Insomnia Disorder PDF

11/16/23, 11:07 AM Realizeit for Student Insomnia Disorder The primary element of insomnia is the dissatisfaction with sleep quantity or quality. The person has difficulty falling asleep, maintaining sleep, and/or early-morning wakening with inability to return to sleep. Subtypes of insomnia disor...

11/16/23, 11:07 AM Realizeit for Student Insomnia Disorder The primary element of insomnia is the dissatisfaction with sleep quantity or quality. The person has difficulty falling asleep, maintaining sleep, and/or early-morning wakening with inability to return to sleep. Subtypes of insomnia disorder include the following: Inadequate sleep hygiene—Engaging in behaviors not conducive to sleep or interfering directly with sleep. Included are consuming caffeine or nicotine before bed time, excessive emotional or physical stimulation just prior to bedtime, daytime naps, and wide variations of daily sleep–wake routines. Treatment modalities include sleep hygiene measures (see “Sleep Hygiene Measures” box), cognitive–behavioral techniques, and medication. Psychophysiological insomnia—Involves conditioned arousal associated with the thought of sleep (i.e., the bed, the bedroom). It is often associated with stress and anxiety. Characteristics include excessive worry about sleep problems, trying too hard to sleep, rumination, increased muscle tension, and other anxiety symptoms. Relaxation therapy, sleep hygiene measures, and stimulus control therapy (included in “Sleep Hygiene Measures” box). Paradoxical insomnia—When the individual thinks he or she is awake or is not sleeping even though brain wave activity is consistent with normal sleep. It is usually due to ruminative worrying that continues into sleep but causes the individual to believe he or she is awake. An interruption of rumination and diminished worry about not sleeping usually diminishes or eliminates the problem. Idiopathic insomnia—A lifelong inability to obtain adequate sleep. It is thought to be a neurologic deficit in the sleep–wake cycle and is, therefore, chronic and lifelong. Treatment consists of improved sleep hygiene, relaxation therapy, and the long-term use of sleep-inducing medication. Insomnia due to a mental disorder, medical condition, or drug or substance use—Primary treatment of the underlying cause is helpful but may not eliminate the insomnia altogether. Use of medications for sleep, sleep hygiene measures, and the avoidance of stimulants, including caffeine, and of medications that interfere with sleep are also effective. Hypersomnolence Disorder Excessive sleepiness for at least 1 month that involves either prolonged sleep episodes or daily daytime sleeping that causes significant distress or impairment in functioning. Major sleep episodes may be 8 to 12 hours long, and the person has difficulty waking up. Daytime naps leave the person unrefreshed upon awakening. It may be due to sleep regulation dysfunction in the brain. Treatment with stimulant medication is often effective. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 1/3 11/16/23, 11:07 AM Realizeit for Student Narcolepsy Chronic excessive sleepiness characterized by repeated, irresistible sleep attacks. After sleeping 10 to 20 minutes, the person is briefly refreshed until the next sleep attack. Sleep attacks can occur at inopportune times, such as during important work activities or while driving a car. People with narcolepsy may also experience cataplexy (sudden episodes of bilateral, reversible loss of muscle tone that last for seconds to minutes) or recurrent intrusions of REM sleep in the sleep–wake transitions, manifested by paralysis of voluntary muscles or dream-like hallucinations. Treatment includes stimulant medication, modafinil (Provigil), and behavioral structuring, such as scheduling naps at convenient times. Sleep-Related Breathing Disorders Sleep disruption leads to excessive sleepiness or, less commonly, insomnia, caused by abnormalities in ventilation during sleep. These sleep-related breathing disorders include obstructive sleep apnea (repeated episodes of upper airway obstruction), central sleep apnea (episodic cessation of ventilation without airway obstruction), and central alveolar hypoventilation (hypoventilation resulting in low arterial oxygen levels). Central sleep apnea is more common in the elderly, while obstructive sleep apnea and central alveolar hypoventilation are commonly seen in obese individuals. The primary treatments for sleep-related breathing disorders are surgical, such as tracheotomy, and use of a continuous positive-airway pressure machine during sleep. Circadian Rhythm Sleep-Wake Disorders Circadian rhythm sleep-wake disorders are persistent or recurring sleep disruption resulting from altered functioning of circadian rhythm or a mismatch between circadian rhythm and external demands. Subtypes include delayed sleep phase (person’s own circadian schedule is incongruent with needed timing of sleep, such as an individual being unable to sleep or remain awake during socially acceptable hours as a result of a work schedule or the like), jet lag (conflict of sleep–wake schedule and a new time zone), shift work (conflict between circadian rhythm and demands of wakefulness for shift work), and unspecified (circadian rhythm pattern is longer than 24 hours despite environmental cues, resulting in varying sleep problems). Sleep hygiene measures (see “Sleep Hygiene Measures” box), melatonin, and bright light therapy can be effective treatments. Bright light therapy consists of being exposed to bright light when wakefulness is initiated and avoiding bright lights when sleep is desired. Parasomnias Parasomnias are disorders characterized by abnormal behavioral or psychological events associated with sleep, specific sleep stages, or sleep–wake transition. These disorders involve activation of https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 2/3 11/16/23, 11:07 AM Realizeit for Student physiological systems, such as the autonomic nervous system, motor system, or cognitive processes, at inappropriate times, as during sleep. Nightmare disorder—Repeated occurrence of frightening dreams that lead to waking from sleep. The dreams are often lengthy and elaborate, provoking anxiety or terror and causing the individual to have trouble returning to sleep and to experience significant distress and, sometimes, lack of sleep. There is no widely accepted treatment. Sleep terror disorder—Repeated occurrence of abrupt awakenings from sleep associated with a panicky scream or cry. Children with sleep terror disorder are confused and upset upon awakening and have no memory of a dream either at the time of awakening or in the morning. Initially, it is difficult to fully awaken or console the child. Sleep terror disorder tends to go away in adolescence. Sleepwalking disorder—Repeated episodes of complex motor behavior initiated during sleep, including getting out of bed and walking around. Persons appear disoriented and confused and on occasion may become violent. Usually, they return to bed on their own or can be guided back to bed. Sleepwalking occurs most often in children between the ages of 4 and 8 years, and it tends to dissipate by adolescence. No treatment is required. Sleep disorders related to another mental disorder may involve insomnia or hypersomnia. Mood disorders, anxiety disorders, schizophrenia, and other psychotic disorders are often associated with sleep disturbances. Treatment of the underlying mental disorder is indicated to resolve the sleep disorder. Sleep disorder due to a general medical condition may involve insomnia, hypersomnia, parasomnias, or a combination of these attributable to a medical condition. These sleep disturbances may result from degenerative neurologic illnesses, cerebrovascular disease, endocrine conditions, viral and bacterial infections, coughing, or pain. Sleep disturbances of this type may improve with treatment of the underlying medical condition or may be treated symptomatically with medication for sleep. Substance-induced sleep disorder involves prominent disturbance in sleep due to the direct physiological effects of a substance, such as alcohol, other drugs, or toxins. Insomnia and hypersomnia are most common. Treatment of the underlying substance use or abuse generally leads to improvement in sleep. Adapted from Hirshkowitz, M., & Sharafkhaneh, A. (2017). Sleep disorders. In B. J. Sadock, V. A. Sadock, & P. Ruiz (Eds.), Comprehensive textbook of psychiatry (Vol. 1, 10th ed., pp. 2083–2109). Philadelphia, PA: Lippincott, Williams, & Wilkins/Wolters Kluwer. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 3/3