Sleep-Wake Disorders
[Pages:16]Sleep-Wake Disorders
page 390-422 starts w/ Circadian Rhythm Sleep-Wake Disorder
All info is either from DSM-5 (diagnostic/assessment) or our Text (treatments) -for the unspecified/specified
I consulted the stated disorder (ie insomnia for "Other Specified Insomnia Disorder") However I did not research this section, so it would be good to take a look at the assessment and treatment of the stated disorder, and compare
It seems like those are quite up in the air depending on symptoms presented
Sleep Wake Disorders
Breathing Related Sleep Disorders
Disorder
Circadian Rhythm Sleep-Wake Disorders Code: 307.45
(DSM-5 pp. 391-8)
Codes Subtypes Assessment
Treatment
Delayed sleep phase type G47.21
Advanced sleep phase type G47.22
Irregular Sleep-Wake type G47.23
Non-24-hour sleep-wake type G47.24
Shift Work type G47.26 Unspecified type G47.20
Sleep Diary Actigraphy (wrist-
sleep/wake detector) Diagnosis Unclear-
Biomarkers (Salivary dim light melatonin onset) Sequential Measurement of phase markers (melatonin) (primarily for Non-24 hour sleep-wake type)
Sleep log associated with chronobiology (resetting daily life schedule)
Behavior modification Techniques
Interventions: psychoeducation, light therapy (increasing melatonin), restrictions on alcohol/caffeine, sleep hygiene rules
(Kress & Paylo, 2015, p. 504)
Sleep Wake Disorders
Parasomnias
Disorder
Non-Rapid Eye Movement Sleep Arousal Disorders
Nightmare Disorder
Rapid Eye Movement Sleep Behavior Disorder Restless Legs Syndrome
Codes
Assessment
Sleepwalking type 307.46 (F51.3)
Sleep Terror type 307.6 (F51.4)
Polysomnography and audiovisual monitoring to document episodes
307.47 (F51.5)
Polysomnography
327.42 (G47.52) 333.94 (G25.81)
Medical evaluation Polysomnography
Self-Report, History of episodes, Immobilization Test, serum ferritin level test (iron in body), Polysomnography
Treatment
Children-family therapy, increased emotional connection
Adults Interventions: reduce deep sleep through medication, behavior changes, counseling to consider options
Cognitive Behavioral Therapy Interventions Image Rehearsal Therapy, Lucid dreaming therapy, Exposure, Relaxation and Rescripting Therapy (EERT)
Medications (melatonin, clonazepam)
For mild case: Self-directed activities during onset of sensation (read, stretch, massage)
For Severe case: medication (low-dose dopamine agonists)
Last resort: Anticonvulsants, Opiods
(Kress & Paylo, 2015, pp. 505-6)
Sleep Wake Disorders Parasomnias (continued)
Disorder
Substance/MedicationInduced Sleep Disorder
Assessment
Medical evaluation/ consultation, Electroencephalographic sleep profile, All night Polysomnography, Multiple Sleep Latency Test, 2 Week Sleep Diary, Actigraphy, Drug Screening
Treatment
Consult with medical doctor, psychiatrist
Cognitive Behavioral Therapy, Behavioral therapy
Psychoeducation, sleep hygiene rules, relaxation techniques, sleep restrictions, cognitive techniques
Other Specified Insomnia Disorder
Unspecified Insomnia Disorder
Polysomnography, Quantitative electroencephalographic analysis
Polysomnography, Quantitative electroencephalographic analysis
Cognitive Behavioral Therapy, Behavioral therapy
Psychoeducation, sleep hygiene rules, relaxation techniques, sleep restrictions, cognitive techniques
Cognitive Behavioral Therapy, Behavioral therapy
Psychoeducation, sleep hygiene rules, relaxation techniques, sleep restrictions, cognitive techniques
Other Specified
Medical evaluation/ consultation,
Hypersomnolence Disorder
Multiple sleep latency test, Nocturnal polysomnography
Cognitive Behavioral Therapy, Behavior therapy, psychopharmacotherapy
Sleep Wake Disorders Parasomnias (continued)
Disorder
Unspecified Hypersomnolence Disorder
Assessment
Medical evaluation/ consultation, Multiple sleep latency test, Nocturnal polysomnography
Treatment
Cognitive Behavioral Therapy, Behavior therapy,
psychopharmacotherapy
Other Specified SleepWake Disorder
Medical evaluation/ consultation, Biological validators, Polysomography
Treatment Depends on presenting symptoms Cognitive Behavioral Therapy,
Behavioral therapy, medications, oral applications, ventilators Psychoeducation, sleep hygiene rules, relaxation techniques, sleep restrictions, cognitive techniques
Unspecified Sleep-Wake Disorder
Medical evaluation/ consultation, Biological validators, Polysomography
Treatment Depends on presenting symptoms Cognitive Behavioral Therapy,
Behavioral therapy, medications, oral applications, ventilators Psychoeducation, sleep hygiene rules, relaxation techniques, sleep restrictions, cognitive techniques
(Kress & Paylo, 2015, pp. 361-73)
Sleep-Wake Disorders: Diagnostic Criteria: Circadian Rhythm Sleep-Wake Disorders
Circadian Rhythm SleepWake Disorders
(DSM-5 pp.391-8)
1. Delayed Sleep Phase Type
Code: 307.45 (G47.21)
2. Advanced Sleep Phase Type
Code: 307.45 (G47.22)
3. Irregular SleepWake Type
4. Non-24 Hour Sleep-Wake Type
5. Shift Work Type
Code: 307.45 (G47.23)
Code: 307.45 (G47.24)
Code: 307.45 (G47.26)
Recurrent Pattern + History of delay in timing of
of Sleep disruption major sleep pd.(usually 2+ hrs.)
compared to desired sleep/wake
Excessive
sleepiness,
+ Lasts 3+ months
insomnia, or both
time
Causes distress or impairment in social occupational, & other functioning
+Difficulty waking in the morning (morning confusion)
+Excessive early day sleepiness
Common features +history of mental disorder/concurrent mental disorder
+Psychophysiological insomnia
Differential Diagnosis: Normative variations in Sleep
Other Sleep Disorders
+Sleep-wake times several hours earlier than desired
+History of advance in timing of major sleep pd. (usually 2+ hrs.) compared to desired sleep/wake time
+Early morning insomnia
+Excessive daytime sleepiness
+"morning types" biomarkers occur 2-4 hr. earlier than normal
+use of drugs to combat sleepwake time may lead to substance abuse
+Onset late adulthood +Familial +Symptom severity increases with age +varies according to lifestyle and lifespan
Differential Diagnosis: Other Sleep Disorders
Depressive and Bipolar Disorders
+history of insomnia at night
+excessive sleepiness/napping in the day
+No major sleep pd.
+Fragmented sleep into at least 3 pds. in 24 hrs.
+Commonly linked to neurodegenerative disorders (major neurocognitive disorder, neurodevelopmental disorders)
+Linked to limited environmental light exposure
Differential Diagnosis: Normative variations in sleep
Other medical conditions and mental disorders
+Pattern of sleep-wake cycles not synchronized to 24 hr. environment
+Consistent daily drift of sleep-wake times.
+pds of insomnia, excessive sleepiness or both altering with asymptomatic pds.
+Common among the visually impaired (50% prevalence)
+based on history of individual working out of 8AM-6PM daylight schedule on a regular basis
+Insomnia during major sleep pd.
and/ or +Excessive sleepiness during major awake pd. associated with a shift work schedule
+In sighted individuals often due to lack of light and structured activity
+May effect travelers frequently flying across time zones
+Associated with traumatic brain injury
+May effect those with rotating shifts
Differential Diagnosis: Circadian Rhythm Sleep-Wake Disorders
Depressive Disorders
+Common in 50+
Differential Diagnosis: Normative Variations in Sleep with Shift Work
R/O: Other Sleep Disorders
Sleep-Wake Disorders: Diagnostic Criteria: Parasomnias
Parasomnias
(DSM-5 pp. 399422)
Abnormal behavioral, experiential or physiological events occurring w/ sleep/specific sleep stages/sleepwake transitions
Most common
NREM Sleep Behavior Disorder
REM Sleep Behavior Disorder
Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders
Sleepwalking type Code: 307.46(F51.3)
Sleep terror type Code: 307.46 (F51.4)
+Repeated occurrence of incomplete arousals can be brief up to 10 mins. or up to 1 hr. in first 3rd of sleeping episode
+eyes are typically open
Sleepwalking +repeated episodes of complex motor behavior initiated during sleep +Episodes begin during NREM +reduced alertness +blank stare +unresponsive to communication +limited recall afterward +initial confusion immediately following +return to full cognitive function afterwards
Sleep Terrors +Repeated occurrence of sudden awakening from sleep +Often begins w/ scream/cry +Automatic arousal +Intense fear, compulsion to escape +Automatic arousal (rapid breathing, sweating, etc.) +Unresponsiveness to others efforts to comfort
Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders
(Continued)
+No or little dream imagery (single scene)
+Amnesia for episode
+Significant stress and impairment of functioning
+Not due to drug use/ Medication
+Mental and Medical disorders do not explain episodes
Sleep Related Eating Disorder +eating w/ amnesia ranging from no-full awareness
Sleep Related sexual behavior (sexsomnia) +Arising from sleep and participating in sexual activity w/ no conscious awareness
Common in children
+link w/ major depressive episodes and obsessivecompulsive disorder
Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders
(Continued)
Differential Diagnosis: Nightmare Disorder
Breathing-Related Sleep Disorders
REM Sleep Behavior Disorder
Parasomnia Overlap Syndrome
Sleep-Related Seizures
Alcohol-Induced Blackouts
Dissociative Amnesia, w/ Dissociative Fugue
Malingering or other voluntary behavior occuring during wakefulness
Medication-Induced Complex Behaviors
Night Eating Syndrome
Nightmare Disorder
Code: 307.47 (F51.5)
Rapid Eye Movement (REM) Sleep Behavior Disorder
Code: 327.42 (G47.52)
Restless Leg Syndrome
Code: 333.94 (G25.81)
+Repeated occurrences of dream imagery involving extreme negative emotions +well remembered +Alert after dream episode +Significant distress or impairment in functioning
Replicative Nightmares -occur after a traumatic experience
Differential Diagnosis: Sleep Terror Disorder
REM Sleep behavior Disorder
Bereavement
Narcolepsy
Nocturnal Seizures
Breathing-Related Sleep Disorders
Panic Disorder
Sleep-Related Dissociative Disorders
Medication or Substance Abuse
+Repeated episodes of arousal during sleep
+Vocal and/or complex motor behaviors in response to threats "dream enacting behaviors"
+Motor behaviors can be violent
+Happen in REM sleep (90 mins into sleep onset)
+Awaken alert and NOT confused/disoriented
+Causes significant distress and/or impairment of functioning
+Present in 30% of narcoleptics
Differential Diagnosis: Other Parasomnias
Nocturnal Seizures
Obstructive Sleep Apnea
Other Specified Dissociative Disorder
Malingering
+desire to move the legs or arms due to uncomfortable feelings
+Urge to move -worsens during rest -is relieved by movement -worse in evening
+3x/week +At least 3 months
+Causes significant distress and/or impairment of functioning
Differential Diagnosis: Substance Intoxication or withdrawal
Delirium
Other Sleep Disorders
Sleep Disorder due to another medical condition
Sleep-Wake Disorders: Diagnostic Criteria: Parasomnias
Substance/ MedicationInduced Sleep Disorder (DSM-5 pp 417-8)
Code: 780.52 (G47.00)
Prominent/severe disturbance in sleep -develop during/after intoxication or -after withdrawal
and -Substance is capable of sleep disturbance
+Sleep disorders are ruled out
+does not occur during delirium
+Symptoms cause significant distress
or Impairment of functioning
Differential Diagnosis: Substance intoxication or withdrawal
Delirium
Other Sleep Disorders
Sleep Disorder due to another medical condition
1.Alcohol (291.82)
+often occurs with insomnia type
+Extremely disrupted sleep
First half of night +Immediate/ short lived sedative effect
+increased intensity of REM sleep (vivid dreams- alcohol withdrawal delirium)
Second half of night +Restlessness
+can aggravate breathing-related sleep disorder
+fragmented sleep can last for weeks/years in chronic alcohol users
2.Caffeine (292.85)
+produces insomnia +signs of withdrawal = daytime sleepiness
3.Cannabis (292.85)
4. Opiods (292.85)
+may shorten sleep latency
+enhances slow wave sleep /sleep inducing
+Chronic users develop tolerance to sleep effects
+ Withdrawal signs sleep difficulties and unpleasant dreams -may last for weeks
-Increase in sleepiness and sleep depth
-W/ chronic use tolerance develops and insomnia
-Respiratory depressant effects worsen sleep apnea
5. Sedative, hypnotic, or anxiolytic (292.85)
6.Amphetamine (or other stimulant) (292.85)
+Similar to Opiods
+Increases sleepiness
+Decreases wakefulness
+W/ chronic use tolerance develops and insomnia
+Daytime sleepiness
+Insomnia during intoxication
+Excessive Sleepiness during withdrawal
+MDMA -restlessness and disturbed sleep within 48 hrs.
-frequent use is connected with anxiety, depression, steep disturbances even during pds. of non use
7. Tobacco (292.85)
8. Other (or unknown) Substance (292.5)
+Insomnia
+Decreased slowwave sleep
+Reduction of sleep efficiency
+Increased daytime sleepiness
+Withdrawal -impaired sleep
+Heavy smokers may awake at night due to cravings
+Medications affecting central. and/or automatic nervous systems may cause sleep disturbances
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