarily distinguished from obstructive sleep apnea?

    <p>At least five central apneas per hour of sleep</p> Signup and view all the answers

    Which subtype of sleep-related hypoventilation is linked to congenital conditions?

    <p>Congenital central alveolar hypoventilation</p> Signup and view all the answers

    What functional consequence is associated with central sleep apnea?

    <p>Excessive daytime sleepiness</p> Signup and view all the answers

    What is an important diagnostic marker for idiopathic central sleep apnea?

    <p>Periods of breathing cessation longer than 10 seconds</p> Signup and view all the answers

    Which group is likely to be affected by Cheyne-Stokes breathing?

    <p>Individuals with heart failure</p> Signup and view all the answers

    What condition is associated with chronic use of long-acting opioids?

    <p>Central sleep apnea</p> Signup and view all the answers

    What determines the severity of sleep-related hypoventilation?

    <p>Degree of hypoxemia and hypercarbia</p> Signup and view all the answers

    What distinguishes central sleep apnea from other sleep disorders during diagnosis?

    <p>Frequency of central events per hour of sleep</p> Signup and view all the answers

    Idiopathic central sleep apnea is classified primarily by what characteristic?

    <p>Absence of identifiable causes</p> Signup and view all the answers

    What characterizes the breathing observed during sleep in individuals with Cheyne-Stokes breathing?

    <p>Periodic apneas with varied tidal volume</p> Signup and view all the answers

    What is the estimated prevalence of delayed sleep phase type in adolescents and young adults in Norway and Sweden?

    <p>3.3%–4.6%</p> Signup and view all the answers

    Which factor is commonly associated with the exacerbation of delayed sleep phase type symptoms?

    <p>Changes in work or school schedule requiring early rises</p> Signup and view all the answers

    Which statement accurately describes the course of advanced sleep phase type?

    <p>Its severity may increase dependent on social schedules.</p> Signup and view all the answers

    What may serve as a delay signal to the circadian clock in some individuals with delayed sleep phase type?

    <p>Evening light sensitivity</p> Signup and view all the answers

    Which of the following conditions is NOT typically associated with delayed sleep phase type?

    <p>Chronic fatigue syndrome</p> Signup and view all the answers

    What is a common characteristic of the irregular sleep-wake type disorder?

    <p>Fragmented sleep across at least three periods in 24 hours</p> Signup and view all the answers

    Which diagnostic markers are used for identifying advanced sleep phase type?

    <p>Actigraphy and sleep diary</p> Signup and view all the answers

    What is the typical onset age for advanced sleep phase type?

    <p>Late adulthood</p> Signup and view all the answers

    What cognitive impact can excessive sleepiness associated with advanced sleep phase type have?

    <p>Decreased cognitive performance and safety concerns</p> Signup and view all the answers

    Which factor may contribute to increased prevalence of advanced sleep phase type in older adults?

    <p>Decreased late afternoon and early evening light exposure</p> Signup and view all the answers

    How is the prevalence of irregular sleep-wake type disorder characterized?

    <p>It is unknown in the general population.</p> Signup and view all the answers

    What is a notable characteristic of the non-24-hour sleep-wake type disorder?

    <p>Sleep-wake patterns are persistent and commonly fragmented.</p> Signup and view all the answers

    What symptom is frequently observed among individuals with both advanced sleep phase type and depressive disorders?

    <p>Excessive sleepiness during the day</p> Signup and view all the answers

    What characterizes idiopathic hypoventilation?

    <p>Reduction of tidal volume with elevated CO2 during sleep</p> Signup and view all the answers

    What is a known consequence of chronic exposure to hypercapnia and hypoxemia in individuals with sleep-related hypoventilation?

    <p>Cor pulmonale or right heart failure</p> Signup and view all the answers

    Which condition is typically associated with mutation of the PHOX2B gene?

    <p>Congenital central alveolar hypoventilation</p> Signup and view all the answers

    What symptom is commonly identified in patients with sleep-related hypoventilation?

    <p>Morning headaches and insomnia complaints</p> Signup and view all the answers

    What is a major factor contributing to the classification of sleep-related hypoventilation?

    <p>Increased arterial pCO2 levels during sleep</p> Signup and view all the answers

    What distinguishes sleep-related hypoventilation from obstructive and central sleep apnea?

    <p>Presence of distinct clinical features and polysomnography findings</p> Signup and view all the answers

    Which of the following risk factors can contribute to sleep-related hypoventilation?

    <p>Use of central nervous system depressants</p> Signup and view all the answers

    Delayed sleep phase type is primarily characterized by which of the following?

    <p>Significant delay in major sleep period relative to desired timing</p> Signup and view all the answers

    What is a common associated feature of delayed sleep phase type?

    <p>Extreme difficulty waking with morning confusion</p> Signup and view all the answers

    Which condition is NOT a potential comorbidity contributing to sleep-related hypoventilation?

    <p>Asthma</p> Signup and view all the answers

    What potential complication may develop with increasing severity of blood gas abnormalities in sleep-related hypoventilation?

    <p>Progressive respiratory failure</p> Signup and view all the answers

    How is polysomnography primarily utilized in diagnosing sleep-related hypoventilation?

    <p>To monitor sleep-related hypoxemia and hypercapnia</p> Signup and view all the answers

    Which of the following outcomes is significantly associated with neurocognitive dysfunction in sleep-related hypoventilation?

    <p>Chronic exposure to hypercapnia</p> Signup and view all the answers

    What aspect of congenital central alveolar hypoventilation is generally true?

    <p>It is linked with disorders such as Hirschsprung's disease.</p> Signup and view all the answers

    What is a prominent characteristic of sleepwalking episodes?

    <p>Reduced alertness and responsiveness.</p> Signup and view all the answers

    Which factor is most likely to increase the frequency of sleepwalking or sleep terrors?

    <p>Use of sedatives before bedtime.</p> Signup and view all the answers

    What type of behavior characterizes sleep-related eating disorders?

    <p>Completely unaware eating episodes with varying amnesia.</p> Signup and view all the answers

    How do sleep terrors typically present themselves during episodes?

    <p>Panicky screams or cries upon awakening.</p> Signup and view all the answers

    Which age demographic is most commonly associated with the prevalence of sleep terrors?

    <p>Toddlers around 18 months.</p> Signup and view all the answers

    What is a distinction between NREM sleep arousal disorders and REM sleep behavior disorder?

    <p>REM behavior disorders are characterized by major movements and injuries.</p> Signup and view all the answers

    What is a common misconception about sleepwalking behavior?

    <p>All sleepwalkers exhibit violent tendencies.</p> Signup and view all the answers

    Which of the following therapies is least likely to be effective for treating sleep disorders according to the content provided?

    <p>Increasing physical activity during the day.</p> Signup and view all the answers

    What unique aspect distinguishes sexsomnia from other forms of sleepwalking?

    <p>It entails complex sexual actions without conscious awareness.</p> Signup and view all the answers

    What factor most influences whether someone experiences clinically significant distress due to NREM sleep arousal disorders?

    <p>The frequency and nature of episodes affecting family members.</p> Signup and view all the answers

    Which of the following statements accurately describes the likelihood of sleepwalking among different genders?

    <p>More prevalent in boys during childhood and men during adulthood.</p> Signup and view all the answers

    What is a common outcome of children outgrowing sleepwalking or sleep terrors?

    <p>Increased likelihood of sleep disorders in their own children.</p> Signup and view all the answers

    How is memory typically affected after episodes of sleep terrors?

    <p>Only fleeting and fragmentary images recalled.</p> Signup and view all the answers

    Which diagnostic method is least effective for diagnosing sleepwalking episodes?

    <p>MRI scans focused on brain activity.</p> Signup and view all the answers

    What characterizes the course of non-24-hour sleep-wake type in individuals?

    <p>It is persistent with intermittent remission and exacerbation.</p> Signup and view all the answers

    Which group is most at risk for developing non-24-hour sleep-wake type?

    <p>Blind or visually impaired individuals.</p> Signup and view all the answers

    What is a key factor that contributes to the exacerbation of symptoms in both blind and sighted individuals with non-24-hour sleep-wake type?

    <p>Irregular sleep-wake schedules and light exposure.</p> Signup and view all the answers

    What distinguishes NREM sleep arousal disorders from other types of sleep disorders?

    <p>They include episodes of sleepwalking and sleep terrors.</p> Signup and view all the answers

    Which of the following is a common symptom of shift work type?

    <p>Excessive sleepiness at work and impaired sleep at home.</p> Signup and view all the answers

    What factors contribute to the development of shift work type?

    <p>A morning-type disposition and long sleep duration needs.</p> Signup and view all the answers

    How is the diagnosis of non-24-hour sleep-wake type confirmed?

    <p>History and sleep diary or actigraphy over an extended period.</p> Signup and view all the answers

    What potential consequence does non-24-hour sleep-wake type have on an individual’s life?

    <p>Difficulty maintaining stable work or school attendance.</p> Signup and view all the answers

    What is the primary feature of parasomnias related to NREM sleep arousal disorders?

    <p>Incomplete awakenings with physical manifestations.</p> Signup and view all the answers

    What does the presence of non-24-hour sleep-wake type symptoms despite regular routines suggest?

    <p>Possible emergence of another sleep disorder.</p> Signup and view all the answers

    Which of the following is a characteristic of REM sleep behavior disorder?

    <p>Acting out dreams with physical movements.</p> Signup and view all the answers

    What is commonly noted about the prevalence of non-24-hour sleep-wake type in sighted individuals?

    <p>It is considered rare among this group.</p> Signup and view all the answers

    Which of the following may be a common comorbidity with shift work type?

    <p>Substance use disorders.</p> Signup and view all the answers

    In the context of parasomnias, what do episodes of sleepwalking indicate?

    <p>Recurrent episodes of incomplete awakening.</p> Signup and view all the answers

    Which aspect of social cues affects individuals with neurological and psychiatric disorders concerning non-24-hour sleep-wake type?

    <p>Insensitivity to social cues can predispose to the disorder.</p> Signup and view all the answers

    What is a primary feature of nightmares experienced by individuals?

    <p>They produce vivid, story-like, and clearly recalled dreams.</p> Signup and view all the answers

    During what phase of sleep do sleep terrors typically occur?

    <p>Deep NREM sleep.</p> Signup and view all the answers

    What physiological markers are associated with nightmare disorder?

    <p>Heart, respiratory, and eye movement rates.</p> Signup and view all the answers

    Which statement correctly differentiates nightmares from sleep terrors?

    <p>Nightmares involve complete awakenings; sleep terrors do not.</p> Signup and view all the answers

    What is the prevalence of REM sleep behavior disorder in individuals within a general population sample in Switzerland?

    <p>Roughly 1%.</p> Signup and view all the answers

    Which factor is associated with an increased risk of developing neurodegenerative diseases in individuals with REM sleep behavior disorder?

    <p>Idiopathic nature of the disorder.</p> Signup and view all the answers

    What symptom differentiates REM sleep behavior disorder from other sleep disorders?

    <p>Complex motor behaviors during REM sleep.</p> Signup and view all the answers

    What emotional response is commonly associated with nightmares?

    <p>Fearfulness and distress.</p> Signup and view all the answers

    How can nightmares impact daytime functioning?

    <p>They may cause excessive daytime sleepiness and poor concentration.</p> Signup and view all the answers

    What gender-related aspect is prevalent in the nature of nightmares reported?

    <p>Women tend to report themes of sexual harassment or loved ones disappearing.</p> Signup and view all the answers

    Which treatment planning consideration is critical for managing nightmares effectively?

    <p>Addressing the cultural and gender-related aspects.</p> Signup and view all the answers

    In what population is REM sleep behavior disorder more frequently identified?

    <p>Men older than 50 years.</p> Signup and view all the answers

    What commonly used substances may precipitate nightmares?

    <p>All of the above.</p> Signup and view all the answers

    What primarily distinguishes parasomnia overlap syndrome from other sleep disorders?

    <p>It involves features of both sleepwalking and REM sleep behavior disorder.</p> Signup and view all the answers

    What do nightmares in narcolepsy possibly indicate?

    <p>Potential PTSD or acute stress disorders.</p> Signup and view all the answers

    Which factor is NOT typically associated with the occurrence of nightmares?

    <p>Daytime sleepiness</p> Signup and view all the answers

    During which sleep phase do nightmares predominantly occur?

    <p>REM sleep</p> Signup and view all the answers

    Which characteristic differentiates nightmares from bad dreams?

    <p>Length and complexity of the dream.</p> Signup and view all the answers

    What condition is frequently associated with frequent nightmares?

    <p>Mood disturbances</p> Signup and view all the answers

    Which statement about the timing of nightmares is true?

    <p>They are more likely to happen in the second half of the sleep episode.</p> Signup and view all the answers

    What typically happens after a nightmare episode?

    <p>Awakening with rapid return to alertness.</p> Signup and view all the answers

    What is a significant risk factor for the development of chronic nightmares?

    <p>Childhood psychosocial stressors</p> Signup and view all the answers

    Which symptom is NOT typical of panic attacks that may occur during sleep?

    <p>Confusion upon waking.</p> Signup and view all the answers

    What might indicate a diagnosis of nightmare disorder rather than just occasional nightmares?

    <p>Significant distress in the daytime related to the nightmares.</p> Signup and view all the answers

    In which scenario might dissociative fugue be confused with sleepwalking?

    <p>Arising from wakefulness during sleep.</p> Signup and view all the answers

    What role do medications play in the manifestation of behaviors similar to NREM sleep arousal disorders?

    <p>They can either induce or exacerbate these behaviors.</p> Signup and view all the answers

    Which of the following statements correctly describes the relationship between sleepwalking and major depressive episodes?

    <p>They are frequently comorbid in adults.</p> Signup and view all the answers

    What may contribute to nightmares during sleep-onset REM periods?

    <p>A preceding episode of sleep paralysis.</p> Signup and view all the answers

    What percentage of individuals with REM sleep behavior disorder may experience injuries?

    <p>55%</p> Signup and view all the answers

    Which condition may present symptoms similar to REM sleep behavior disorder?

    <p>Obstructive sleep apnea</p> Signup and view all the answers

    Which of the following medications could potentially result in REM sleep behavior disorder as a side effect?

    <p>Selective serotonin reuptake inhibitors</p> Signup and view all the answers

    In pediatric cases of restless legs syndrome (RLS), what aspect of the diagnosis is often challenging?

    <p>Self-reporting of symptoms</p> Signup and view all the answers

    What is a common sensation experienced by individuals with restless legs syndrome?

    <p>Creeping</p> Signup and view all the answers

    What percentage of the population is estimated to experience severe restless legs syndrome that significantly impairs functioning?

    <p>2% – 3%</p> Signup and view all the answers

    In individuals diagnosed with RLS during adulthood, what percentage reported symptoms before age 20?

    <p>40%</p> Signup and view all the answers

    What reflects a typical clinical course associated with late-onset cases of restless legs syndrome?

    <p>Rapid progression</p> Signup and view all the answers

    Which findings are essential for diagnosing REM sleep behavior disorder?

    <p>Clinical dream-enacting behaviors with REM sleep without atonia</p> Signup and view all the answers

    Which of the following is NOT a characteristic associated with restless legs syndrome?

    <p>Severe pain in the legs</p> Signup and view all the answers

    What is the usual age of onset for familial restless legs syndrome compared to nonfamilial cases?

    <p>Younger age at onset</p> Signup and view all the answers

    What common behavioral manifestation might indicate impaired functioning in children with RLS?

    <p>Difficulties in school performance</p> Signup and view all the answers

    Which factor may contribute to significant clinical distress in individuals with RLS?

    <p>Reduced sleep quality</p> Signup and view all the answers

    What distinguishes REM sleep behavior disorder from a simple polysomnographic observation?

    <p>Clinical history of dream-enacting behaviors</p> Signup and view all the answers

    What factor is significantly associated with the prevalence of Restless Legs Syndrome in women?

    <p>Nulliparity</p> Signup and view all the answers

    Which factor is NOT a predisposing factor for Restless Legs Syndrome?

    <p>Increased physical activity</p> Signup and view all the answers

    What is a key pathophysiological mechanism involved in Restless Legs Syndrome?

    <p>Iron metabolism disturbances</p> Signup and view all the answers

    Why might serotonergic antidepressants worsen Restless Legs Syndrome symptoms?

    <p>They can induce or aggravate RLS</p> Signup and view all the answers

    What demographic has the highest prevalence of Restless Legs Syndrome during pregnancy?

    <p>Pregnant women without previous RLS history</p> Signup and view all the answers

    What diagnostic test is commonly used to assess abnormalities in sleep associated with Restless Legs Syndrome?

    <p>Polysomnography</p> Signup and view all the answers

    Which of the following statements regarding genetic factors and Restless Legs Syndrome is accurate?

    <p>Genetic risk variants are linked to specific disorders like uremia</p> Signup and view all the answers

    What is a common consequence of Restless Legs Syndrome that affects daily life?

    <p>Daytime sleepiness or fatigue</p> Signup and view all the answers

    Which medical condition is most commonly associated with restless legs syndrome (RLS)?

    <p>Cardiovascular disease</p> Signup and view all the answers

    Which type of sleep disturbance is NOT categorized under substance/medication-induced sleep disorder?

    <p>Sleep apnea</p> Signup and view all the answers

    What is the proper coding for substance-induced sleep disorder when there is a moderate substance use disorder present?

    <p>Moderate [substance] use disorder with [substance]-induced sleep disorder</p> Signup and view all the answers

    What category is utilized when symptoms characteristic of insomnia disorder exist but do not meet the full criteria for diagnosis?

    <p>Other specified insomnia disorder</p> Signup and view all the answers

    During what time period can sleep disturbances arise after cessation of substance use?

    <p>4 weeks</p> Signup and view all the answers

    Which physiological process is essential in regulating sleep?

    <p>Circadian rhythm</p> Signup and view all the answers

    Which of the following substances is most likely to produce acute insomnia once intoxicated?

    <p>Alcohol</p> Signup and view all the answers

    What is the estimated percentage of adults affected by diagnosed sleep disorders in the United States?

    <p>Approximately 33%</p> Signup and view all the answers

    Which symptoms are primarily associated with sleep disorders stemming from inadequate sleep quality or quantity?

    <p>Morning sleepiness and difficulties maintaining sleep</p> Signup and view all the answers

    Which is NOT a common characteristic during acute alcohol withdrawal related to sleep?

    <p>Increased REM sleep</p> Signup and view all the answers

    Which sleep disorder category is used when symptoms indicative of hypersomnolence disorder exist but do not meet full criteria?

    <p>Other specified hypersomnolence disorder</p> Signup and view all the answers

    When diagnosing substance/medication-induced sleep disorder, what must symptoms meet to avoid being classified solely as substance intoxication?

    <p>Prominent severity</p> Signup and view all the answers

    Which method is primarily used to objectively assess sleep structure and quantity?

    <p>Polysomnography</p> Signup and view all the answers

    Which unique coding strategy applies specifically to caffeine-induced sleep disorder?

    <p>Single ICD-10-CM code</p> Signup and view all the answers

    What common economic burden is related to managing sleep disorders?

    <p>Administrative healthcare costs</p> Signup and view all the answers

    Which type of sleep disturbance is NOT typically associated with substance use or withdrawal?

    <p>Obstructive sleep apnea</p> Signup and view all the answers

    What major factor can lead to dysphoric mood during substance use or withdrawal?

    <p>Persistent fatigue</p> Signup and view all the answers

    Which two sleep stages are primarily described in sleep regulation processes?

    <p>REM and non-REM sleep</p> Signup and view all the answers

    What impact do sleep disorders have on broader societal aspects?

    <p>Increased economic and workload burden</p> Signup and view all the answers

    What distinguishes substance-induced sleep disorder from other sleep disorders?

    <p>Association with substance use</p> Signup and view all the answers

    Which medical condition is commonly treated alongside sleep disorders due to comorbidity?

    <p>Mental health conditions</p> Signup and view all the answers

    In terms of classification, which statement correctly reflects the coding approach for substance-induced sleep disorders?

    <p>Primary disorder always first</p> Signup and view all the answers

    Which of the following medications is commonly associated with the induction of sleep disturbances?

    <p>Antihistamines</p> Signup and view all the answers

    What is the primary focus of clinical standards in addressing sleep complaints?

    <p>Assessing and addressing specific sleep concerns</p> Signup and view all the answers

    How does polysomnography contribute directly to the diagnostic process of sleep disorders?

    <p>By monitoring sleep patterns in real-time</p> Signup and view all the answers

    What type of sleep disturbance predominates with chronic alcohol consumption?

    <p>Fragmented sleep</p> Signup and view all the answers

    What can result from inadequate recognition and management of sleep disorders?

    <p>Decreased productivity and increased accidents</p> Signup and view all the answers

    What effect does caffeine consumption typically have on nighttime sleep for normal sleepers when consumed in low to moderate doses during the morning hours?

    <p>Does not significantly affect nighttime sleep</p> Signup and view all the answers

    Which substance enhances slow-wave sleep while also suppressing REM sleep after acute administration?

    <p>Cannabis</p> Signup and view all the answers

    What is a consequence of chronic opioid use concerning sleep?

    <p>Development of tolerance to sedative effects</p> Signup and view all the answers

    In individuals withdrawing from cannabis, which symptom is most likely to be reported?

    <p>Unpleasant dreams</p> Signup and view all the answers

    What is a recognized sleep disturbance associated with regular tobacco use?

    <p>Symptoms of insomnia</p> Signup and view all the answers

    Which type of sleep disorder is characterized by insomnia during intoxication and excessive sleepiness during withdrawal?

    <p>Substance/medication-induced sleep disorder</p> Signup and view all the answers

    What distinguishes the diagnosis of substance/medication-induced sleep disorder from substance intoxication or withdrawal?

    <p>Severity and predominance of sleep disturbance</p> Signup and view all the answers

    What type of sleep disturbances do individuals using MDMA frequently report?

    <p>Restless and disturbed sleep</p> Signup and view all the answers

    What plays a crucial role in distinguishing sleep symptoms from those related to medical conditions?

    <p>Chronology of symptoms</p> Signup and view all the answers

    During withdrawal from a substance, what might increase the risk for relapse according to sleep quality?

    <p>Severe sleep disturbances</p> Signup and view all the answers

    How are drug screening results beneficial when assessing sleep disturbances?

    <p>When individuals deny substance intake</p> Signup and view all the answers

    What happens to sleep quality in individuals who smoke heavily due to tobacco craving upon withdrawal?

    <p>Regular nocturnal awakenings</p> Signup and view all the answers

    What type of sleep architecture changes might be indicated by withdrawal from substances?

    <p>Reduced slow-wave sleep and increased REM sleep</p> Signup and view all the answers

    What may indicate a different diagnosis than substance-induced sleep disorder in a patient taking medications?

    <p>Presence of a pre-existing medical condition</p> Signup and view all the answers

    Which type of sleep disorder involves excessive daytime dysfunction often linked to recurrent nightmares?

    <p>Nightmares</p> Signup and view all the answers

    What is primarily associated with the emotional and behavioral disturbances linked to sleep-related breathing disorders?

    <p>Obstructive Sleep Apnea</p> Signup and view all the answers

    Which of the following risk factors increases the likelihood of developing obstructive sleep apnea?

    <p>Deviated septum</p> Signup and view all the answers

    How does age specifically influence sleep stages?

    <p>Most deep sleep occurs in the first sleep cycles, and REM sleep increases later.</p> Signup and view all the answers

    What feature primarily differentiates nightmares from night terrors?

    <p>Memory of the experience</p> Signup and view all the answers

    Which treatment has been critically reviewed for its efficacy in managing adult parasomnias?

    <p>Cognitive-behavioral therapy</p> Signup and view all the answers

    What is the typical duration of NREM-REM sleep cycles throughout the night?

    <p>90–110 minutes</p> Signup and view all the answers

    What is one of the common emotional reactions experienced during night terrors?

    <p>Fear and confusion</p> Signup and view all the answers

    Which of the following best describes the primary role of the hypothalamus in sleep regulation?

    <p>It is responsible for sleep onset and maintenance.</p> Signup and view all the answers

    Which of the following does NOT typically require clinical intervention among parasomnias?

    <p>Sleep talking</p> Signup and view all the answers

    What can be a consequence of sleep deprivation related to circadian rhythms?

    <p>Health risks like hypertension and diabetes</p> Signup and view all the answers

    What is a potential consequence of untreated obstructive sleep apnea?

    <p>Progressively worsening hypoxemia</p> Signup and view all the answers

    Which of the following conditions is characterized by an excess need for daytime sleep or frequent naps?

    <p>Hypersomnia</p> Signup and view all the answers

    Which condition might require assessing a child's growth patterns in diagnosing sleep-related issues?

    <p>Congenital central alveolar hypoventilation</p> Signup and view all the answers

    What is a distinguishing feature of primary insomnia when compared to secondary insomnia?

    <p>It has no underlying comorbid psychological disorders.</p> Signup and view all the answers

    What type of sleep study might older children undergo to investigate potential narcolepsy?

    <p>Multiple sleep latency test</p> Signup and view all the answers

    What role does REM sleep primarily play in cognitive functioning?

    <p>It enhances learning and emotional regulation.</p> Signup and view all the answers

    What is a notable characteristic of obesity hypoventilation syndrome (OHS)?

    <p>Association with chronic respiratory failure</p> Signup and view all the answers

    How is the internal biological clock primarily kept in sync?

    <p>With environmental time cues</p> Signup and view all the answers

    Which psychosocial factor may exacerbate children's parasomnias?

    <p>Stress and anxiety</p> Signup and view all the answers

    What type of sleep disorder is categorized as secondary somnipathy?

    <p>Obstructive sleep apnea</p> Signup and view all the answers

    How does sleep architecture get disrupted in patients with obstructive sleep apnea?

    <p>Reduced slow-wave sleep stages</p> Signup and view all the answers

    What are the potential psychiatric ramifications of sleep disorders like insomnia?

    <p>Heightened risk of depression and anxiety</p> Signup and view all the answers

    What is primarily inhibited during REM sleep?

    <p>Pain perception and muscle tone</p> Signup and view all the answers

    Which of the following statements accurately reflects a risk associated with short sleep duration?

    <p>It is linked to increased mortality risk.</p> Signup and view all the answers

    What lifestyle modifications can effectively help manage conditions like Restless Leg Syndrome?

    <p>Regular exercise and avoiding stimulants</p> Signup and view all the answers

    What characterizes instant insomnia as opposed to chronic insomnia?

    <p>It is self-limiting and occurs due to specific incidents.</p> Signup and view all the answers

    Which factor is NOT considered a major determinant for obstructive sleep apnea (OSA)?

    <p>Diabetes</p> Signup and view all the answers

    What is the primary function of polysomnography in sleep disorder diagnosis?

    <p>To measure sleep-wake cycles and physiological variables</p> Signup and view all the answers

    What aspect of clinical assessment is emphasized for diagnosing sleep disorders?

    <p>A comprehensive patient interview</p> Signup and view all the answers

    What is highlighted as an important first-line therapy for sleep disorders?

    <p>Non-pharmacological interventions</p> Signup and view all the answers

    Which statement correctly describes cognitive behavioral therapy (CBT) in relation to sleep disorders?

    <p>It encourages changing thoughts and routines that obstruct sleep</p> Signup and view all the answers

    What is the diagnostic tool of choice for a specific group of patients with sleep disorders?

    <p>Polysomnography</p> Signup and view all the answers

    Which of the following is a recommended tool for tracking sleep-wake patterns?

    <p>Sleep diary</p> Signup and view all the answers

    Which of the following best illustrates a significant risk associated with certain psychiatric agents used for sleep disorders?

    <p>Reduced coordination</p> Signup and view all the answers

    What factor is essential to consider when interpreting polysomnography results?

    <p>Presence of comorbid disorders</p> Signup and view all the answers

    What primary purpose does cognitive behavioral therapy serve in the management of sleep disorders?

    <p>Behavioral modification and education</p> Signup and view all the answers

    Which of the following best describes the purpose of actigraphy in clinical settings?

    <p>Assess behavioral and sleep patterns over time</p> Signup and view all the answers

    What element is NOT part of the information included in a sleep diary?

    <p>Next scheduled medical appointment</p> Signup and view all the answers

    What is a critical element in the success of multidisciplinary treatment for sleep disorders?

    <p>Teamwork among specialists</p> Signup and view all the answers

    In terms of clinical guidelines, what approach is emphasized for managing sleep disorders?

    <p>Individualized and tailored interventions</p> Signup and view all the answers

    Which of the following contributes most significantly to sleep centers' challenges in multidisciplinary staff meetings?

    <p>Insufficient time for discussions</p> Signup and view all the answers

    Which best describes the approach to disseminating knowledge about sleep disorders?

    <p>Engagement through community events</p> Signup and view all the answers

    Which emerging therapy is specific to the treatment of sleep disorders?

    <p>Dual orexin receptor antagonists</p> Signup and view all the answers

    What role does ongoing assessment of treatment play in the management of sleep disorders?

    <p>It enables progress monitoring and treatment adjustment</p> Signup and view all the answers

    What characteristic defines individuals who may benefit from melatonin receptor agonists?

    <p>Difficulty initiating sleep</p> Signup and view all the answers

    Which component is least likely to be included in effective interdisciplinary practices in sleep medicine?

    <p>Infrequent communication</p> Signup and view all the answers

    What strategy is essential for patient engagement in sleep disorder treatments?

    <p>Involvement in treatment decisions</p> Signup and view all the answers

    Which benefit of cognitive behavioral therapy is most important for long-term outcomes in sleep disorder management?

    <p>Long-lasting behavioral change</p> Signup and view all the answers

    What approach to managing complex sleep conditions emphasizes the need for close follow-up?

    <p>Continued evaluation of progress</p> Signup and view all the answers

    Study Notes

    Sleep-Wake Disorders in DSM-5

    • DSM-5 recognizes 10 sleep-wake disorders: insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian rhythm sleep-wake disorders, non-REM sleep arousal disorders, nightmare disorder, REM sleep behavior disorder, restless legs syndrome, and substance/medication-induced sleep disorder.
    • These disorders typically present with complaints about sleep quality, timing, and amount.
    • DSM-5 takes a simplified approach to sleep-wake disorder classification compared to the ICSD-3, which is intended for sleep specialists.

    Insomnia Disorder

    • Insomnia disorder is characterized by dissatisfaction with sleep quality or quantity, and at least one of these symptoms: difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening with inability to return to sleep.
    • It occurs at least three nights per week for at least three months despite adequate opportunity for sleep.
    • Insomnia disorder is not better explained by another sleep-wake disorder, substance use, or other medical or mental conditions.
    • Both subjective reports and objective data from polysomnography are crucial in diagnosing insomnia disorder.
    • Nonrestorative sleep, a complaint of poor sleep quality that doesn’t leave the individual feeling rested, is frequently associated with insomnia disorder.
    • Insomnia disorder is more common among older individuals and when it coexists with another medical condition or sleep disorder.
    • Insomnia can be situational, persistent, or recurrent, with situational or acute insomnia usually lasting a few days or weeks.
    • The course of insomnia can be episodic, with recurrent episodes of sleep difficulties associated with stressful events.
    • Insomnia is a common and potentially fatal sleep disorder, with risk factors including major life events or chronic stress.
    • Perpetuating factors contributing to insomnia include poor sleep habits, irregular sleep scheduling, and fear of not sleeping.
    • Anxiety, worry-prone personality, higher stress reactivity, and tendency to repress emotions can increase susceptibility to insomnia.
    • Noise, light, high or low temperatures, and high altitudes can predispose individuals to insomnia.
    • Sex and advancing age are associated with increased vulnerability to insomnia.
    • Disrupted sleep and insomnia exhibit a familial disposition, with 35% to 75% of those with insomnia disorder reporting family members with a history of insomnia.
    • Insomnia has been identified as an independent risk factor for suicidal thoughts and behavior.
    • Insomnia disorder can lead to various functional consequences, such as increased or decreased attention and concentration, higher rates of accidents, and long-term consequences like new-onset major depressive disorder, anxiety disorders, and substance use disorders.
    • It is a significant risk factor for numerous cardiovascular diseases, including hypertension, coronary artery disease/myocardial infarction, congestive heart failure, and cerebrovascular disease.
    • Clinical Insomnia should be distinguished from normal, age-related sleep changes and sleep deprivation due to inadequate opportunity for sleep.
    • Situational/acute insomnia, often associated with acute stress or changes in sleep schedules, may last a few days to several weeks.
    • When these symptoms meet all other criteria except for the 3-month duration, a diagnosis of "another specified insomnia disorder" or "unspecified insomnia disorder" is made.
    • Delayed sleep phase, shift work types of circadian rhythm sleep-wake disorder, restless legs syndrome, breathing-related sleep disorders, narcolepsy, parasomnias, and substance/medication-induced sleep disorder are common comorbidities of many medical conditions.
    • Approximately one in seven individuals with insomnia disorder has moderate to severe obstructive sleep apnea.
    • Individuals with insomnia may misuse medications, alcohol, anxiolytics, caffeine, and stimulants to alleviate nighttime sleep disturbances and daytime fatigue.
    • ICSD-3 recognizes three insomnia diagnoses: chronic insomnia disorder, short-term insomnia disorder, and other insomnia disorder.

    Hypersomnolence Disorder

    • Hypersomnolence disorder is characterized by excessive sleepiness, despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms: recurrent periods of sleep or lapses into sleep within the same day, a prolonged main sleep episode of more than 9 hours per day that is nonrestorative, and difficulty being fully awake after abrupt awakening.
    • The hypersomnolence occurs at least three times per week, for at least 3 months, and is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning.
    • The hypersomnolence is not better explained by another sleep disorder, substance use, or other medical or mental conditions.

    Hypersomnolence Disorder

    • Characterized by excessive sleep, sleepiness, and sleep inertia
    • Individuals fall asleep quickly and have good sleep efficiency (over 90%)
    • Unintentional sleep episodes usually occur in sedentary situations
    • Can lead to automatic behavior with little recall
    • About 40% experience sleep inertia (sleep drunkenness) which helps differentiate it from other sleepiness causes
    • Difficulty waking up in the morning, confusion, combativeness, or ataxia may occur
    • Sleep inertia can occur after daytime naps as well
    • Approximately 80% experience nonrestorative sleep, but this is non-specific
    • Frequent long (over one hour) and unrefreshing naps
    • Often appear sleepy and may even fall asleep at the doctors
    • Some have a family history with symptoms of autonomic nervous system dysfunction
    • Typically begins in late adolescence or early adulthood, with a mean age of onset of 17-24 years
    • Gradual progression over weeks to months
    • Spontaneous remission occurs in about 11%-25% of individuals after 5-7 years
    • Diagnosed 10-15 years after first symptoms
    • Pediatric cases are rare
    • Can be caused by stress, alcohol, viral infections, and may be familial
    • Normal to prolonged sleep duration, short sleep latency, and normal to increased sleep continuity are markers
    • Nocturnal REM sleep distribution is normal, with sleep efficiency > 90%
    • Functional consequences include reduced efficiency, concentration, memory, distress in work and social relationships, and difficulty meeting morning obligations
    • Unintentional daytime sleep episodes can be embarrassing and dangerous
    • Normal sleep duration varies in the general population, "long sleepers" do not have excessive sleepiness or sleep inertia
    • Symptoms of excessive sleepiness occur regardless of nocturnal sleep duration
    • Inadequate nocturnal sleep can produce similar symptoms

    Narcolepsy

    • Recurrent daytime naps or lapses into sleep that occur typically daily, but must occur at least three times a week for at least three months
    • Naps are accompanied by one or more of the following: cataplexy, hypocretin deficiency, or characteristic abnormalities on a nocturnal polysomnogram or on the MSLT
    • Sleepiness is worse in sedentary circumstances and typically is relieved by brief naps
    • Cataplexy is brief episodes of sudden, bilateral loss of muscle tone precipitated by emotions, which can be triggered by positive emotions
    • Muscles affected include those of the neck, jaw, arms, legs, or whole body, resulting in head bobbing, jaw dropping, or complete falls
    • NT1 is caused by the loss of hypothalamic neurons that produce the hypocretin neuropeptides, and CSF hypocretin levels are typically less than one-third of control values
    • Hypocretin deficiency is a sufficient diagnostic test for NT1, and if CSF hypocretin is measured and not low, an NT2 diagnosis is based on clinical symptoms and sleep study data
    • A nocturnal polysomnogram followed by an MSLT is the conventional method for confirming the diagnosis of both NT1 and NT2
    • These tests must be performed after the individual has stopped all psychotropic medications and obtained adequate sleep time on a normal sleep-wake schedule, ideally for two weeks
    • The MSLT result must be positive for a diagnosis of NT2, showing a mean sleep latency of ≤ 8 minutes plus at least two SOREMPs
    • The nocturnal polysomnogram and MSLT are diagnostically limited, especially in NT2
    • Associated features include automatic behaviors, vivid hypnagogic hallucinations, sleep paralysis, nocturnal eating, obesity, and impaired working memory and executive functioning
    • Narcolepsy-cataplexy (NT1) affects 0.02%–0.05% of the adult general population worldwide and has an incidence of 0.74 per 100,000 person-years in the United States
    • The true prevalence of NT2 is unknown due to diagnostic variability
    • Affects both genders fairly equally
    • Onset occurs most often in childhood and adolescence or young adulthood, with peak age at onset around 15-25 years
    • Onset can be abrupt or progressive, with cataplexy developing over years
    • Children presenting with abrupt onset of NT1 symptoms have the highest disease severity, but disease severity tends to partially improve in the first few years after onset
    • About 50% of individuals with narcolepsy diagnosed in adulthood recall symptom onset in childhood or adolescence
    • Once the disorder has manifested, the course is persistent and lifelong
    • In 90% of cases, the first symptom to manifest is sleepiness or increased sleep, followed by cataplexy
    • Sleepiness, hypnagogic hallucinations, vivid dreaming, and REM sleep behavior disorder are early symptoms
    • Excessive sleep rapidly progresses to an inability to stay awake during the day and to maintain good sleep at night without a clear increase in total 24-hour sleep time
    • Young children and adolescents with narcolepsy often develop aggression or behavioral problems secondary to sleepiness and/or nighttime sleep disruption
    • Workload and social pressure increase through high school and college, reducing available sleep time at night
    • Pregnancy does not seem to modify symptoms consistently, and after retirement, individuals typically have more opportunity for napping, reducing the need for stimulants
    • Maintaining a regular schedule benefits individuals at all ages
    • Risk and prognostic factors include increased sleep needs, autoimmune processes, head trauma, and changes in sleep-wake patterns
    • Narcolepsy is strongly associated with HLA DQB1*06:02
    • Culture-related diagnostic issues include differences in onset and prevalence among ethnoracial groups and cultural contexts
    • Categorized into three distinct disorders: obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation
    • Obstructive sleep apnea hypopnea is the most common breathing-related sleep disorder, characterized by repeated episodes of upper (pharyngeal) airway obstruction during sleep
    • The diagnosis is based on symptoms of nocturnal breathing disturbances, daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that are not better explained by another mental disorder (including a sleep disorder) and is not attributable to another medical condition, and evidence by polysomnography of five or more obstructive apneas or hypopneas per hour of sleep
    • Disease severity is measured by a count of the number of apneas plus hypopneas per hour of sleep (apnea hypopnea index) using polysomnography or other overnight monitoring
    • Apnea refers to the total absence of airflow, while hypopnea refers to a reduction in airflow
    • Overall severity is also informed by levels of nocturnal desaturation and sleep fragmentation (measured by brain cortical arousal frequency and sleep stages) and the degree of associated symptoms and daytime impairment
    • Diagnosis can be made in the absence of these symptoms if there is evidence by polysomnography (or limited OCST) of 15 or more obstructive apneas and/or hypopneas per hour of sleep
    • In children, criteria for a diagnosis differ from those for a diagnosis in adults, with an obstructive apnea hypopnea index of one or more events per hour or evidence of obstructive hypoventilation in association with snoring or polysomnographic evidence of airflow obstruction used to define thresholds of abnormality in children
    • Most cases of obstructive sleep apnea remain undiagnosed, so specific attention to symptoms of disturbed sleep occurring in association with snoring or breathing pauses and physical findings that increase the risk of obstructive sleep apnea hypopnea is important to reduce the chance of failure to diagnose this treatable condition

    Obstructive Sleep Apnea Hypopnea (OSAH)

    • Prevalence:

      • 13% of men and 6% of women have OSAH with 15 or more obstructive apneas or hypopneas per hour of sleep in the United States.
      • Prevalence is higher in older adults, obese children, African Americans, American Indians, and Hispanics.
      • Obesity is a significant factor in OSAH, and its prevalence is increasing in midlife and after menopause.
      • Higher rates of obesity among African Americans, American Indians, and Hispanics may be due to food insecurity and limited access to exercise opportunities.

    • Risk Factors:

      • Male sex, obesity, maxillary-mandibular retrognathia or micrognathia, family history of sleep apnea, genetic syndromes that reduce upper airway patency, adenotonsillar hypertrophy, menopause, various endocrine syndromes.
      • Males have a higher risk due to the influence of sex hormones on ventilatory control and body fat distribution.
      • One-third of the variance in apnea-hypopnea index is explained by familial factors.

    • Culture-related Diagnostic Issues:

      • Sleepiness and fatigue may be reported differently across cultures.
      • Snoring may be viewed as normal in some cultures, leading to underdiagnosis.

    • Diagnostic Markers:

      • Primary snoring, other sleep disorders, central sleep apnea.
      • Polysomnography provides quantitative data on sleep-related respiratory disturbances, oxygen saturation, and sleep continuity.

    • Functional Consequences:

      • More than 50% of individuals report daytime sleepiness.
      • Increased risk of occupational accidents, motor vehicle crashes, and reduced health-related quality of life.
      • Severe OSAH negatively affects general health, physical, and social functioning.

    Central Sleep Apnea (CSA)

    • Prevalence:

      • Prevalence is unknown, but thought to be rare.
      • Cheyne-Stokes breathing (CSB) occurs in approximately 20% of individuals with acute stroke.
      • CSB is high in individuals with depressed cardiac ventricular ejection fraction, with prevalence increasing with age.

    • Etiology:

      • CSA is most commonly seen in individuals with congestive heart failure, neurological disease, or opioid medications.
      • Idiopathic CSA is characterized by sleepiness, insomnia, and awakenings due to dyspnea.
      • The pathogenesis of CSA comorbid with opioid use is attributed to the effects of opioids on respiratory rhythm generators.

    • Risk and Prognostic Factors:

      • Heart failure, atrial fibrillation, older age, male sex, acute stroke, and possibly renal failure.

    • Diagnostic Markers:

      • Repeated episodes of apneas and hypopneas during sleep caused by variability in respiratory effort.
      • CSB is characterized by a pattern of periodic crescendo-decrescendo variation in tidal volume resulting in central apneas and hypopneas occurring at a frequency of at least five events per hour.

    • Functional Consequences:

      • Disrupted sleep, including insomnia and sleepiness.
      • CSB with comorbid heart failure has been associated with excessive sleepiness, fatigue, and insomnia.
      • Coexistence of heart failure and CSB may be associated with increased cardiac arrhythmias and increased mortality or cardiac transplantation.

    • Prevalence:

      • Prevalence of idiopathic hypoventilation is unknown.

    • Etiology:

      • Idiopathic hypoventilation is not attributable to any readily identified condition.
      • Congenital central alveolar hypoventilation is a rare disorder that typically manifests during the perinatal period.
      • Comorbid sleep-related hypoventilation occurs as a consequence of a medical condition such as a pulmonary disease.

    • Risk Factors:

      • Use of central nervous system depressants, reduced ventilatory drive, and the presence of neuromuscular disorders influencing breathing.

    • Diagnostic Markers:

      • Episodes of decreased respiration associated with elevated CO2 levels.
      • The gold standard for diagnosis is increased arterial pCO2 levels to >55 mmHg during sleep or a ≥10-mmHg increase in pCO2 levels during sleep compared to awake supine values.

    • Functional Consequences:

      • Pulmonary hypertension, cor pulmonale, polycythemia, and neurocognitive dysfunction.
      • Idiopathic sleep-related hypoventilation is thought to be a slowly progressive disorder of respiratory impairment.
      • Complications such as pulmonary hypertension, cor pulmonale, cardiac dysrhythmias, polycythemia, neurocognitive dysfunction, and worsening respiratory failure can develop with increasing severity of blood gas abnormalities.

    Differential Diagnosis

    • OSAH vs. Narcolepsy:

      • Absence of cataplexy, sleep-related hallucinations, sleep paralysis in OSAH.
      • Presence of loud snoring, gasping during sleep, or observed apneas in sleep in OSAH.

    • OSAH vs. Insomnia Disorder:

      • Absence of snoring and history, signs, and symptoms characteristic of OSAH in insomnia disorder.
      • OSAH and Insomnia Disorder may coexist and require concurrent treatment.

    • OSAH vs. Nocturnal Panic Attacks:

      • Lower frequency of episodes, intense autonomic arousal, and lack of excessive sleepiness in nocturnal panic attacks.
      • Polysomnography in individuals with nocturnal panic attacks does not reveal the typical pattern of apneas or oxygen desaturation characteristic of OSAH.

    • OSAH vs. Nocturnal Asthma:

      • A history of asthma is generally present in nocturnal asthma.
      • Polysomnography does not find evidence of apneas, hypopneas, or oxygen desaturation indicative of OSAH.

    • CSA vs. OSAH:

      • At least five central apneas per hour of sleep in CSA.

    • CSB vs. Other Medical Conditions:

      • Presence of a predisposing condition (e.g., heart failure or stroke) and signs and polysomnographic evidence of the characteristic breathing pattern.

    • Sleep-related Hypoventilation vs. Other Breathing-related Sleep Disorders:

      • Increased arterial pCO2 levels to >55 mmHg during sleep or a ≥10-mmHg increase in pCO2 levels during sleep compared to awake supine values.
    • Can be distinguished from obstructive and central sleep apnea based on clinical features and polysomnography findings.
    • May exacerbate hypoxemia and hypercapnia during sleep and wakefulness.

    Circadian Rhythm Sleep-Wake Disorders

    • Characterized by persistent sleep disruption due to an alteration of the circadian system or mismatch between the internal rhythm and external sleep-wake schedule.
    • Leads to excessive sleepiness or insomnia, causing significant distress and impairment in various areas of functioning.

    Delayed Sleep Phase Type

    • Primarily based on a delayed major sleep period, resulting in insomnia, and excessive sleepiness.
    • Individuals exhibit normal sleep quality and duration when allowed to follow their own schedule.
    • Symptoms include sleep-onset insomnia, difficulty waking up in the morning, and excessive sleepiness early in the day.
    • Associated with mental disorders, extreme difficulty awakening with morning confusion.
    • Prevalence is highest in adolescents and young adults, with rates decreasing significantly in adults.
    • Course is persistent, with intermittent exacerbations throughout adulthood.
    • Symptoms typically begin in adolescence and persist for several months to years before diagnosis.
    • Severity may decrease with age, and relapse of symptoms is common.
    • Exacerbation is usually triggered by a change in work or school schedule.
    • Predisposing factors include a longer than average circadian period, changes in light sensitivity, and impaired homeostatic sleep drive.
    • Individuals may be hypersensitive to evening light, which can delay the circadian clock, or hyposensitive to morning light.
    • Genetic factors may play a role in both familial and sporadic delayed sleep phase.
    • Diagnostic markers include salivary dim light melatonin onset (DLMO) time, although not all individuals with delayed sleep phase exhibit delayed DLMO.
    • Associated with depressive disorders, personality disorders, somatic symptom disorders, anxiety disorders, obsessive-compulsive disorder, attention deficit/hyperactivity disorder, and autism spectrum disorder.

    Advanced Sleep Phase Type

    • Associated with depressive disorders, personality disorders, somatic symptom disorders, anxiety disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, and autism spectrum disorder.
    • Comorbid sleep disorders such as insomnia, restless leg syndrome, and sleep apnea, can exacerbate symptoms.
    • May overlap with non-24-hour sleep-wake type, with sighted individuals with non-24-hour sleep-wake type disorder commonly having a history of delayed circadian sleep phase.
    • Prevalence is approximately 1% in middle-age adults in the United States.
    • Onset usually occurs in late adulthood, although in the familial form, it can occur earlier.
    • Course is typically persistent, lasting more than 3 months, but the severity may increase depending on work and social schedules.
    • Risk and prognostic factors include decreased late afternoon/early evening exposure to light and/or increased exposure to early-morning light.
    • In familial type, a shortening of the endogenous circadian period results in an advanced sleep phase.
    • Diagnostic markers include a sleep diary and actigraphy.
    • Excessive sleepiness associated with advanced sleep phase can negatively affect cognitive performance, social interaction, and safety.

    Irregular Sleep-Wake Type

    • Characterized by a lack of discernible sleep-wake circadian rhythm, with symptoms of insomnia at night and excessive sleepiness during the day.
    • There is no major sleep period, and sleep and wake periods across 24 hours are fragmented, with sleep fragmented into at least three periods during the 24-hour day.
    • The longest sleep period tends to occur between 2:00 A.M. and 6:00 A.M. and is usually less than 4 hours.
    • Associated features include a history of isolation or reclusion, frequent naps throughout the day, and neurodegenerative disorders.
    • Prevalence in the general population is unknown.
    • Development and course are persistent, with age at onset being variable, but the disorder is more common in older adults.
    • Risk and prognostic factors include decreased exposure to environmental light and structured daytime activity, which can be associated with a low-amplitude circadian rhythm.
    • Hospitalized individuals are especially prone to such weak external entraining stimuli, and even outside the hospital setting, individuals with major neurocognitive disorder are exposed to significantly less bright light.
    • Most common among blind or visually impaired individuals who have decreased light perception.
    • In sighted individuals, there is often a history of delayed sleep phase and decreased exposure to light and structured social and physical activity.
    • Sighted individuals with non-24-hour sleep-wake type also demonstrate increased sleep duration.
    • Prevalence in the general population is unclear, but the disorder appears rare in sighted individuals.
    • The course is persistent, with intermittent remission and exacerbations due to changes in work and social schedules throughout the life span.
    • Age at onset is variable, depending on the onset of visual impairment.
    • In sighted individuals, because of the overlap with delayed sleep phase type, non-24-hour sleep-wake type may develop in adolescence or early adulthood.
    • Remission and relapse of symptoms in blind and sighted individuals largely depend on adherence to treatments designed to control sleep and wake structure and light exposure.
    • In adolescents and adults, irregular sleep-wake schedules and exposure to light or lack of light at critical times of the day can exacerbate the effects of sleep loss and disrupt circadian entrainment, resulting in worsening symptoms of insomnia, daytime sleepiness, and school, occupational, and interpersonal functioning.
    • In sighted individuals, decreased exposure to light and social and physical activity cues may contribute to a free-running circadian rhythm.
    • This disorder is more common in individuals with neurological and psychiatric disorders who become insensitive to social cues, predisposing them to the development of non-24-hour sleep-wake type.
    • Blindness is a risk factor for non-24-hour sleep-wake type, which has been associated with traumatic brain injury.
    • Diagnosis is confirmed by history and sleep diary or actigraphy for an extended period, and sequential measurement of phase markers can help determine circadian phase in both sighted and blind individuals.
    • Functional consequences include complaints of insomnia, excessive sleepiness, or both.
    • The unpredictability of sleep and wake times results in difficulty attending school or maintaining a steady job, increasing the potential for social isolation.
    • Depressive disorders may result in similar circadian dysregulation and symptoms.
    • Blindness is often comorbid with non-24-hour sleep-wake type, as are depressive and bipolar disorders with social isolation.

    Shift Work Type

    • Primarily based on a history of working outside of the normal 8:00 A.M. to 6:00 P.M. daytime window (particularly at night) on a regularly scheduled basis.
    • Symptoms of excessive sleepiness at work and impaired sleep at home are prominent.
    • Presence of both sets of symptoms is usually required for a diagnosis.
    • Predisposing factors include a morning-type disposition and a need for long sleep durations to feel well rested.
    • Balancing strong competing social and domestic needs can lead to the development of shift work type.
    • Persons who commit to a nocturnal lifestyle with few competing day-oriented demands appear at lower risk for shift work type.
    • Obstructive sleep apnea may be present and may exacerbate symptoms.
    • Diagnosis depends on the severity of symptoms and/or level of distress experienced by the individual.
    • The presence of shift work type symptoms even when the individual can live on a day-oriented routine for several weeks at a time may suggest the presence of other sleep disorders, which should be ruled out.
    • Travelers across many time zones may experience effects similar to those experienced by individuals with shift work type who work rotating shifts.
    • Comorbidity includes increased alcohol use disorder, other substance use disorders, depression, and physical health disorders associated with prolonged exposure to shift work.

    Parasomnias

    • Disorders characterized by abnormal behavioral, experiential, or physiological events occurring in association with sleep, specific sleep stages, or sleep-wake transitions.
    • The most common parasomnias are non-rapid eye movement (NREM) sleep arousal disorders and rapid eye movement (REM) sleep behavior disorder.

    NREM Sleep Arousal Disorders

    • Involve recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode.
    • These episodes can be accompanied by either sleepwalking or sleep terrors.
    • The essential feature is the repeated occurrence of incomplete arousals, typically brief, lasting 1-10 minutes, but may be protracted, lasting up to 1 hour.
    • The maximum duration of an event is unknown, and the eyes are typically open during these events.
    • Many individuals exhibit both subtypes of arousal on different occasions, highlighting the unitary underlying pathophysiology.
    Sleepwalking
    • Repeated episodes of complex motor behavior initiated during sleep, including rising from bed and walking about.
    • Begins during any stage of NREM sleep, most commonly during slow-wave sleep and often occurring during the first third of the night.
    • During episodes, the individual has reduced alertness and responsiveness, a blank stare, and relative unresponsiveness to communication with others or efforts to awaken the individual.
    • There are two "specialized" forms of sleepwalking: sleep-related eating behavior and sleep-related sexual behavior (sexsomnia or sleep sex).
    • Unwanted recurrent episodes of eating with varying degrees of amnesia, ranging from no awareness to full awareness without the ability to avoid or stop eating.
    Sexsomnia
    • Varying degrees of sexual activity occur as complex behaviors arising from sleep without conscious awareness.
    • More common in males and may result in serious interpersonal relationship problems or medicolegal consequences.
    Sleep Terrors
    • Repeated occurrence of precipitous awakenings from sleep, usually beginning with a panicky scream or cry.
    • May last considerably longer, particularly in children, and the individual may be inconsolable and unresponsive to the efforts of others to awaken or comfort them.
    • Sleepwalking and sleep terrors are two subtypes of NREM sleep arousal disorders, with the severity determined by factors such as frequency, potential for violence or injurious behaviors, embarrassment, or disruption/distress of other household members.
    • Sleepwalking episodes can include a wide variety of behaviors, from confusion to attempting to escape an apparent threat.
    • Most episodes are routine and low complexity, but cases of unlocking doors and operating machinery have been reported.
    • Sleepwalking can also involve inappropriate behavior, such as urinating in a closet or wastebasket.
    • Sleep terrors often involve overwhelming dread and a compulsion to escape, with fragmentary vivid dream images occurring but not a storylike dream sequence.
    • The prevalence of sleep terror episodes is estimated to be between 34.4%–36.9% at 18 months of age, 19.7% at 30 months of age in Canadian toddlers, and 2.2% in Canadian and British adults.
    • NREM sleep arousal disorders occur most commonly in childhood and diminish in frequency with increasing age.
    • Sleepwalking and sleep terrors are frequently outgrown following infancy and childhood and become less frequent by adolescence, with remission rates between 50% and 65%.
    • Violence or sexual activity during sleepwalking episodes is more likely to occur in adults.
    • The onset of sleepwalking in adults with no history of sleepwalking as children should prompt a search for specific etiologies, such as obstructive sleep apnea, nocturnal seizures, or effect of medication.
    • Older children and adults may provide a more detailed recollection of fearful images associated with sleep terrors than younger children, who are more likely to have complete amnesia or report only a vague sense of fear.
    • Sleepwalking or sleep terrors are a common condition characterized by abnormalities in the deep-wave region of the brain (NREM).
    • These disorders can be triggered by various factors such as sedative use, sleep deprivation, sleep-wake schedule disruptions, fatigue, and physical or emotional stress.
    • A family history of sleepwalking or sleep terrors can increase the likelihood of episodes, with the risk further increased when both parents have a history of the disorder.
    • Sex- and gender-related diagnostic issues include eating during sleepwalking episodes being more common in women, sleepwalking occurring more often in girls during childhood but more often in men during adulthood.
    • Sleep terrors are more common in boys than in girls, and they are equally common in men and women in adults.
    • Diagnostic markers for NREM sleep arousal disorders are typically from deep NREM sleep (slow-wave sleep), which are most likely to appear in the first third of the night and do not typically occur during daytime naps.
    • The electroencephalogram (EEG) may show various patterns during the episode, including continuation of rhythmic delta activity into awakening, partial or incomplete arousal, or frequent mixed slow/mixed frequency EEG activity.
    • Polysomnography and audiovisual monitoring can be used to document sleepwalking episodes, but there are no reliable polysomnographic features that can serve as a marker for sleepwalking.
    • Sleep deprivation may increase the likelihood of capturing an event, and the pathophysiology of NREM sleep parasomnia disorders is poorly understood.
    • For the diagnosis of an NREM sleep arousal disorder to be made, the individual or household members must experience clinically significant distress or impairment.
    • Embarrassment concerning the episodes can impair social relationships, leading to social isolation or occupational difficulties.
    • Uncommonly, NREM sleep arousal disorders may result in serious injury to the individual or someone trying to console them.
    • For individuals with sleep-related eating behaviors, unknowingly preparing or eating food during the sleep period may lead to problems such as poor diabetes control, weight gain, injury (cuts and burns), or consequences of eating dangerous or toxic inedibles.
    • NREM sleep arousal disorders, such as nightmare disorder, can be distinguished from REM sleep behavior disorder, which is characterized by episodes of prominent, complex movements often involving personal injury arising from sleep.
    • These disorders are more stereotypical in nature and may occur multiple times nightly, often from daytime naps.
    • Parasomnia overlap syndrome consists of clinical and polysomnographic features of both sleepwalking and REM sleep behavior disorder.
    • Some types of seizures can produce episodes of very unusual behaviors that occur predominantly or exclusively during sleep.

    Nocturnal Seizures

    • May closely mimic NREM sleep arousal disorders.
    • Tend to be more stereotypic in nature.
    • Occur multiple times nightly.
    • More likely to occur from daytime naps.

    Alcohol-Induced Blackouts

    • May be associated with extremely complex behaviors.
    • Occur in the absence of other suggestions of intoxication.
    • Reflect an isolated disruption of memory for events during a drinking episode.

    Dissociative Fugue

    • May be difficult to distinguish from sleepwalking.
    • Arises from a period of wakefulness during sleep.
    • Starts during sleep but without intervening wakefulness.

    NREM Sleep Arousal Disorders

    • Often have a history of recurrent childhood physical or sexual abuse.
    • Can be induced by use of, or withdrawal from, substances or medications.
    • Behaviors similar to those in NREM sleep arousal disorders can be induced by benzodiazepines, nonbenzodiazepine sedative-hypnotics, opiates, cocaine, nicotine, antipsychotics or other dopamine receptor-blocking agents, tricyclic antidepressants, chloral hydrate.

    Night Eating Syndrome

    • Considered an abnormality in the circadian rhythm of meal timing.
    • Normal circadian timing of sleep onset.
    • Individual wakes up in the middle of the night and overeats.

    Sleepwalking

    • In adults, there is an association between sleepwalking and major depressive episodes and obsessive-compulsive disorder.

    Sleep Terrors

    • Children or adults with sleep terrors may have elevated scores for depression and anxiety on personality inventories.

    Nightmare Disorder

    • Characterized by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams.
    • Dreams usually involve efforts to avoid threats to survival, security, or physical integrity.
    • Occur during the second half of the major sleep episode.
    • Can be acute, subacute, persistent, or persistent.
    • Severity of the disorder can be rated by the frequency with which the nightmares occur.
    • Nightmares are typically lengthy, elaborate, story-like sequences of dream imagery.
    • Arise almost exclusively during REM sleep.
    • May be more likely in the second half of the major sleep episode.
    • Factors that increase early-night REM intensity, such as sleep fragmentation or deprivation, jet lag, and medications that affect REM sleep, might facilitate nightmares earlier in the night, including at sleep onset.
    • Usually terminate with awakening and rapid return of full alertness.
    • Dysphoric emotions may persist into wakefulness.
    • Contribute to difficulty returning to sleep and lasting daytime distress.
    • Some nightmares, known as "bad dreams," may not induce awakening and are recalled only later.
    • If nightmares occur during sleep-onset REM periods (hypnagogic), the dysphoric emotion is frequently accompanied by an awakening and being unable to move voluntarily (sleep paralysis).
    • Sleep paralysis may also occur in isolation without a preceding dream or nightmare.
    • Associated features of nightmares include mild autonomic arousal, body movements and vocalizations, and true dream enactment behavior.
    • Prevalence of nightmares during childhood is approximately 1%–5%.
    • Prevalence increases to 5.2% in children ages 5–15 years.
    • Family history of nightmares, parasomnia symptoms, and daytime consequences of temper outbursts/mood disturbance and poor academic performance are associated with frequent nightmares during childhood and adolescence.
    • Nightmares often begin between ages 3 and 6 years.
    • Reach a peak prevalence and severity in late adolescence or early adulthood.
    • Most likely appear in children exposed to acute or chronic psychosocial stressors.
    • May not resolve spontaneously.
    • In a minority, frequent nightmares persist into adulthood, becoming virtually a lifelong disturbance.
    • Risk and prognostic factors for nightmares include low income, mood disturbance, insomnia or sleep-disordered breathing, use of antidepressants or frequent heavy alcohol use, sleep deprivation or fragmentation, irregular sleep-wake schedules that alter the timing, intensity, or quantity of REM sleep, more frequent past adverse events, but not necessarily trauma.
    • Twin studies have identified genetic effects on the disposition to nightmares and their co-occurrence with other nocturnal behaviors.
    • Adaptive parental bedside behaviors, such as soothing the child following nightmares, may protect against developing chronic nightmares.
    • Nightmares can be a significant diagnostic issue.
    • Significance varies by culture and gender.
    • In some cultures, they may be seen as indicators of an individual's spiritual status or the condition of those who have died.
    • Frequent nightmares are strongly associated with posttraumatic stress disorder (PTSD).
    • Assess the temporal sequence and severity of nightmares relative to other symptoms to determine whether a separate diagnosis of nightmare disorder is warranted.
    • Sex- and gender-related diagnostic issues also play a role in the diagnosis of nightmares.
    • Adult women report having nightmares more frequently than adult men.
    • Gender difference was not found in children and the elderly.
    • Nightmare content differs by gender.
    • Women tend to report themes of sexual harassment or of loved ones disappearing/dying.
    • Men tend to report themes of physical aggression or war/terror.
    • Diagnostic markers for nightmare disorder include abrupt awakenings from REM sleep, heart, respiratory, and eye movement rates, and sleep terror disorder.

    Sleep Terror Disorder

    • Typically arise during the first third of the night during deep NREM sleep.
    • Produce either no dream recall or images without an elaborate story-like quality.

    Commonalities in Sleep Arousal Disorders

    • Can cause excessive daytime sleepiness, poor concentration, depression, anxiety, or irritability.

    Similarities between Nightmare Disorder and Sleep Terror Disorder

    • Both include awakenings or partial awakenings with fearfulness and autonomic activation.

    Differentiating Nightmare Disorder and Sleep Terror Disorder

    • Nightmares typically occur later in the night, during REM sleep, and produce vivid, story-like, and clearly recalled dreams; mild autonomic arousal; and complete awakenings.
    • Sleep terrors typically arise in the first third of the night during deep NREM sleep, producing either no dream recall or images without an elaborate story-like quality.

    Other Influences on Nightmares

    • Substance or medication use can also precipitate nightmares.
    • Nightmares in narcolepsy may be a component of PTSD or acute stress disorder.
    • Pain attacks arising during sleep can produce abrupt awakenings with autonomic arousal and fearfulness, but nightmares are typically not reported and symptoms are similar to panic attacks arising during wakefulness.

    Cultural and Gender Aspects of Nightmares

    • Recognizing the cultural and gender-related aspects of nightmares is crucial for effective diagnosis and treatment.

    Comorbidity of Nightmare Disorder

    • Nightmares can be comorbid with various medical conditions, such as coronary heart disease, cancer, parkinsonism, and pain.
    • Can accompany medical treatments like hemodialysis or withdrawal from medications or substances of abuse.
    • Often co-occur with other mental disorders, such as PTSD, acute stress disorder, insomnia disorder, REM sleep behavior disorder, and psychotic, mood, anxiety, adjustment, and personality disorders.
    • Can also co-occur with grief during bereavement.
    • A concurrent nightmare disorder diagnosis should only be considered when independent clinical attention is warranted.

    Rapid Eye Movement Sleep Behavior Disorder (REM Sleep Behavior Disorder)

    • Diagnosed by repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.
    • Behaviors usually occur more than 90 minutes after sleep onset.
    • More frequent during later portions of the sleep period.
    • Uncommonly occur during daytime naps.
    • Upon awakening, the individual is completely awake, alert, and not confused or disoriented.
    • The essential feature of REM sleep behavior disorder is repeated episodes of vocalizations and/or complex motor behaviors arising from REM sleep.
    • Behaviors often reflect motor responses to the content of action-filled or violent dreams of being attacked or trying to escape from a threatening situation.
    • May be termed dream enacting behaviors.
    • Vocalizations are often loud, emotion-filled, and profane.
    • May be very bothersome to the individual and the bed partner.
    • May result in significant injury.
    • Individuals with REM sleep behavior disorder may also present with relatively subtle vocal or motor behaviors during REM sleep.
    • May manifest during history taking or polysomnography in sleep, neurological, and psychiatric clinical visits.
    • Prevalence of REM sleep behavior disorder was approximately 1% in a middle- to older-age general population sample in Switzerland.
    • Approximately 2% in an elderly general population sample in South Korea.
    • Prevalence in individuals with psychiatric disorders may be greater, possibly related to medications prescribed for the psychiatric disorder.
    • Development and course of REM sleep behavior disorder may be gradual or rapid.
    • Individuals with REM sleep behavior disorder should have closely monitored neurological status due to its high association with the later appearance of an underlying neurodegenerative disorder.
    • In individuals with idiopathic REM sleep behavior disorder, the risk of developing a defined neurodegenerative disease, most often a synucleinopathy, is approximately 75% within 10-15 years following diagnosis.
    • Annual risk is approximately 6%–7% per year.
    • Symptoms in young individuals, particularly young women, should raise the possibility of narcolepsy, substance/medication-induced sleep disorder, parasomnia type, a brainstem lesion, or an autoimmune encephalopathy.
    • More common in men older than 50 years.
    • Increasingly being identified in women and younger individuals.
    • Characterized by increased tonic and/or phasic electromyographic activity during REM sleep, which is normally associated with muscle atonia.
    • Electromyographic monitoring should be considered for a REM sleep behavior disorder diagnosis, as it is more specific for this type of disorder.
    • Most serious consequences of REM sleep behavior disorder are the short-term risks for injury to the individual or bed partner related to attacks of dream enactment and the long-term risk of developing a defined neurodegenerative disease.
    • About 55% of individuals with REM sleep behavior disorder may experience injury as a consequence of their attacks.
    • 12% of injuries are serious and require medical attention.
    • Confusional arousals, sleepwalking, and sleep terrors can be easily confused with REM sleep behavior disorder, which generally occur in individuals younger than 50 years.
    • These disorders arise from NREM sleep and tend to occur in the early portion of the sleep period.
    • Polysomnographic monitoring in the disorders of arousal generally reveals normal REM sleep atonia unless there is a comorbid parasomnia.
    • Medications, including tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors, may result in polysomnographic evidence of REM sleep without atonia and in frank REM sleep behavior disorder, which is diagnosed as a medication-induced sleep disorder, parasomnia type.
    • It is not known whether the medications per se result in REM sleep without atonia and/or REM sleep behavior disorder, or whether they unmask an underlying predisposition.
    • Clinical dream-enacting behaviors coupled with the polysomnographic finding of REM sleep without atonia are necessary for the diagnosis of REM sleep behavior disorder.
    • REM sleep without atonia without a clinical history of dream-enacting behaviors is simply an asymptomatic polysomnographic observation with an as yet unknown clinical significance.
    • Obstructive sleep apnea may result in vocalizations and motor behaviors that very closely resemble REM sleep behavior disorder.
    • Polysomnographic monitoring is necessary to differentiate between these two disorders.
    • REM sleep behavior disorder is present concurrently in approximately 30% of patients with narcolepsy.
    • Demographics reflect the younger age range of narcolepsy, with equal frequency in men and women.
    • Based on findings from individuals presenting to sleep clinics, most individuals with initially "idiopathic" REM sleep behavior disorder will eventually develop a neurodegenerative disease, most notably one of the neurocognitive disorder with Lewy bodies.

    Restless Legs Syndrome (RLS)

    • Sensorimotor, neurological sleep disorder.
    • Characterized by an urge to move the legs or arms, usually associated with uncomfortable sensations such as creeping, crawling, tingling, burning, or itching.
    • Symptoms of RLS can delay sleep onset and awaken the individual from sleep.
    • Associated with significant sleep fragmentation.
    • May no longer be apparent in severe cases.
    • Associated with daytime sleepiness.
    • Frequently accompanied by significant clinical distress or functional impairment.
    • Diagnostic features include periodic leg movements in sleep (PLMS), reports of difficulty initiating and maintaining sleep, and excessive daytime sleepiness.
    • A family history of RLS among first-degree relatives can support a diagnosis of RLS.
    • Reduction in symptoms, at least initially, with dopaminergic treatment can support a diagnosis of RLS.
    • Prevalence rates of RLS vary widely when broad criteria are utilized.
    • In the United States and Europe, the prevalence rate is estimated at 1.6% when frequency of symptoms is at least three times per week with moderate or severe distress.
    • RLS that is severe enough to significantly impair functioning or is associated with mental disorders, including depression and anxiety, occurs in approximately 2%–3% of the population.
    • RLS is about twice as common in women as men.
    • Increases in prevalence with age.
    • Reports of RLS vary across geographic regions, with lower prevalence in several Asian populations.
    • The onset of RLS typically occurs in the second or third decade.
    • Approximately 40% of individuals diagnosed with RLS during adulthood report having experienced symptoms before age 20 years.
    • 20% report having experienced symptoms before age 10 years.
    • Prevalence rates of RLS increase steadily with age until about age 60 years.
    • Symptoms remain stable or decrease slightly in older age groups.
    • Compared with nonfamilial cases, familial RLS usually has a younger age at onset and a slower progressive course.
    • The clinical course of RLS differs by age at onset.
    • When onset occurs before age 45, there is often a slow progression of symptoms.
    • In late-onset RLS, rapid progression is typical, and aggravating factors are common.
    • The RLS phenotype appears similar across the life span.
    • Diagnosis of RLS in children can be difficult due to the centrality of self-report in genetic and physiological establishing the diagnosis.
    • Pediatric diagnosis also requires a description in the child's own words rather than by a parent or caretaker.
    • Children rarely use or understand the word "urge," reporting instead that their legs "have to" or "got to" move.
    • Nocturnal worsening tends to persist even in pediatric RLS, with a significant negative impact on sleep, mood, cognition, and function.
    • Impairment in children and adolescents is manifested more often in behavioral and educational domains.

    Restless Legs Syndrome (RLS)

    • RLS is a disorder affecting the central nervous system, impacting sleep patterns.
    • Predisposing factors include genetics, age, female sex, and family history.
    • Triggering factors like iron deficiency are often temporary, resolving after the cause is removed.
    • Genetic factors contribute to RLS, especially in combination with other risk factors.
    • Genetic studies indicate multiple genetic variants associated with RLS.
    • The MEIS1 gene variant is strongly linked to RLS, doubling the risk in 7% of the European population.
    • RLS involves disruptions in the dopamine and opioid systems, as well as iron metabolism.
    • Treatment with dopamine drugs, opioids, and iron supports the role of these systems.
    • RLS can lead to depression, and successful RLS treatment can reduce depressive symptoms.
    • Serotonin-based antidepressants can trigger or worsen RLS in some individuals.
    • RLS is more common in women, with no diagnostic differences based on gender.
    • Pregnancy significantly increases RLS prevalence, doubling or tripling the risk.
    • The higher prevalence in women is partially explained by parity, with nulliparous women having similar risk to men.
    • Diagnostic markers include polysomnography, revealing abnormalities like increased sleep latency and arousal index.
    • RLS commonly causes sleep disruptions, including difficulty falling asleep and fragmented sleep.
    • It also affects quality of life, leading to daytime sleepiness, fatigue, and significant distress across daily activities.
    • Differential diagnosis considers conditions like leg cramps, positional discomfort, arthritis, muscle pain, and peripheral neuropathy.
    • Co-occurring conditions include depression, anxiety disorders, and post-traumatic stress disorder.
    • The most common medical comorbidity with RLS is cardiovascular disease, alongside hypertension, migraine, Parkinson's disease, multiple sclerosis, diabetes, fibromyalgia, and other sleep disorders.

    Substance/Medication-Induced Sleep Disorder (SIDS)

    • SIDS is characterized by severe sleep disturbances caused by substance intoxication, withdrawal, or medication exposure/withdrawal.
    • Diagnosis is prioritized over intoxication or withdrawal when sleep symptoms dominate the clinical picture and warrant attention.
    • ICD-10-CM codes vary depending on co-occurring substance use disorder.
    • The specific substance or medication inducing the sleep disorder is included in the diagnosis.
    • Sleep disturbance subtypes include insomnia, daytime sleepiness, parasomnia, and mixed types.
    • SIDS distinguishes itself from other sleep disorders by occurring specifically during intoxication or withdrawal periods.
    • The sleep disturbance onset can occur within 4 weeks of substance cessation and may exhibit atypical features.
    • During substance use periods, dysphoric mood, depression, anxiety, cognitive impairments, and fatigue may occur.
    • Substances causing sleep disturbances include alcohol, caffeine, cannabis, opioids, sedatives, stimulants, tobacco, and others.
    • Medications inducing sleep disturbances include adrenergic agents, dopamine agents, cholinergic agents, serotonergic agents, antihistamines, and corticosteroids.

    Specific Substance-Induced Sleep Disorders

    • Alcohol-induced sleep disorder typically presents as insomnia.
    • Acute intoxication: initial sedative effect, followed by wakefulness, restless sleep, and vivid dreams.
    • Withdrawal: chronic alcohol users may experience light, fragmented sleep for prolonged periods.
    • Alcohol exacerbates breathing-related sleep disorders like obstructive sleep apnea.
    • Caffeine consumption in low to moderate doses during the morning generally doesn't impact sleep.
    • However, larger doses later in the day can cause insomnia, prolong sleep latency, reduce slow-wave sleep, and increase awakenings.
    • Some individuals, particularly heavy consumers, may experience daytime sleepiness during withdrawal.
    • Acute cannabis use shortens sleep latency but also causes arousing effects.
    • Cannabis enhances slow-wave sleep and suppresses REM sleep acutely.
    • Chronic use leads to tolerance, and withdrawal can result in sleep difficulties and unpleasant dreams lasting weeks.
    • Opioids initially increase sleepiness and subjective sleep depth but reduce REM and slow-wave sleep.
    • With continued use, tolerance to sedative effects develops, leading to insomnia complaints.
    • Sedatives, hypnotics, or anxiolytics with short durations of action are more likely to cause rebound insomnia.
    • Stimulants (amphetamine-type substances) cause insomnia during intoxication and excessive sleepiness during withdrawal.
    • MDMA (ecstasy) causes restless and disturbed sleep within 48 hours of use.
    • Frequent MDMA use is associated with persistent anxiety, depression, and sleep disturbances even during abstinence.
    • Chronic tobacco use leads to insomnia, reduced slow-wave sleep, and increased daytime sleepiness.
    • Tobacco withdrawal impairs sleep, with heavy smokers experiencing nocturnal awakenings due to craving.
    • Insomnia in children can be identified by either the child or parent.
    • Recreational substance use (cannabis, ecstasy) is prevalent in adolescence and young adulthood.
    • Older individuals take more medications, increasing SIDS risk.
    • Sleep disturbance help-seeking behaviors are limited in these age groups.
    • Risk and prognostic factors vary based on age group and type of sleep disturbance.
    • Substance use is more likely to trigger insomnia in vulnerable individuals.
    • Preexisting sleep disorders may increase SIDS risk (e.g., hypersomnia and stimulant use).
    • Sex-specific differences in hepatic functioning can lead to distinct sleep-related outcomes in males and females.

    Diagnostic Markers for SIDS

    • Electroencephalographic sleep patterns associated with SIDS are not conclusive, resembling patterns seen in other disorders.
    • Polysomnography assists in determining the severity of insomnia complaints.
    • Multiple Sleep Latency Test (MSLT) provides information about daytime sleepiness.
    • Sleep diaries and actigraphy are helpful in confirming SIDS, particularly for suspected insomnia type.
    • Drug screening is useful when the individual is unaware or reluctant to divulge substance intake.

    Functional Consequences of SIDS

    • Increased relapse risk, especially during alcohol withdrawal.
    • Monitoring sleep quality during and after withdrawal provides insight into relapse risk.

    Differential Diagnosis of SIDS

    • SIDS should be diagnosed instead of substance intoxication or withdrawal when sleep disturbance is predominant and clinically significant.
    • SIDS may present with similar symptoms to sleep disorders related to medical conditions.
    • Chronology of symptoms is crucial in distinguishing between these disorders.
    • Sleep difficulties preceding medication use for a medical condition suggest a separate diagnosis.
    • Other specified sleep-wake disorder categories are used when symptoms characteristic of a sleepwake disorder that cause clinically significant distress or impairment in social.

    General Sleep Disorder Information

    • Sleep disorders are primarily caused by inadequate sleep quality or quantity.
    • Common symptoms include morning sleepiness, difficulty initiating and maintaining sleep, and disrupted sleep.
    • Polysomnography objectively assesses sleep structure and quantity in a lab setting.
    • Recognizing and managing sleep disorders is crucial for public health, as they impact well-being, productivity, and safety.
    • Sleep disorder prevalence and incidence vary based on population, country, classification systems, sampling methods, and measurement instruments.
    • Sleep disorders significantly impact work, social, and family life, creating economic burdens on healthcare resources.
    • Up to 50% of individuals with mental health conditions experience co-occurring sleep disorders.
    • Sleep is a complex physiological process regulated by various biological factors.

    Sleep Stages

    • Sleep is divided into two main stages: REM (Rapid Eye Movement) and NREM (Non-REM), with REM sleep accounting for 20-25% of an adult's sleep time.
    • NREM sleep has four stages ranging from light sleep to deep sleep.
    • The progression from wakefulness to NREM sleep takes less than 10 minutes, while NREM-REM sleep cycles last roughly 90-110 minutes.
    • Each night, individuals typically cycle through 4-5 cycles, with the length of REM periods increasing throughout the night.
    • Age influences the duration of deep sleep, with most occurring in the first sleep cycles, while REM sleep increases as the night progresses.

    Sleep Function and Physiology

    • REM sleep is characterized by rapid eye movements, a chaotic brainwave pattern, muscle atonia, and an awake-like cardiovascular system.
    • Sleep plays a vital role in numerous biological functions, including cellular repair, energy metabolism, immune regulation, and cognitive processes.
    • REM sleep is particularly important for learning, emotional regulation, immune function, and energy homeostasis.
    • Circadian rhythms, controlled by the suprachiasmatic nucleus (SCN) in the hypothalamus, regulate sleep-wake cycles and other biological processes, including body temperature and hormone production.
    • Disruptions in circadian rhythms can lead to sleep disorders, such as insomnia.

    Sleep Disorders

    • Sleep disorders, collectively known as somnipathies, are medical conditions impacting sleep patterns and often lead to psychiatric conditions.
    • Insomnia, characterized by difficulties initiating or maintaining sleep, and hypersomnia, defined by excessive daytime sleepiness and a strong need to nap, are the most common sleep disorders.
    • Sleep disorders can significantly impact daily functioning, health, and quality of life.

    Insomnia and Hypersomnia

    • Insomnia often stems from multiple factors, including circadian rhythm disruptions, and can be associated with conditions like anxiety, depression, and mania.
    • Hypersomnia can fall into three categories: extrinsic, intrinsic, and mixed, with extrinsic hypersomnia often linked to psychological or physical factors.

    Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD)

    • RLS and PLMD are characterized by unpleasant leg sensations and an urge to move the legs, often occurring during sleep.
    • These disorders can be secondary to conditions such as iron deficiency, neuropathy, and pregnancy.

    Parasomnias

    • Parasomnias are abnormal behaviors during sleep, with diminished consciousness.
    • Common parasomnias include nightmares, night terrors, sleepwalking, and sleep talking.
    • Nightmares are frightening dreams often occurring in the second half of the night, while night terrors occur during deep sleep, typically in the first third of the night.
    • Sleepwalking, most common in children, can be associated with alcohol use, sleep deprivation, and stress.
    • Sleepwalking is often associated with alcohol intake, sleep deprivation, stress, and psychiatric disorders.
    • Sleep-related breathing disorders are characterized by pauses or reductions in breathing during sleep.
    • Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is caused by the collapse of the upper airway during sleep.
    • OSA can lead to sleep fragmentation, low blood oxygen levels (hypoxemia), and daytime sleepiness.
    • Obesity, male gender, advanced age, and anatomical features of the airway (e.g., large tonsils, deviated septum) are common risk factors for OSA.

    Diagnosis and Management of Sleep Disorders

    • A comprehensive assessment is crucial for diagnosing sleep disorders, including a detailed sleep history, medical and psychiatric history, and lifestyle factors.
    • Polysomnography (PSG) is the gold standard for diagnosing sleep disorders, recording various physiological variables during sleep.
    • Non-pharmacological interventions, such as cognitive behavioral therapy (CBT), are often the first-line treatment for sleep disorders.
    • Pharmacological interventions, including sedative-hypnotics and melatonin receptor agonists, can also be used but should be carefully considered due to potential side effects and risks.
    • Multidisciplinary approaches are recommended, with collaboration among various healthcare professionals, such as sleep medicine physicians and psychologists.
    • Dissemination of knowledge and public awareness about sleep disorders are essential to promote early detection and treatment.

    Coordinated Approach to Disseminating Information

    • Professional associations and organizations can disseminate information on various therapies.
    • Evaluation of clinical training programs and exposure to patients with sleep disorders can encourage interest and questions.

    Continuing Education

    • Healthcare providers need continuing education to engage their team members in sleep medicine.

    Patient Engagement

    • Tools and strategies are needed to engage patients in their treatment decisions and support long-term adherence to recommended treatments.

    Sleep Services

    • Access to coordinated sleep services linked to health practices is preferred.

    Research Settings

    • In research settings, all persons under the direction of a supervisor diagnose and/or treat sleep disorders in children.

    General Sleep Centers

    • General sleep centers offer interdisciplinary approaches for individuals, usually involving collaboration between sleep physicians, psychologists, and primary care providers.

    Sleep Disorder Treatments

    • Studies have confirmed the effectiveness of combining cognitive-behavioral treatments with management for obstructive sleep apnea, circadian, or movement disorders.

    Follow-Up Care

    • Close follow-up is crucial to understand the impact of treatment and develop strategies to manage complex sleep conditions.

    Effective Teamwork

    • Effective teamwork and approaches start from the necessity of working together, considering the patient's best interests, and acknowledging expertise in the field.
    • Interdisciplinary practice requires time, agreement, and compromise.
    • Any discrepancies in treatment opinions should be reported, discussed, and clarified with the patient.

    Team Training

    • In the long term, team training could become integrated into dedicated sleep management, fostering collaboration between professionals, equipment, and lab aspirations.

    Challenges

    • The major challenge in accredited sleep centers remains the lack of direct time in multidisciplinary staff meetings.

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    Explore the various sleep-wake disorders recognized by the DSM-5, including insomnia and narcolepsy. This quiz delves into the characteristics and symptoms of these disorders, offering insights into their classification. Understand how DSM-5 differs from other classification systems.

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