INSOMNIA DISORDER, AND HYPERSOMNOLENCE DISORDER

Objectives:

 To define each disorder.

 To explain the diagnostic criteria & features of each disorder.
 To explain each disorder's development, course, risk, and prognostic factors.
 To discuss the incidence and prevalence of each disorder.
 To analyze various treatments and therapy applicably to each disorder.

INSOMNIA DISORDER

- is the most common sleep disorder involving problems getting to or staying

asleep (Torres, 2020).

I. Diagnostic criteria and features

A. (The most essential feature of insomnia) A predominant complaint of

dissatisfaction with sleep quantity or quality, associated with one or more of the
following symptoms:
1. Difficulty initiating sleep for at least more than 20-30 minutes after getting
into bed (also called sleep onset Insomnia or initial Insomnia).
 In children, this may manifest as difficulty initiating sleep without
caregiver intervention.
2. Difficulty maintaining sleep, characterized by frequent awakenings or
problems returning to sleep after awakenings (also called sleep
maintenance insomnia or middle insomnia).
 Subjective time awake after sleep onset of more than 20–30
minutes.
 Most common single symptom of insomnia, and 60% of people with
insomnia disorder are affected by this symptom.
 In children, this may manifest as difficulty returning to sleep without
caregiver intervention.
 3. Early-morning awakening with inability to return to sleep (also called late
insomnia).
 At least 1 hour before the scheduled time and before total sleep
time reaches about 6½ hours.
B. The sleep disturbance causes clinically significant distress or impairment in
social, occupational, educational, academic, behavioral, or other important areas
of functioning.
C. The sleep difficulty occurs at least 3 nights per week.
D. D. The sleep difficulty is present for at least 3 months.
E. The sleep difficulty occurs despite adequate opportunity for sleep.
F. The insomnia is not better explained by and does not occur exclusively during
the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related
sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
G. The insomnia is not attributable to the physiological effects of a substance (e.g.,
a drug of abuse, a medication).
H. Coexisting mental disorders and medical conditions do not adequately explain
the predominant complaint of insomnia.

Specify if:

 With mental disorder, medical condition, or another sleep disorder.

 Episodic (with an episode of symptoms lasting one to three months)
 Persistent (with symptoms lasting three months or more)
 Recurrent (with two or more episodes within a year)

II. Development and Course

 Precipitating factors. Insomnia disorder can be triggered by some factors such

as stress, major life events or changes, traumatic experiences, changes in sleep
schedule, poor sleep habits, certain medical conditions, or the use of certain
medications or substances.
 Acute insomnia. Acute insomnia is episodic or situational. This usually occurs
for a few days to a few weeks, and it is associated with possible precipitating
 factors. Usually, it goes away but for some people it becomes persistent. Hence,
the precipitating factors may differ from the perpetuating factors.
 Chronic Insomnia. When the sleep difficulties persist or reoccur frequently for
over a period of at least 3 months, then it may be classified as Chronic Insomnia.
It can also become a self-perpetuating cycle wherein anxious thoughts and
feelings about sleep problems will contribute more to the sleep disturbances
already present.

III. Risk and Prognostic Factors

 Temperamental. Anxiety or worry-prone personality and cognitive styles would

probably contribute to insomnia.
 Environmental. The environment of the room where you sleep is important.
Noisy, bright lights, and uncomfortable temperatures in your bedroom would
definitely increase your vulnerability to insomnia.
 Genetic and physiological factors. Females and older people are more
vulnerable to insomnia. It’s also reported that heritability is the highest cause of
insomnia without comorbidities.
 Course modifiers. Harmful modifiers include poor sleep hygiene will cause
insomnia such as poor sleep habits, drinking caffeine, and eating heavy meals
before going to bed.

IV. Prevalence

 Insomnia is the most prevalent among sleep-wake disorders.

 Approximately 1/3 of adults report some insomnia symptoms across multiple
countries.
 10%–15% experience associated daytime impairments, and 4%–22% have
symptoms that meet the criteria for insomnia disorder, with an average of about
10%.
 20%– 40% of individuals complain of significant insomnia symptoms.
V. Treatment and therapy

 Sleep hygiene/healthy sleep habits

 Sticking to a sleep schedule, same bedtime and wake up time even on
weekends, hence, training yourself to restore the appropriate body clock.
 Calming activities such as avoiding bright lights, and electronic devices.
 Exercise daily.
 Paying attention to the ambiance of the room.
 Avoiding alcohol, caffeine, and heavy meals at night.
 Medication that can be bought over the counter.
 Drugs that contain antihistamines - sleeping aids.
 Melatonin - a sleep hormone that is made in the laboratory that helps with
sleep quality.
 Dietary supplements
 Cognitive behavioral therapy - is a 6- to 8-week treatment plan to help the
person learn how to fall asleep faster and stay asleep longer. This is usually
recommended as the first treatment option for long-term insomnia and is
considered to be very effective. It will help in changing your negative thoughts
and behavior related to sleep patterns.

Under this, the professionals could apply therapies like relaxation or meditation
therapy which is for the person to train themselves how to sleep faster.
Moreover, stimulus control therapy involves linking your bed only to the sleep-
wake cycle.
HYPERSOMNOLENCE DISORDER

 which can also be called idiopathic hypersomnia involves daytime sleepiness

and prolonged periods of sleep (Stubblefield, 2023).

I. Diagnostic criteria and features

A. Self-reported excessive sleepiness (hypersomnolence) despite a main sleep

period lasting at least 7 hours, with at least one of the following symptoms:

1. Recurrent periods of sleep or lapses into sleep within the same day.
2. A prolonged main sleep episode of more than 9 hours per day that is
nonrestorative.
3. Difficulty being fully awake after abrupt awakening.
B. The hypersomnolence occurs at least three times per week, for at least 3

months.

C. The hypersomnolence is accompanied by significant distress or impairment in

cognitive, social, occupational, or other important areas of functioning.

D. The hypersomnolence is not better explained by and does not occur exclusively

during the course of another sleep disorder (e.g., narcolepsy, breathing-related

sleep disorder, circadian rhythm sleep-wake disorder, or a parasomnia).

E. The hypersomnolence is not attributable to the physiological effects of a

substance (e.g., a drug of abuse, a medication).

F. Coexisting mental and medical disorders do not adequately explain the

predominant complaint of hypersomnolence.

Specify if:

 With mental disorder, medical condition, or another sleep disorder.

  Acute (Duration of less than 1 month)
 Subacute (Duration of 1–3 months)
 Persistent (Duration of more than 3 months)

Note:

 Sleep episodes are different from sleep attacks. Sleepiness develops gradually
and it usually occurs during sedentary situations, such as attending lectures,
reading, watching tv, or driving long distances.
 Sleep episodes can last up to 20 hours.

II. Development and Course

 The development of hypersomnolence usually starts in late adolescence in the

17-24 age group. Individuals with hypersomnolence disorder are diagnosed, on
average, 10–15 years after the appearance of the first symptoms
 Pediatric cases are rare.

III. Risk and Prognostic Factors

 Environmental - External factors can be prognostic factors. Stress can contribute

to the vulnerability of hypersomnolence. Moreover, viral infections can be a factor
but rarely as 10% of cases were recorded. It is also common for people who
underwent traumatic brain injury to develop hypersomnolence.
 Genetic and physiological - may be familial, or may be inherited.

IV. Prevalence

 Approximately 5%–10% of individuals in the United States who consult in sleep

disorder clinics with complaints of daytime sleepiness are diagnosed as having
hypersomnolence disorder.
 It is estimated that about 1% of the European and U.S. general population has
episodes of sleep inertia. Hypersomnolence occurs with relatively equal
frequency in men and women.
V. Treatment and therapy

 Medication - these medications help to promote wakefulness and reduce

excessive sleepiness. It can also help improve alertness during the day and
manage symptoms of the disorder.
1. Amphetamine
2. Methylphenidate
3. Modafinil
 Lifestyle change - Adopting healthy sleep habits and making lifestyle changes
can be beneficial. This may include maintaining a consistent sleep schedule,
creating a comfortable sleep environment, avoiding alcohol and sedatives,
practicing good sleep hygiene, and implementing relaxation techniques before
bed.
 Cognitive-behavioral therapy - helps them address underlying psychological
factors, manage stress, and improve sleep patterns. It focuses on changing
negative thoughts and behaviors that may contribute to excessive sleepiness.
SUMMARY

Sleep disorders involve problems with the quality, timing, and amount of sleep,
which result in daytime distress and impairment in functioning (APA, 2020). Insomnia
and hypersomnolence disorder are two common sleep disorders that affect sleep
patterns and contribute to daytime sleepiness.

Insomnia is a sleep disorder characterized by persistent difficulty falling asleep,

staying asleep, or experiencing non-restorative sleep, despite adequate opportunity for
sleep. An inability to fall asleep, numerous nighttime awakenings, morning awakenings
that are too early, fatigue upon awakening, daytime sleepiness, irritability, difficulties
concentrating, and poor performance in daily activities are all common symptoms of
insomnia. To address insomnia, there are various options that are available for the
treatment and therapy suitable for insomnia including developing sleep hygiene and
healthy sleep habits, medication, and Cognitive-behavioral therapy or CBT.

On the other hand, Hypersomnolence disorder is characterized by excessive

daytime sleepiness and prolonged sleep episodes, despite obtaining sufficient sleep at
night. People who have the condition frequently deal with chronic tiredness, which can
have a serious negative impact on everyday functioning. Medical conditions (such as
sleep apnea, narcolepsy, or neurological abnormalities), particular drugs, and
psychological illnesses can all be contributing factors to hypersomnolence disorder.
Depending on the individual, the precise cause could differ. Lastly, the treatment and
therapy suited for this disorder are medication, lifestyle change, and Cognitive-
behavioral therapy or CBT.

These two different sleep disorders, insomnia, and hypersomnolence disorder,

can have a significant effect on a person's sleep patterns and general functioning. In
order to diagnose and create efficient therapies for these sleep disorders, it is crucial to
get professional help who specializes in sleep disorders.
REFERENCES

American Psychiatric Association. (2022). Sleep-Wake Disorders. In Diagnostic and

statistical manual of mental disorders (5th ed., text rev.). Retrieved from
https://doi.org/10.1176/appi.books.9780890425787

APA. (2020). Sleep Disorders. Retrieved from https://www.psychiatry.org/patients-

families/sleep-disorders/what-are-sleep disorders

NIH. (2022). Insomnia. Treatment. Retrieved from

https://www.nhlbi.nih.gov/health/insomnia/treatment

Psychology. (2022). Treatment:Hypersomnolence. Retrieved from

https://www.psychologytoday.com/intl/conditions/hypersomnolence#:~:text=Hype
rsomnolence%20can%20be%20treated%20with,monoamine%20oxidase%20inhi
bitors%20(MAOIs).

Stubblefield, H. (2023). Hypersomnia. Retrieved from

https://www.healthline.com/health/hypersomnia#prevention

Torres, F. (2020). What are Sleep Disorders? Retrieved from

https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-
disorders#:~:text=Sleep%20disorders%20(or%20sleep%2Dwake,%2C%20anxiet
y%2C %20or%20cognitive%20disorders.