ASSIGNMENT: Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned( HYPERSOMNIA)  to the diagnostic features of the disorder your colleagues were assigned. Note: Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. Colleagues Respond # 1 The assigned sleep/wake disorder is Insomnia. According to Ruiz, Sadock, & Sadock (2014) insomnia is defined as difficulty initiating or maintaining sleep. It is currently considered as an independent condition where as in the past causes of the condition rather than symptoms were treated. Diagnostic Criteria for Insomnia According to American psychiatric association (2013), individuals need to meet criteria A to criteria H to diagnose insomnia. Criteria A requires one or more of the three symptoms such as difficulty in initiating sleep, difficulty in maintain sleep and early morning awakening with inability to return back to sleep which cause dissatisfaction with the sleep quantity or quality (American Psychiatric association 2013). The other criteria from B to H explains that the sleep disturbance causes impairment in social,  occupational, educational, educational, behavioral or other important areas of functioning, disturbance occurs three nights per week and present for at least three months, it occurs despite adequate opportunity to sleep, insomnia do not caused by another sleep wake disorder, not attributable to physiological effect of a substance, and coexisting mental disorders or medical condition do not adequately explain insomnia (American psychiatric association 2013). Psychotherapy Treatment The psychological and behavioral therapies for insomnia according to Gabbard (2014) are sleep hygiene education, stimulus control therapy, sleep restriction, cognitive therapy, and relaxation therapies. Sleep focused cognitive-behavior therapy (SCBT) is a combination of various non pharmacological strategies and it is structured and time limited with a focus on sleep related issues (Gabbard 2014). It is for 6-8 weeks, once in each week. The treatment has shown benefit for up to six months after termination of SCBT (Gabbard 2014). However, there are some pitfalls with this treatment as it requires patient initiative, motivation and active participation in the treatment process, along with greater time commitment and limited availability of practitioners (Gabbard 2014). Psychopharmacological Treatments The pharmacological treatment of insomnia are hypnotics and the sleep medications according to Ruiz et al (2014) should not be prescribed for more than 2 weeks due to development of tolerance and withdrawal. According to Gabbard (2014) the FDA approved hypnotic agents are benzodiazepines, non-benzodiazepines, melatonin receptor agonists, and Histamine H1 receptor antagonists. For Treatment of insomnia character.

1. ASSIGNMENT:
Respond
to at least
two
of your colleagues by comparing the differential diagnostic
features of the disorder you were assigned(
HYPERSOMNIA)
to the diagnostic features of the disorder your colleagues were
assigned.
Note:
Support your responses with evidence-based literature with at
least two references in each colleague’s response with proper
citation in APA Format.
Colleagues
Respond # 1
The assigned sleep/wake disorder is Insomnia. According to
Ruiz, Sadock, & Sadock (2014) insomnia is defined as difficulty
initiating or maintaining sleep. It is currently considered as an
independent condition where as in the past causes of the
condition rather than symptoms were treated.
Diagnostic Criteria for Insomnia

2. According to American psychiatric association (2013),
individuals need to meet criteria A to criteria H to diagnose
insomnia. Criteria A requires one or more of the three
symptoms such as difficulty in initiating sleep, difficulty in
maintain sleep and early morning awakening with inability to
return back to sleep which cause dissatisfaction with the sleep
quantity or quality (American Psychiatric association 2013).
The other criteria from B to H explains that the sleep
disturbance causes impairment in social, occupational,
educational, educational, behavioral or other important areas of
functioning, disturbance occurs three nights per week and
present for at least three months, it occurs despite adequate
opportunity to sleep, insomnia do not caused by another sleep
wake disorder, not attributable to physiological effect of a
substance, and coexisting mental disorders or medical condition
do not adequately explain insomnia (American psychiatric
association 2013).
Psychotherapy Treatment
The psychological and behavioral therapies for insomnia
according to Gabbard (2014) are sleep hygiene education,
stimulus control therapy, sleep restriction, cognitive therapy,
and relaxation therapies. Sleep focused cognitive-behavior
therapy (SCBT) is a combination of various non
pharmacological strategies and it is structured and time limited
with a focus on sleep related issues (Gabbard 2014). It is for 6-

3. 8 weeks, once in each week. The treatment has shown benefit
for up to six months after termination of SCBT (Gabbard 2014).
However, there are some pitfalls with this treatment as it
requires patient initiative, motivation and active participation in
the treatment process, along with greater time commitment and
limited availability of practitioners (Gabbard 2014).
Psychopharmacological Treatments
The pharmacological treatment of insomnia are hypnotics and
the sleep medications according to Ruiz et al (2014) should not
be prescribed for more than 2 weeks due to development of
tolerance and withdrawal. According to Gabbard (2014) the
FDA approved hypnotic agents are benzodiazepines, non-
benzodiazepines, melatonin receptor agonists, and Histamine H1
receptor antagonists. For Treatment of insomnia characterized
by difficulty in falling asleep, frequent nocturnal awakenings,
and/or early morning awakening flurazepam can be used which
is a benzodiazepine (Gabbard 2014). It is expected to work in
one hour and if it does not work after 7-10 days it may be
manifestation of primary psychiatric or physical illness (Stahl
2014) The other benzodiazepines used for insomnia are
Temazepam, and Triazolam which are used for short term
treatment of insomnia. Benzodiazepines used to treat
individuals with difficulty in falling asleep, frequent nocturnal
awakenings, and/or early morning awakenings are Quazepam,
and Estazolam (short term use). The non-benzodiazepines which
can be used for insomnia are zolpidem which is available in oral
pill, oral spray, extended release and sublingual, zaleplon, and
eszopiclone (Gabbard 2014). Ramelteon which is a melatonin

4. receptor agonist used for sleep onset and Doxepin which is a
histamine H1 receptor antagonist also used for sleep
maintenance (Gabbard 2014)
There are over the counter treatments such as sedating
antihistamines, protein precursors. Melatonin is an endogenous
hormone produced by the pineal gland to regulate sleep and
exogenous form of melatonin have resulted in mixed results in
insomnia (Ruiz et al., 2014).
Point at which Referral is Required
Individuals with sleep disorders because of breathing related
sleep disorders, treatment should be by a specialist other than
the psychiatry practitioner. Conditions such as obstructive sleep
apnea hypopnea where the symptoms are excessive sleepiness,
snoring, obesity, restless sleep, nocturnal awakening with
chocking or gasping for breath, morning dry mouth, morning
head aches and heavy nocturnal sweating (Ruiz et al., 2014).
Another situation where a referral is needed is in elderly
individuals where the insomnia is related to central sleep apnea
where it is caused by lack of respiratory effort leads to repeated
efforts of apneas and hypopneas in a periodic intermittent
pattern during sleep (Ruiz et al., 2014). The lack of respiratory
effort is due to disorder of ventilatory control (Ruiz et al.,
2014). Comorbid sleep-related hypoventilation occurs as a
consequence of medical condition such as pulmonary

5. parenchymal or vascular pathology, lower airway obstruction or
neuromuscular or chest wall disorders (Ruiz et al., 2014) and it
requires a referral to appropriate medical practitioner. Common
neurological issues associated with insomnia are epilepsy,
neuromuscular disorders, movement disorders, and stroke. If the
patients sleep disturbance is related to above condition, clients
must be referred to neurologists (Penn medicine 2020).
Colleagues
Respond # 2
Parasomnia Disorder
Parasomnia is a sleep disorder that causes abnormalities in
sleeping behavior. We can see the behavior at any stage of sleep
that includes the transition from wakefulness to sleep. Having
parasomnia makes one move around, do unusual things during
sleep, and even talk. This makes other people think you are
awake while, in the real sense, the person is unconscious, and
definitely, you won't remember anything about the incident.
This condition is common but makes sleep difficult by giving
one a restless sleep (Mysliwiec, 2018). It might disturb
someone's sleep and even other people in the same room. This
condition can be dangerous to other people, especially since
they are not are of the surroundings, and it has health-related
side effects, including psychological stress. Just like any other
sleep disorder, this condition is treatable.
Diagnosis of Parasomnia
A primary doctor can help diagnose the parasomnia condition,
and they will most likely refer you to see a sleep specialist who

6. further will examine the sleeping behavior. The diagnosis
includes the following: the doctor will follow up on the medical
history, and they will ask about the underlying medical
conditions, lifestyle, family history, and current medications.
Sleep history will be analyzed, and a sleep diary will show
sleep behavior patterns. This can be achieved with the help of
sleeping partners who can observe how one sleeps.
Polysomnogram is where one has to sleep in the lab overnight,
where the specialist will analyze the individual's sleeping
behavior. They will have to record the breathing, heart rate, and
brain waves to make the diagnosis.
Parasomnia Treatment
The treatments of this condition can be varying depending on
the severity and the frequency of the individual's symptoms. In
the first instance, the doctor must observe and identify the
underlying health issues or sleep disorders. If there is an
existing condition, treating it may also result in treating the
resulting parasomnia. Hypnosis, talk therapy, and cognitive
behavioral therapy may help relieve the symptoms associated
with NREM parasomnias. There are tranquilizers, which include
benzodiazepines, which are very useful in treating arousal of
parasomnias such as the RBD and sleepwalking (Schenck,
2019).
People who live with individuals with movement-related
parasomnia such as sleepwalking and RBD may need to sleep in
a separate bedroom with such individuals. This will create a
safe environment by removing padding and sharp object in the
bedroom furniture.
In children
Most of the parasomnias occur in children except for the RBD
condition, mostly seen in male adults. Some of the causes of

7. this condition are genetic components of the family and maybe
running in the family's bloodline. This condition does not have
significant adverse health effects; however, RBD indicates an
underlying neurological condition. As children get older, the
frequency of parasomnia episodes decreases. Medical treatment
cannot be necessary at this stage unless the symptoms affect the
child’s daily activities or mental health.
Behavioral therapy, hypnosis, and relaxation techniques are
methods that can be used to reduce the frequency and intensity
of the parasomnias resulting from anxiety or stress. A doctor
may prescribe antidepressants or tranquilizers for children with
frequent or severe sleep terrors or sleepwalking (Thorpy, 2017).
In conclusion, parasomnias can interfere with someone's quality
of sleep and increase the risk of injuries or accidents.
Fortunately, this condition is treatable and can be resolved
mostly during the childhood stages. An individual may seek
medical advice when they notice that their loved ones exhibit
the symptoms of parasomnia.