Common Disorders in Sleep
Classifications of Sleep Disorders <ul><li>Dyssomnias </li></ul><ul><ul><li>Disorders that produce complaints of insomnia ...
Intrinsic Sleep Disorders <ul><li>Sleep disorders  which originate or develop within the body or arise from causes within ...
Narcolepsy <ul><li>Definition: </li></ul><ul><ul><li>A disorder of unknown origin, which is characterized by abnormal slee...
Narcolepsy <ul><li>Symptoms </li></ul><ul><ul><li>Excessive daytime sleepiness </li></ul></ul><ul><ul><li>Cataplexy </li><...
Narcolepsy <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Decreased sleep latency </li></ul></ul><ul><ul><li>Slee...
Narcolepsy <ul><li>Treatment-Stimulants </li></ul><ul><ul><li>Provigil (Modafinil) </li></ul></ul><ul><ul><ul><li>Single m...
Recurrent Hypersomnia <ul><li>Definition: </li></ul><ul><ul><li>A disorder characterized by recurrent episodes of hypersom...
Recurrent Hypersomnia <ul><li>Symptoms: </li></ul><ul><ul><li>Excessive daytime sleepiness </li></ul></ul><ul><ul><ul><li>...
Recurrent Hypersomnia <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Low voltage slow EEG patterns or diffuse alp...
Recurrent Hypersomnia <ul><li>Treatment-Stimulants </li></ul><ul><ul><li>Provigil (Modafinil) </li></ul></ul><ul><ul><li>R...
Obstructive Sleep Apnea Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Repetitive episodes of upper airway obstruction...
Obstructive Sleep Apnea Syndrome <ul><li>Symptoms: </li></ul><ul><ul><li>Excessive daytime sleepiness or insomnia </li></u...
Obstructive Sleep Apnea Syndrome <ul><li>Polysomnographic Findings: </li></ul><ul><ul><li>Apneic episodes in the presence ...
Obstructive Sleep Apnea Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Continuous Positive Airway Pressure </li></ul></u...
Central Sleep Apnea Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Cessation or decrease of ventilatory effort during ...
Central Sleep Apnea Syndrome <ul><li>Signs & Symptoms: </li></ul><ul><ul><li>Systemic hypertension </li></ul></ul><ul><ul>...
Central Sleep Apnea Syndrome <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Central apneas or central hypopneas t...
Central Sleep Apnea Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Nocturnal ventilation </li></ul></ul><ul><ul><li>CPAP...
Central Alveolar Hypoventilation Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Ventiltory impairment, resulting in ar...
Central Alveolar Hypoventilation Syndrome <ul><li>Signs & Symptoms: </li></ul><ul><ul><li>Insomnia or excessive daytime sl...
Central Alveolar Hypoventilation Syndrome <ul><li>Polysomnographic Findings: </li></ul><ul><ul><li>Periods of decreased ti...
Central Alveolar Hypoventilation Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Mild: without pulmonary HTN or complicat...
Periodic Limb Movement Disorder <ul><li>Definition:  </li></ul><ul><ul><li>Periodic episodes of repetitive and highly ster...
Periodic Limb Movement Disorder <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Excessive daytime sleepiness </li></ul></ul...
Periodic Limb Movement Disorder <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Periodic limb movements usually ap...
Periodic Limb Movement Disorder <ul><li>Treatment </li></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><ul><li>Doe...
Periodic Limb Movement Disorder <ul><li>Treatment </li></ul><ul><ul><li>Pain Relievers </li></ul></ul><ul><ul><ul><li>Code...
Restless Leg Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Characterized by disagreeable leg sensations, usually prio...
Restless Leg Syndrome <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Itchy, creepy crawling feeling in the legs </li></ul>...
Restless Leg Syndrome <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Sustained  tonic EMG activity that alternate...
Restless Leg Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><ul><li>Does not stop...
Restless Leg Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Pain relievers </li></ul></ul><ul><ul><ul><li>Codeine, darvo...
Extrinsic Sleep Disorders <ul><li>Sleep disorders that originate or develop from causes from outside the body </li></ul>
Inadequate Sleep Hygiene <ul><li>Definition: </li></ul><ul><ul><li>A sleep disorder due to the performance of daily living...
Environmental Sleep Disorder <ul><li>Definition: </li></ul><ul><ul><li>A sleep disturbance due to a disturbing environment...
Adjustment Sleep Disorder <ul><li>Definition: </li></ul><ul><ul><li>A sleep disturbance temporally related to acute stress...
Insufficient Sleep Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Failure to obtain sufficient nocturnal sleep require...
Limit-Setting Sleep Disorder <ul><li>Definition: </li></ul><ul><ul><li>A childhood disorder that is characterized by the i...
Extrinsic Sleep Disorders <ul><li>Treatment </li></ul><ul><ul><li>Polysomnography not typically performed on extrinsic sle...
Circadian Rhythm Disorders <ul><li>Primary Circadian Dysrhythmias </li></ul><ul><ul><li>Definition: </li></ul></ul><ul><ul...
Delayed Sleep Phase Syndrome (DSPS) <ul><li>The inability to fall asleep until late with difficulty arising in the morning...
Advanced Sleep Phase Syndrome (ASPS) <ul><li>Sleepiness beginning early in the afternoon, and sufferers often wake up earl...
Secondary Circadian Dysrythmias <ul><li>The  biological clock is functioning properly, but is out of phase due to the envi...
Time Zone Change Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Varying degrees of difficulty in initiating or maintai...
Shift Work Sleep Disorder <ul><li>Definition: </li></ul><ul><ul><li>Symptoms of insomnia or excessive sleepiness that occu...
Circadian Rhythm Disorders <ul><li>Treatment </li></ul><ul><ul><li>Evaluate for an underlying cause </li></ul></ul><ul><ul...
Parasomnias <ul><li>Definition: </li></ul><ul><ul><li>Clinical disorders that are not abnormalties of sleep and wakefulnes...
Parasomnias <ul><li>Classification of Parasomnias </li></ul><ul><ul><li>Arousal Disorders </li></ul></ul><ul><ul><li>Sleep...
Arousal Disorders <ul><li>Definition: </li></ul><ul><ul><li>Consists of the classical disorders of arousal </li></ul></ul>...
Confusional Arousals <ul><li>Definition: </li></ul><ul><ul><li>Confusion during and following arousals from slow wave slee...
Sleepwalking <ul><li>Definition: </li></ul><ul><ul><li>A series of complex behaviors that are initiated during slow wave s...
Sleep Terrors <ul><li>Definition: </li></ul><ul><ul><li>A sudden arousal from slow wave sleep with a piercing scream or cr...
Arousal Disorders <ul><li>Treatment </li></ul><ul><ul><li>Often treatment is unnecessary </li></ul></ul><ul><ul><li>Benzod...
Sleep-Wake Transition Disorders <ul><li>Definition: </li></ul><ul><ul><li>Disorders that occur in the transition from wake...
Rhythmic Movement Disorder <ul><li>Definition: </li></ul><ul><ul><li>Repetitive movements involving large muscles usually ...
Sleep Starts <ul><li>Definition: </li></ul><ul><ul><li>Brief body movements occurring at sleep onset </li></ul></ul><ul><l...
Sleep Talking <ul><li>Definition: </li></ul><ul><ul><li>The utterance of speech or sounds during sleep without simultaneou...
Sleep-Wake Transition Disorders <ul><li>Treatment </li></ul><ul><ul><li>Treatment often unnecessary </li></ul></ul><ul><ul...
REM Parasomnias <ul><li>Definition: </li></ul><ul><ul><li>Parasomnias that are typically associated with the REM sleep sta...
Nightmares <ul><li>Definition: </li></ul><ul><ul><li>Frightening dreams that usually awaken the sleeper from REM sleep </l...
Sleep Paralysis <ul><li>Definition: </li></ul><ul><ul><li>A period of inability to perform voluntary movements either at s...
REM Sleep-Related Sinus Arrest <ul><li>Definition: </li></ul><ul><ul><li>A cardiac  rhythm disorder that is characterized ...
REM Sleep Behavior Disorder <ul><li>Definition: </li></ul><ul><ul><li>Intermittent loss of REM sleep electromyographic (EM...
REM Parasomnias <ul><li>Treatment </li></ul><ul><ul><li>REM-suppressing drugs </li></ul></ul><ul><ul><ul><li>Benzodiazepin...
Other Parasomnias <ul><li>Definition: </li></ul><ul><ul><li>Parasomnias that cannot be classified in other sections. </li>...
Sleep Bruxism <ul><li>Definition: </li></ul><ul><ul><li>Grinding or clenching the teeth during sleep </li></ul></ul><ul><l...
Sleep Enuresis <ul><li>Definition: </li></ul><ul><ul><li>Recurrent involuntary micturition that occurs during sleep </li><...
Nocturnal Paroxysmal Dystonia <ul><li>Definition: </li></ul><ul><ul><li>Repeated dystonia or dyskinetic episodes that are ...
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Common disorders in sleep

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Common disorders in sleep

  1. 1. Common Disorders in Sleep
  2. 2. Classifications of Sleep Disorders <ul><li>Dyssomnias </li></ul><ul><ul><li>Disorders that produce complaints of insomnia or excessive sleepiness </li></ul></ul><ul><ul><ul><li>Intrinsic Sleep Disorders </li></ul></ul></ul><ul><ul><ul><li>Extrinsic Sleep Disorders </li></ul></ul></ul><ul><ul><ul><li>Circadian Rhythm Sleep Disorders </li></ul></ul></ul><ul><li>Parasomnias </li></ul><ul><ul><li>Disorders that intrude into or occur during sleep but do not result in insomnia or excessive sleepiness </li></ul></ul><ul><ul><ul><li>Arousal Disorders </li></ul></ul></ul><ul><ul><ul><li>Sleep-Wake Transition Disorders </li></ul></ul></ul><ul><ul><ul><li>REM related Parasomnias </li></ul></ul></ul><ul><ul><ul><li>Other Parasomnias </li></ul></ul></ul>
  3. 3. Intrinsic Sleep Disorders <ul><li>Sleep disorders which originate or develop within the body or arise from causes within the body </li></ul>
  4. 4. Narcolepsy <ul><li>Definition: </li></ul><ul><ul><li>A disorder of unknown origin, which is characterized by abnormal sleep tendencies, excessive daytime sleepiness, disturbed nocturnal sleep and manifestations of REM sleep </li></ul></ul>
  5. 5. Narcolepsy <ul><li>Symptoms </li></ul><ul><ul><li>Excessive daytime sleepiness </li></ul></ul><ul><ul><li>Cataplexy </li></ul></ul><ul><ul><li>Hypnagogic hallucinations </li></ul></ul><ul><ul><li>Sleep paralysis </li></ul></ul><ul><ul><li>Automatic behavior </li></ul></ul>
  6. 6. Narcolepsy <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Decreased sleep latency </li></ul></ul><ul><ul><li>Sleep onset REM </li></ul></ul><ul><ul><li>Increased stage 1 sleep </li></ul></ul><ul><li>Multiple Sleep Latency Test Findings </li></ul><ul><ul><li>Sleep latency typically less than 5 minutes </li></ul></ul><ul><ul><li>Two or more sleep onset REM periods </li></ul></ul>
  7. 7. Narcolepsy <ul><li>Treatment-Stimulants </li></ul><ul><ul><li>Provigil (Modafinil) </li></ul></ul><ul><ul><ul><li>Single morning dose 100-400 mg </li></ul></ul></ul><ul><ul><li>Ritalin (methylphenidate) </li></ul></ul><ul><ul><ul><li>5 mg BID (up to 50 mg) </li></ul></ul></ul><ul><ul><ul><li>Small doses taken in the morning and again at the sleepiest time of the day </li></ul></ul></ul><ul><ul><li>Dexedrine (Dextroamphetamine) </li></ul></ul><ul><ul><ul><li>5 mg daily or BID (up to 50 mg) </li></ul></ul></ul><ul><ul><ul><li>Causes more irritability and nervousness than other drugs </li></ul></ul></ul>
  8. 8. Recurrent Hypersomnia <ul><li>Definition: </li></ul><ul><ul><li>A disorder characterized by recurrent episodes of hypersomnia that typically occur weeks or months apart </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Periodic hypersomnia, Kleine-Levin syndrome, binge eating, hypersexuality </li></ul></ul>
  9. 9. Recurrent Hypersomnia <ul><li>Symptoms: </li></ul><ul><ul><li>Excessive daytime sleepiness </li></ul></ul><ul><ul><ul><li>Episodes of somnolence last for at least 18 hours </li></ul></ul></ul><ul><ul><ul><li>Occurs at least once per year, lasting a minimum of 3 days </li></ul></ul></ul><ul><ul><li>Voracious eating </li></ul></ul><ul><ul><li>Hypersexuality </li></ul></ul><ul><ul><li>Disinhibited behaviors </li></ul></ul>
  10. 10. Recurrent Hypersomnia <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Low voltage slow EEG patterns or diffuse alpha patterns </li></ul></ul><ul><ul><li>High sleep efficiency </li></ul></ul><ul><ul><li>Decreased delta sleep </li></ul></ul>
  11. 11. Recurrent Hypersomnia <ul><li>Treatment-Stimulants </li></ul><ul><ul><li>Provigil (Modafinil) </li></ul></ul><ul><ul><li>Ritalin (Methylphenidate) </li></ul></ul><ul><ul><li>Dexedrine (Dextroamphetamine) </li></ul></ul>
  12. 12. Obstructive Sleep Apnea Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Sleep apnea, obstructive apnea, upper airway apnea, sleep apnea syndrome </li></ul></ul>
  13. 13. Obstructive Sleep Apnea Syndrome <ul><li>Symptoms: </li></ul><ul><ul><li>Excessive daytime sleepiness or insomnia </li></ul></ul><ul><ul><li>Loud snoring </li></ul></ul><ul><ul><li>Morning headaches </li></ul></ul><ul><ul><li>Dry mouth upon awakening </li></ul></ul><ul><ul><li>Nocturnal gasping and choking </li></ul></ul><ul><ul><li>Personality changes or cognitive problems </li></ul></ul>
  14. 14. Obstructive Sleep Apnea Syndrome <ul><li>Polysomnographic Findings: </li></ul><ul><ul><li>Apneic episodes in the presence of respiratory muscle effort </li></ul></ul><ul><ul><ul><li>Apneic episodes greater than 10 seconds are considered clinically significant </li></ul></ul></ul><ul><ul><ul><li>Episodes most prevalent in REM sleep </li></ul></ul></ul><ul><ul><li>Bradytachycardia </li></ul></ul><ul><ul><li>Oxyhemoglobin desaturation </li></ul></ul><ul><ul><li>Increased arousals </li></ul></ul>
  15. 15. Obstructive Sleep Apnea Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Continuous Positive Airway Pressure </li></ul></ul><ul><ul><li>BiLevel Positive Airway Pressure </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><ul><li>Uvulopalatopharyngoplasty (UPPP) </li></ul></ul></ul><ul><ul><ul><li>Laser-Assisted Uvulopalatopharyngoplasty (LAUP) </li></ul></ul></ul><ul><ul><ul><li>Radiofrequency Ablation (RFA) </li></ul></ul></ul><ul><ul><ul><li>Reconstructive surgery </li></ul></ul></ul><ul><ul><ul><li>Tonsillectomy </li></ul></ul></ul><ul><ul><ul><li>Tracheostomy </li></ul></ul></ul><ul><ul><li>Oral Appliances </li></ul></ul>
  16. 16. Central Sleep Apnea Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Cessation or decrease of ventilatory effort during sleep usually with associated oxygen desaturation </li></ul></ul><ul><ul><li>Synonyms: </li></ul></ul><ul><ul><ul><li>Central apnea, nonobstructive sleep apnea, Cheyne-Stokes respiration </li></ul></ul></ul>
  17. 17. Central Sleep Apnea Syndrome <ul><li>Signs & Symptoms: </li></ul><ul><ul><li>Systemic hypertension </li></ul></ul><ul><ul><li>Cardiac arrhythmias </li></ul></ul><ul><ul><li>Pulmonary hypertension </li></ul></ul><ul><ul><li>Cardiac failure </li></ul></ul><ul><ul><li>Memory loss </li></ul></ul><ul><ul><li>Excessive sleepiness </li></ul></ul><ul><ul><li>Loss of libido </li></ul></ul>
  18. 18. Central Sleep Apnea Syndrome <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Central apneas or central hypopneas typically between 10 and 30 seconds </li></ul></ul><ul><ul><ul><li>Most prevalent from wake to sleep and in the supine position </li></ul></ul></ul><ul><ul><li>Increase stage 1 sleep </li></ul></ul><ul><ul><li>Prolonged sleep latency </li></ul></ul>
  19. 19. Central Sleep Apnea Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Nocturnal ventilation </li></ul></ul><ul><ul><li>CPAP with pressure cycled ventilation </li></ul></ul><ul><ul><li>Nasal CPAP for patients with pharyngeal collapse and CHF </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><ul><li>Acetazolamide </li></ul></ul></ul><ul><ul><ul><li>Theophylline </li></ul></ul></ul><ul><ul><ul><li>Clomipramine </li></ul></ul></ul><ul><ul><ul><li>Hypnotic </li></ul></ul></ul><ul><ul><li>Oxygen </li></ul></ul>
  20. 20. Central Alveolar Hypoventilation Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Ventiltory impairment, resulting in arterial oxygen desaturation that is worsened by sleep in patients with normal mechanical properties of the lung </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Primary alveolar hypoventilation, idiopathic alveolar hypoventilation, non-apneic alvelar hypoventilation, obesity hypoventilation sydrome </li></ul></ul>
  21. 21. Central Alveolar Hypoventilation Syndrome <ul><li>Signs & Symptoms: </li></ul><ul><ul><li>Insomnia or excessive daytime sleepiness </li></ul></ul><ul><ul><li>Hypercapnia and hypoxemia </li></ul></ul><ul><ul><li>Morning headaches </li></ul></ul><ul><ul><li>Cardiac arrhythmias </li></ul></ul>
  22. 22. Central Alveolar Hypoventilation Syndrome <ul><li>Polysomnographic Findings: </li></ul><ul><ul><li>Periods of decreased tidal volume lasting from minutes to hours with sustained arterial oxygen desaturation. </li></ul></ul><ul><ul><ul><li>Worse in REM sleep </li></ul></ul></ul><ul><ul><li>Increased carbon dioxide levels during the hypoventilation </li></ul></ul><ul><ul><li>Frequent awakening and arousals </li></ul></ul>
  23. 23. Central Alveolar Hypoventilation Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Mild: without pulmonary HTN or complications </li></ul></ul><ul><ul><li>Moderate: Ventilatory assistance at night </li></ul></ul><ul><ul><li>Severe: Full-time ventilatory support </li></ul></ul>
  24. 24. Periodic Limb Movement Disorder <ul><li>Definition: </li></ul><ul><ul><li>Periodic episodes of repetitive and highly stereotyped limb movements that occur during sleep </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Periodic leg movements (PLMs), nocturnal myclonus, periodic movements in sleep (PMS), leg jerks </li></ul></ul>
  25. 25. Periodic Limb Movement Disorder <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Excessive daytime sleepiness </li></ul></ul><ul><ul><li>Bedpartner may or may not notice </li></ul></ul><ul><ul><li>Bedpartner complaints of being kicked or shaken </li></ul></ul><ul><ul><li>Patients are usually unaware that the movements occur </li></ul></ul>
  26. 26. Periodic Limb Movement Disorder <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Periodic limb movements usually appear at sleep onset and persist into stage 1, 2, 3 and 4 </li></ul></ul><ul><ul><li>Movements are usually absent during REM sleep </li></ul></ul><ul><ul><li>Fragmented sleep if limb movements are associated with arousal </li></ul></ul>
  27. 27. Periodic Limb Movement Disorder <ul><li>Treatment </li></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><ul><li>Does not stop the movement, but eliminates the arousal from the movement </li></ul></ul></ul><ul><ul><ul><li>Clonazepam (klonopin), temazepam (restoril), triazolam </li></ul></ul></ul><ul><ul><li>Dopaminergic Agents </li></ul></ul><ul><ul><ul><li>Dopamine receptor agonists </li></ul></ul></ul><ul><ul><ul><ul><li>Mirapex (pramipexole), Permax (pergolide), Requip (ropinirole) </li></ul></ul></ul></ul><ul><ul><ul><li>Dopamine </li></ul></ul></ul><ul><ul><ul><ul><li>Sinemet (carbidopa/levodopa) </li></ul></ul></ul></ul>
  28. 28. Periodic Limb Movement Disorder <ul><li>Treatment </li></ul><ul><ul><li>Pain Relievers </li></ul></ul><ul><ul><ul><li>Codeine, Darvon, Darvocet, Vicodin </li></ul></ul></ul><ul><ul><li>Anticonvulsants </li></ul></ul><ul><ul><ul><li>Gabapentin (neurontin), carbamazepine (tegretol) </li></ul></ul></ul>
  29. 29. Restless Leg Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Characterized by disagreeable leg sensations, usually prior to sleep onset, that cause an almost irresistable urge to move the legs </li></ul></ul>
  30. 30. Restless Leg Syndrome <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Itchy, creepy crawling feeling in the legs </li></ul></ul><ul><ul><li>Patients feel an intense urge to move legs to reduce discomfort </li></ul></ul><ul><ul><li>Symptoms usually occur when the patient is sitting quietly in a chair or lying in bed </li></ul></ul><ul><ul><li>Chief complaint is insomnia </li></ul></ul>
  31. 31. Restless Leg Syndrome <ul><li>Polysomnographic Findings </li></ul><ul><ul><li>Sustained tonic EMG activity that alternates from one leg to another </li></ul></ul><ul><ul><li>Movements seen during wakefulness and at sleep onset </li></ul></ul><ul><ul><li>Many people who suffer from restless legs also suffer from PLMs </li></ul></ul>
  32. 32. Restless Leg Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><ul><li>Does not stop the movement, but eliminates the arousal from the movement </li></ul></ul></ul><ul><ul><ul><li>Clonazepam (Klonopin), temazepam (restoril), triazolam </li></ul></ul></ul><ul><ul><li>Dopaminergic Agents </li></ul></ul><ul><ul><ul><li>Dopamine receptor agonists </li></ul></ul></ul><ul><ul><ul><ul><li>Mirapex (pramipexole), Permax (pergolide), Requip (ropinrole) </li></ul></ul></ul></ul>
  33. 33. Restless Leg Syndrome <ul><li>Treatment </li></ul><ul><ul><li>Pain relievers </li></ul></ul><ul><ul><ul><li>Codeine, darvon, darvocet. Vicodin </li></ul></ul></ul><ul><ul><li>Anticonvulsants </li></ul></ul><ul><ul><ul><li>Gapentin (neurontin), carbamazepine (tegretol) </li></ul></ul></ul>
  34. 34. Extrinsic Sleep Disorders <ul><li>Sleep disorders that originate or develop from causes from outside the body </li></ul>
  35. 35. Inadequate Sleep Hygiene <ul><li>Definition: </li></ul><ul><ul><li>A sleep disorder due to the performance of daily living activities that are inconsistent with the maintenance of good quality sleep and daytime alertness </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Bad sleep habits, irregular sleep habits, sleep hygiene abuse </li></ul></ul>
  36. 36. Environmental Sleep Disorder <ul><li>Definition: </li></ul><ul><ul><li>A sleep disturbance due to a disturbing environmental factor that causes insomnia or excessive daytime sleepiness </li></ul></ul>
  37. 37. Adjustment Sleep Disorder <ul><li>Definition: </li></ul><ul><ul><li>A sleep disturbance temporally related to acute stress, conflict or environmental change causing emotional arousal </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Transient insomnia, short term insomnia </li></ul></ul>
  38. 38. Insufficient Sleep Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Failure to obtain sufficient nocturnal sleep required to support normally alert wakefulness </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Sleep curtailment, sleep restriction, inadequate sleep </li></ul></ul>
  39. 39. Limit-Setting Sleep Disorder <ul><li>Definition: </li></ul><ul><ul><li>A childhood disorder that is characterized by the inadequate enforcement of bedtime by a caretaker, with resultant stalling or refusal to go to bed at an appropriate time </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Childhood insomnia </li></ul></ul>
  40. 40. Extrinsic Sleep Disorders <ul><li>Treatment </li></ul><ul><ul><li>Polysomnography not typically performed on extrinsic sleep disorders </li></ul></ul><ul><ul><li>Detailed analysis of sleep wake pattern and diaries </li></ul></ul><ul><ul><li>Evaluate and treat for underlying cause </li></ul></ul>
  41. 41. Circadian Rhythm Disorders <ul><li>Primary Circadian Dysrhythmias </li></ul><ul><ul><li>Definition: </li></ul></ul><ul><ul><ul><li>Malfunctioning of the biological clock within the conventional environment </li></ul></ul></ul>
  42. 42. Delayed Sleep Phase Syndrome (DSPS) <ul><li>The inability to fall asleep until late with difficulty arising in the morning </li></ul><ul><li>More prevalent in young adults </li></ul>
  43. 43. Advanced Sleep Phase Syndrome (ASPS) <ul><li>Sleepiness beginning early in the afternoon, and sufferers often wake up early and are unable to resume sleep </li></ul><ul><li>More common in older adults </li></ul><ul><li>Less prevalent than DSPS </li></ul>
  44. 44. Secondary Circadian Dysrythmias <ul><li>The biological clock is functioning properly, but is out of phase due to the environment and behaviors </li></ul>
  45. 45. Time Zone Change Syndrome <ul><li>Definition: </li></ul><ul><ul><li>Varying degrees of difficulty in initiating or maintaining sleep, excessive sleepiness related to rapid travel across several time zones </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Jet lag, transmeridian flight desynchronosis, transmeridian dyschronism </li></ul></ul>
  46. 46. Shift Work Sleep Disorder <ul><li>Definition: </li></ul><ul><ul><li>Symptoms of insomnia or excessive sleepiness that occur in relation to work schedules </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Transient insomnia, transient excessive sleepiness, acute phase shift of sleep </li></ul></ul>
  47. 47. Circadian Rhythm Disorders <ul><li>Treatment </li></ul><ul><ul><li>Evaluate for an underlying cause </li></ul></ul><ul><ul><li>Phototherapy </li></ul></ul><ul><ul><li>Chronotherapy </li></ul></ul><ul><ul><li>Sleep Hygiene </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><ul><li>Hypnotics </li></ul></ul></ul><ul><ul><ul><ul><li>Ambien, Sonata, Klonopin </li></ul></ul></ul></ul><ul><ul><ul><li>Melatonin </li></ul></ul></ul>
  48. 48. Parasomnias <ul><li>Definition: </li></ul><ul><ul><li>Clinical disorders that are not abnormalties of sleep and wakefulness, but rather are undesirable physical phenomena that occur predominantly during sleep </li></ul></ul>
  49. 49. Parasomnias <ul><li>Classification of Parasomnias </li></ul><ul><ul><li>Arousal Disorders </li></ul></ul><ul><ul><li>Sleep-Wake Transition Disorders </li></ul></ul><ul><ul><li>REM Parasomnias </li></ul></ul><ul><ul><li>Other Parasomnias </li></ul></ul>
  50. 50. Arousal Disorders <ul><li>Definition: </li></ul><ul><ul><li>Consists of the classical disorders of arousal </li></ul></ul><ul><ul><li>Onset of these disorders is typically in slow wave sleep (delta) </li></ul></ul>
  51. 51. Confusional Arousals <ul><li>Definition: </li></ul><ul><ul><li>Confusion during and following arousals from slow wave sleep (delta sleep) </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Sleep drunkenness, excessive sleep inertia </li></ul></ul>
  52. 52. Sleepwalking <ul><li>Definition: </li></ul><ul><ul><li>A series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Somnambulism, semi-purposeful automatisms, amnesia </li></ul></ul>
  53. 53. Sleep Terrors <ul><li>Definition: </li></ul><ul><ul><li>A sudden arousal from slow wave sleep with a piercing scream or cry, accompanied by automatic and behavioral manifestations of intense fear </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Pavor nocturnus </li></ul></ul>
  54. 54. Arousal Disorders <ul><li>Treatment </li></ul><ul><ul><li>Often treatment is unnecessary </li></ul></ul><ul><ul><li>Benzodiazepines may be helpful </li></ul></ul><ul><ul><ul><li>Clonazapam (Klonopin) </li></ul></ul></ul>
  55. 55. Sleep-Wake Transition Disorders <ul><li>Definition: </li></ul><ul><ul><li>Disorders that occur in the transition from wakefulness to sleep or sleep to wakefulness and occasionally in sleep stage transitions </li></ul></ul>
  56. 56. Rhythmic Movement Disorder <ul><li>Definition: </li></ul><ul><ul><li>Repetitive movements involving large muscles usually of the head and neck which occur at sleep onset and are sustained into light sleep </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Jactatio capitis nocturna, headbanging, bodyrocking </li></ul></ul>
  57. 57. Sleep Starts <ul><li>Definition: </li></ul><ul><ul><li>Brief body movements occurring at sleep onset </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Hypnagogic jerks, predormital myclonus, hypnic jerks </li></ul></ul>
  58. 58. Sleep Talking <ul><li>Definition: </li></ul><ul><ul><li>The utterance of speech or sounds during sleep without simultaneous subjective detailed awareness of the event </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Somniloquy, utterances, moans, verbilization </li></ul></ul>
  59. 59. Sleep-Wake Transition Disorders <ul><li>Treatment </li></ul><ul><ul><li>Treatment often unnecessary </li></ul></ul><ul><ul><li>Hypnotics in severe cases </li></ul></ul>
  60. 60. REM Parasomnias <ul><li>Definition: </li></ul><ul><ul><li>Parasomnias that are typically associated with the REM sleep stage </li></ul></ul>
  61. 61. Nightmares <ul><li>Definition: </li></ul><ul><ul><li>Frightening dreams that usually awaken the sleeper from REM sleep </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Dream anxiety attack, terrifying dream, REM-nightmare </li></ul></ul>
  62. 62. Sleep Paralysis <ul><li>Definition: </li></ul><ul><ul><li>A period of inability to perform voluntary movements either at sleep onset (hypnagogic) or upon awakening either during the night or in the morning (hypnopompic). </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Isolated sleep paralysis, familial sleep paralysis, hypnagogic and hypnopompic paralysis, predormital and postdormital paralysis </li></ul></ul>
  63. 63. REM Sleep-Related Sinus Arrest <ul><li>Definition: </li></ul><ul><ul><li>A cardiac rhythm disorder that is characterized by sinus arrest during REM sleep in otherwise normal healthy individuals </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Nocturnal asystole, sinus arrest </li></ul></ul>
  64. 64. REM Sleep Behavior Disorder <ul><li>Definition: </li></ul><ul><ul><li>Intermittent loss of REM sleep electromyographic (EMG) atonia and by the appearance of elaborate motor activity associated with dream mentation </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>REM sleep behavior disorder (RBD), oneirism, acting out dreams, REM motor parasomnia </li></ul></ul>
  65. 65. REM Parasomnias <ul><li>Treatment </li></ul><ul><ul><li>REM-suppressing drugs </li></ul></ul><ul><ul><ul><li>Benzodiazepines </li></ul></ul></ul><ul><ul><ul><ul><li>Clonazepam (Klonopin) </li></ul></ul></ul></ul>
  66. 66. Other Parasomnias <ul><li>Definition: </li></ul><ul><ul><li>Parasomnias that cannot be classified in other sections. </li></ul></ul>
  67. 67. Sleep Bruxism <ul><li>Definition: </li></ul><ul><ul><li>Grinding or clenching the teeth during sleep </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Nocturnal bruxism, nocturnal tooth grinding, tooth-clenching </li></ul></ul>
  68. 68. Sleep Enuresis <ul><li>Definition: </li></ul><ul><ul><li>Recurrent involuntary micturition that occurs during sleep </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Enuresis nocturna, nocturnal bed-wetting </li></ul></ul>
  69. 69. Nocturnal Paroxysmal Dystonia <ul><li>Definition: </li></ul><ul><ul><li>Repeated dystonia or dyskinetic episodes that are stereotyped and occur during NREM sleep </li></ul></ul><ul><li>Synonyms: </li></ul><ul><ul><li>Hypnogenic paroxysmal dystonia, extrapyramidal seizures </li></ul></ul>
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