Sleep disorders

Vorokhta Y., MD, PhD

 Classification
Parasomnias – These are unusual experiences or behaviors
that occur during sleep; they include sleep terror disorder
and sleepwalking (which occur during stage 4 sleep) and
nightmare disorder (which occurs during rapid eye
movement [REM] sleep).

Dyssomnias – These are characterized by abnormalities in

the amount, quality, or timing of sleep; they include primary
insomnia and hypersomnia, narcolepsy, breathing-related
sleep disorder (ie, sleep apnea), and circadian rhythm sleep
disorder
 Pathophysiology
Sleep is divided into the following 2 categories, each of which is
associated with distinct patterns of central nervous system (CNS)
activity:
-REM sleep – This is characterized by muscle atony, episodic
REMs, and low-amplitude fast waves on electroencephalography
(EEG); dreaming occurs mainly during REM sleep
-Non-REM (NREM) sleep – This is further subdivided into 4
progressive categories, termed stages 1–4 sleep; the arousal
threshold rises with each stage, and stage 4 (delta),
characterized by high-amplitude slow waves, is the sleep state
from which arousal is most difficult
Somnambulism is an arousal
parasomnia consisting of a series of
complex behaviors that result in large
movements in bed or walking during
sleep. Most frequent in children (2-
14% of children), it is usually a benign,
self-limited maturational occurrence.
Sleepwalking often decreases with the
onset of puberty, but at least 25% of
children with recurrent sleepwalking
may continue to sleepwalk in
adulthood

Bharadwaj R, Kumar S. Somnambulism:

Diagnosis and treatment. Indian J
Psychiatry. 2007; 49(2): 123-125.
doi:10.4103/0019-5545.33261
HALSEY — NIGHTMARE ( 2019)
 Symptoms/Criteria
According to the International Classification of Sleep Disorders,
the criteria needed to diagnose a nightmare disorder are the
following.
First, the presence of frequent nightmares that imply a danger for
the person and that impact mood in a negative way is needed.
Second, when waking up from nightmares, the person behaves in
an alert way.
Finally, the disorder has to impact clinically in a significative way
the personal, social or professional functioning, in areas such as
mood, sleep, cognition, behaviour, fatigue, family and occupation
 Narcolepsy
A sleep disorder defined by excessive daytime
sleepiness and what are called “sleep attacks
.” These attacks cause the individual to
immediately and uncontrollably fall asleep.
Narcolepsy likely results from an autoimmune
response that happens after a viral infection.
The disorder tends to appear during childhood,
when a child’s developing body is more
vulnerable to influenza and other viral illnesses.
Tyree Susan M., Borniger Jeremy C., de Lecea Luis Hypocretin as a Hub for Arousal and
Motivation Frontiers in Neurology Vol.9 2018 413
 Kleine-Levin syndrome
A rare disorder characterized by periods of
excessive daytime sleepiness and increased
hours of sleep, followed by a series of unusual
symptoms. These symptoms include excessive
hunger, unusually high sex drive, and a
heightened feeling of being awake.
Kleine-Levin syndrome is thought to result from
problems in the temporal lobe of the brain,
along with hormonal imbalances
 A case report on Klein- Levin Syndrome
Attygalle U.R ,1 ,Lokuwithanage .J.P, 2
1.Consultant Child and Adolescent Psychiatrist ,Colombo South Teaching Hospital Kalubowila ,2.Medical
officer Psychiatry , Colombo South Teaching Hospital ,Kalubowila

Introduction
Klein-Levin Syndrome (KLS) is a rare condition, affecting around one in
a million people, seen mostly among young male adolescents.. It is Conclusion
characterized by recurrent episodes of hypersomnia and to various Klein Levin syndrome is a rare condition, which disturbs social,
degrees behavioural or cognitive disturbances, including compulsive ,educational and occupational activities Early diagnosis prompt
eating behavior, and hyper sexuality. The etiology, pathology, and treatment with appropriate medication would enable patient to
treatment of this condition is still not fully understood.. Treatment with function normally
stimulant drugs such as methylphenidate, amphetamine, had been proven
to be effective in some cases. Melatonin alone or with lithium carbonate
has been found to be effective in a few cases.. Key words Klein Levin syndrome, Hypersomnia, Hyperphagia,
Case report Hyper sexuality, Methylphenidate
We describe a case of a 12 year old boy who presented with excessive
daytime sleepiness and increased appetite for five months. He was Abbreviations
irritable and behaved inappropriately at times while he was awake.. The KLS- Klein Levin Syndrome
changes in sleep and behavior were episodic, with periods of no CT scan Computerized Tomographic scan
symptoms in-between. His physical examination including neurological MRI Scan -Magnetic Resonance imaging
examination was normal. Investigations including Liver Function Tests,
NMDA receptor Antigen- N-Methyl -D- Aspartate receptor Antigen
Urine analysis , Thyroid Function Tests, EEG, CT and MRI scans , CSF
culture and analysis for NMDA receptor antigen and for PCR for CSF Cerebrospinal fluid
Tuberculous meningitis were normal. Clinically he fulfilled the criteria EEG -Electroencephalography
for KLS. Initially he was treated with short acting methylphenidate in the
morning and afternoon. Although his hypersomnia improved, he
developed several days of continuous insomnia. This improved
significantly with the combined treatment with methylphenidate and
melatonin. . Currently his sleep and appetite is normal. He attends
school regularly.

Conference:
•
Annual Academic Sessions of the Sri Lanka College of Psychiatrists 2020
 Idiopathic hypersomnia
Hypersomnia with no known cause. Despite
getting more sleep than is medically necessary,
sufferers may never feel fully rested or awake.
Living with idiopathic hypersomnia may be
frustrating to sufferers, not only because of the
disorder’s symptoms, but because the
symptoms lack an apparent explanation
Trenkwalder, C., Paulus, W. Restless legs syndrome: pathophysiology, clinical
presentation and management. Nat Rev Neurol 6, 337–346 (2010).
https://doi.org/10.1038/nrneurol.2010.55
Patrick L., 2007
• Hypertension (which can be caused by sleep apnea)
• Disturbed coordination (which can be caused by sleep
deprivation)
• Drowsiness
• Poor concentration
• Slowed reaction time
• Weight gain