Sleep Related DisordersSleep Related Disorders

Assessment & DiagnosisAssessment & Diagnosis

SW 593SW 593

Introduction Introduction

Diagnoses are related to disturbances in the Diagnoses are related to disturbances in the sleep process that cause clinically sleep process that cause clinically significant distress and/or psychosocial significant distress and/or psychosocial impairment.impairment.

Two major categories:Two major categories:– Dyssomnias: person sleeps too much, too little, Dyssomnias: person sleeps too much, too little,

or at the wrong timeor at the wrong time– Parasomnias: abnormal things occur during Parasomnias: abnormal things occur during

sleep or immediately before/after sleep.sleep or immediately before/after sleep.

IntroductionIntroduction

Sleep disturbances are expected in a Sleep disturbances are expected in a number of instances:number of instances:– Mood and anxiety disordersMood and anxiety disorders– Cognitive, schizophrenic, somatization Cognitive, schizophrenic, somatization

disordersdisorders

Sleep disorder is only made when that Sleep disorder is only made when that symptom is excessive or has become the symptom is excessive or has become the primary focus of intervention.primary focus of intervention.

Insomnia Insomnia

Sleeping too littleSleeping too little Takes the form of problems falling or staying Takes the form of problems falling or staying

asleep.asleep. It may be characterized by non-restorative It may be characterized by non-restorative

sleep.sleep. Insomnia must last at least one month and Insomnia must last at least one month and

be causing distress or psychosocial be causing distress or psychosocial impairment.impairment.

InsomniaInsomnia

Etiology:Etiology:– Primary InsomniaPrimary Insomnia– Insomnia Related to Another Mental DisorderInsomnia Related to Another Mental Disorder– Sleep Disorder due to a General Medical Sleep Disorder due to a General Medical

Condition, Insomnia TypeCondition, Insomnia Type– Substance-Induced Sleep Disorder, Insomnia Substance-Induced Sleep Disorder, Insomnia

TypeType

Hypersomnia Hypersomnia

Sleeping too much.Sleeping too much. Characterized either by prolonged sleep Characterized either by prolonged sleep

episodes or by daytime sleep episodes that episodes or by daytime sleep episodes that occur daily or almost daily.occur daily or almost daily.

Problem must have lasted at least one Problem must have lasted at least one month or be recurrent.month or be recurrent.– Lasting 3 days several time a year for at least 2 Lasting 3 days several time a year for at least 2

years.years.

Narcolepsy Narcolepsy

Characterized by irresistible episodes of Characterized by irresistible episodes of refreshing sleep that occur daily over at leas refreshing sleep that occur daily over at leas a 3-month period.a 3-month period.

Client experiences episodes of cataplexy Client experiences episodes of cataplexy (brief episode of loss of muscle power) or (brief episode of loss of muscle power) or recurrent intrusions of REM sleep in the recurrent intrusions of REM sleep in the transitions between being awake and transitions between being awake and sleeping (experienced as hallucinations or sleeping (experienced as hallucinations or sleep paralysis). sleep paralysis).

Breathing-Related Sleep DisorderBreathing-Related Sleep Disorder

Involves sleep disruption that leads to Involves sleep disruption that leads to excessive sleepiness or insomnia.excessive sleepiness or insomnia.

Disruption is caused by a sleep-related Disruption is caused by a sleep-related breathing condition but not by some other breathing condition but not by some other general medical condition, mental disorder, general medical condition, mental disorder, or substance use.or substance use.

Practitioner should list the underlying Practitioner should list the underlying breathing-related medical condition on Axis breathing-related medical condition on Axis III.III.

Circadian Rhythm Sleep Disorder Circadian Rhythm Sleep Disorder

A persistent or recurrent pattern of sleep A persistent or recurrent pattern of sleep disruption due to disruptions in the normal disruption due to disruptions in the normal sleep-wake schedule.sleep-wake schedule.

Origin(s) of this problem is made clearer by Origin(s) of this problem is made clearer by the specifiers used:the specifiers used:– Shift work typeShift work type– Jet lag typeJet lag type– Delayed Sleep Phase type Delayed Sleep Phase type

Parasomnia Parasomnia

Some disruptive event occurs during Some disruptive event occurs during specific sleep periods and/or transitions.specific sleep periods and/or transitions.

These conditions refer to instances in which These conditions refer to instances in which behaviors or physiological processes are behaviors or physiological processes are activated inappropriately while the individual activated inappropriately while the individual is asleep.is asleep.

Nightmare DisorderNightmare Disorder

Usually begins in children between the age of 3 Usually begins in children between the age of 3 and 6.and 6.

Causes significant disruption for both the children Causes significant disruption for both the children and their parents.and their parents.

It can persist into adulthood.It can persist into adulthood. The individual experiences repeated awakenings The individual experiences repeated awakenings

with detailed recall of frightening dreams.with detailed recall of frightening dreams. Upon awakening, becomes oriented.Upon awakening, becomes oriented. Episodes generally occur during second half of Episodes generally occur during second half of

sleep period.sleep period.

Sleep Terror Disorder Sleep Terror Disorder

Occurs both among children and adults.Occurs both among children and adults. Individual experiences repeated episodes of Individual experiences repeated episodes of

abrupt awakening during the first third of a sleep abrupt awakening during the first third of a sleep cycle.cycle.

Individual awakes with a scream and physiological Individual awakes with a scream and physiological symptoms similar to those of a panic attack.symptoms similar to those of a panic attack.

Individual is generally unresponsive to attempts to Individual is generally unresponsive to attempts to be comforted and when finally awake, no memory be comforted and when finally awake, no memory of the dream.of the dream.

Sleepwalking DisorderSleepwalking Disorder

Begins in childhood and ends during Begins in childhood and ends during adolescence.adolescence.

Initial onset of sleepwalking in adulthood is Initial onset of sleepwalking in adulthood is unusual.unusual.

Involves the client getting up and walking Involves the client getting up and walking around, usually during the first third of the around, usually during the first third of the sleep cycle.sleep cycle.

Very difficult to awake and no memory of the Very difficult to awake and no memory of the incident. incident.

Assessment Assessment

Has become a technologically advanced Has become a technologically advanced medical procedure in recent years.medical procedure in recent years.

Sleep studies are conducted by having the Sleep studies are conducted by having the person check in to a facility in the evening person check in to a facility in the evening and leaves when the person awakes the and leaves when the person awakes the following morning.following morning.

AssessmentAssessment

Monitored throughout the night for:Monitored throughout the night for:– Breathing patterns and effortsBreathing patterns and efforts– Heart rateHeart rate– Oxygen saturationOxygen saturation– Brain activityBrain activity– Muscle activityMuscle activity

Typically non-medical clinicians do not Typically non-medical clinicians do not administer self-report sleep instruments.administer self-report sleep instruments.