LARANA, INC.

SLEEP
DISORDERS
GROUP 2
 INTRODUCTION
Sleep and wakefulness disorders can be
organized into five categories: insomnia,
hypersomnia, sleep-related breathing
disorders, circadian rhythm disorders, and
parasomnias
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.
SUBTYPE: 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
SUBTYPE: 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
SUBTYPE: 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
SUBTYPE: 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.
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.
NARCOLEPSY
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:
A. obstructive sleep apnea (repeated episodes of
upper airway obstruction)
B. central sleep apnea (episodic cessation of
ventilation without airway obstruction),
c. Central alveolar hypoventilation (hypoventilation
resulting in low arterial oxygen levels).
SLEEP-RELATED BREATHING
DISORDERS
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 slee
 CIRCADIAN RHYTHM SLEEP–
WAKE DISORDERS
Persistent or recurring sleep disruption resulting from
altered functioning of circadian rhythm or a mismatch
between circadian rhythm and external demands.
Subtypes include
a. 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)
b. jet lag (conflict of sleep–wake schedule and a new time
zone)
CIRCADIAN RHYTHM SLEEP–
WAKE DISORDERS
c. shift work (conflict between circadian rhythm and
demands of wakefulness for shift work)
d. unspecified (circadian rhythm pattern is longer than 24
hours despite environmental cues, resulting in varying
sleep problems).

Sleep hygiene measures , 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 physiological
systems, such as the autonomic nervous system,
motor system, or cognitive processes, at
inappropriate times, as during sleep.
SUBTYPE: 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.
SUBTYPE: 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.
SUBTYPE: 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 HYGIENE
MEASURES
Sleep disorders related to another mental disorder may involve insomnia or
hypersomnia. Mood disorders, anxiety disorders, schizophrenia, and other

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.