Sleep-Wake Disorders · 2018-09-02 · Sleep Behavior Disorder Code: 327.42 (G47.52) Restless Leg Syndrome Code: 333.94 (G25.81) Abnormal behavioral, experiential or physiological

Sleep-Wake Disorderspage 390-422 starts w/ Circadian Rhythm Sleep-Wake Disorder

❖ All info is either from DSM-5 (diagnostic/assessment) or our Text (treatments)

❖ -for the unspecified/specified

❖ I consulted the stated disorder (ie insomnia for “Other Specified Insomnia Disorder”) However I did not research this section, so it would be good to take a look at the assessment and treatment of the stated disorder, and compare

❖ It seems like those are quite up in the air depending on symptoms presented

Sleep Wake DisordersBreathing Related Sleep Disorders

Disorder Codes Subtypes Assessment Treatment

Circadian Rhythm Sleep-WakeDisordersCode: 307.45(DSM-5 pp. 391-8)

❖ Delayed sleep phase type G47.21

❖ Advanced sleep phase type G47.22

❖ Irregular Sleep-Waketype G47.23

❖ Non-24-hour sleep-wake type G47.24

❖ Shift Work type G47.26❖ Unspecified type G47.20

❖ Sleep Diary❖ Actigraphy (wrist-

sleep/wake detector)❖ Diagnosis Unclear-

Biomarkers (Salivary dim light melatonin onset)

❖ Sequential Measurement of phase markers (melatonin) (primarily for Non-24 hour sleep-wake type)

❖ Sleep log associated with chronobiology (resetting daily life schedule)

❖ Behavior modification Techniques

❖ Interventions: psychoeducation, light therapy (increasing melatonin), restrictions on alcohol/caffeine, sleep hygiene rules

(Kress & Paylo, 2015, p. 504)

Sleep Wake DisordersParasomnias

Disorder Codes Assessment Treatment

Non-Rapid Eye Movement Sleep Arousal Disorders

❖ Sleepwalking type 307.46 (F51.3)

❖ Sleep Terror type 307.6 (F51.4)

❖ Polysomnography and audiovisual monitoring to document episodes

❖ Children-family therapy, increased emotionalconnection

❖ Adults Interventions: reduce deep sleep through medication, behavior changes, counseling to consider options

Nightmare Disorder ❖ 307.47 (F51.5) ❖ Polysomnography ❖ Cognitive Behavioral TherapyInterventionsImage Rehearsal Therapy, Lucid dreaming therapy, Exposure, Relaxation and RescriptingTherapy (EERT)

Rapid Eye Movement Sleep Behavior Disorder

❖ 327.42 (G47.52) ❖ Medical evaluationPolysomnography

❖ Medications (melatonin, clonazepam)

Restless Legs Syndrome

❖ 333.94 (G25.81) ❖ Self-Report, History of episodes, Immobilization Test, serum ferritin level test (iron in body), Polysomnography

❖ For mild case: Self-directed activities during onset of sensation (read, stretch, massage)

❖ For Severe case: medication (low-dose dopamine agonists)

Last resort: Anticonvulsants, Opiods

(Kress & Paylo, 2015, pp. 505-6)

Sleep Wake DisordersParasomnias (continued)

Disorder Assessment Treatment

Substance/Medication-Induced Sleep Disorder

❖ Medical evaluation/ consultation, Electroencephalographic sleep profile,All night Polysomnography, Multiple Sleep Latency Test, 2 Week Sleep Diary, Actigraphy, Drug Screening

❖ Consult with medical doctor, psychiatrist

❖ Cognitive Behavioral Therapy, Behavioral therapy

❖ Psychoeducation, sleep hygiene rules, relaxation techniques, sleep restrictions, cognitive techniques

Other Specified Insomnia Disorder

❖ Polysomnography, Quantitative electroencephalographic analysis



Unspecified InsomniaDisorder

❖ Polysomnography, Quantitative electroencephalographic analysis



Other Specified Hypersomnolence Disorder

❖ Medical evaluation/ consultation, Multiple sleep latency test, Nocturnal polysomnography

❖ Cognitive Behavioral Therapy, Behavior therapy, psychopharmacotherapy

Sleep Wake DisordersParasomnias (continued)

Disorder Assessment Treatment

Unspecified Hypersomnolence Disorder

❖ Medical evaluation/ consultation, Multiple sleep latency test, Nocturnal polysomnography

❖ Cognitive Behavioral Therapy, Behavior therapy,

psychopharmacotherapy

Other Specified Sleep-Wake Disorder

❖ Medical evaluation/ consultation, Biological validators, Polysomography

Treatment Depends on presenting symptoms❖ Cognitive Behavioral Therapy,

Behavioral therapy, medications, oral applications, ventilators


Unspecified Sleep-Wake Disorder

❖ Medical evaluation/ consultation, Biological validators, Polysomography

Treatment Depends on presenting symptoms❖ Cognitive Behavioral Therapy,

Behavioral therapy, medications, oral applications, ventilators


(Kress & Paylo, 2015, pp. 361-73)

Sleep-Wake Disorders: Diagnostic Criteria: Circadian Rhythm Sleep-Wake Disorders

Circadian

Rhythm Sleep-

Wake Disorders (DSM-5 pp.391-8)

1. Delayed Sleep

Phase Type

Code: 307.45 (G47.21)

2. Advanced Sleep

Phase Type

Code: 307.45 (G47.22)

3. Irregular Sleep-

Wake Type

Code: 307.45 (G47.23)

4. Non-24 Hour

Sleep-Wake Type

Code: 307.45 (G47.24)

5. Shift Work

Type

Code: 307.45

(G47.26)

❖ Recurrent Pattern

of Sleep disruption

❖ Excessive

sleepiness,

insomnia, or both

❖ Causes distress or

impairment in

social

occupational, &

other functioning

+ History of delay in timing of

major sleep pd.(usually 2+ hrs.)

compared to desired sleep/wake

+ Lasts 3+ months

time

+Difficulty waking in the

morning (morning confusion)

+Excessive early day sleepiness

Common features

+history of mental

disorder/concurrent mental

disorder

+Psychophysiological insomnia

Differential Diagnosis:

Normative variations in Sleep

Other Sleep Disorders

+Sleep-wake times several hours

earlier than desired

+History of advance in timing of

major sleep pd. (usually 2+ hrs.)

compared to desired sleep/wake

time

+Early morning insomnia

+Excessive daytime sleepiness

+”morning types” biomarkers

occur 2-4 hr. earlier than normal

+use of drugs to combat sleep-

wake time may lead to substance

abuse

+Onset late adulthood

+Familial

+Symptom severity increases

with age

+varies according to lifestyle and

lifespan



Depressive and Bipolar

Disorders

+history of insomnia at night

+excessive sleepiness/napping

in the day

+No major sleep pd.

+Fragmented sleep into at

least 3 pds. in 24 hrs.

+Commonly linked to

neurodegenerative disorders

(major neurocognitive

disorder, neurodevelopmental

disorders)

+Linked to limited

environmental light exposure


Normative variations in sleep

Other medical conditions and

mental disorders

+Pattern of sleep-wake cycles

not synchronized to 24 hr.

environment

+Consistent daily drift of

sleep-wake times.

+pds of insomnia, excessive

sleepiness or both altering

with asymptomatic pds.

+Common among the visually

impaired (50% prevalence)

+In sighted individuals often

due to lack of light and

structured activity

+Associated with traumatic

brain injury


Circadian Rhythm Sleep-Wake

Disorders

Depressive Disorders

+based on history of

individual working out

of 8AM-6PM daylight

schedule on a regular

basis

+Insomnia during major

sleep pd.

and/ or

+Excessive sleepiness

during major awake pd.

associated with a shift

work schedule

+May effect travelers

frequently flying across

time zones

+May effect those with

rotating shifts

+Common in 50+


Normative Variations in

Sleep with Shift Work

R/O:


Sleep-Wake Disorders: Diagnostic Criteria: Parasomnias

Parasomnias

(DSM-5 pp. 399-

422)

Non-Rapid Eye

Movement (NREM)

Sleep Arousal

Disorders

Sleepwalking type Code:

307.46(F51.3)

Sleep terror type

Code: 307.46 (F51.4)

Non-Rapid Eye

Movement (NREM)

Sleep Arousal

Disorders

(Continued)

Non-Rapid Eye

Movement

(NREM)

Sleep Arousal

Disorders

(Continued)

Nightmare

Disorder

Code: 307.47

(F51.5)

Rapid Eye

Movement (REM)

Sleep Behavior

Disorder

Code: 327.42

(G47.52)

Restless Leg

Syndrome

Code: 333.94

(G25.81)

❖ Abnormal

behavioral,

experiential or

physiological

events

occurring w/

sleep/specific

sleep

stages/sleep-

wake

transitions

❖ Most common

NREM Sleep

Behavior Disorder

REM Sleep

Behavior Disorder

+Repeated occurrence of

incomplete arousals can be brief

up to 10 mins. or up to 1 hr. in

first 3rd of sleeping episode

+eyes are typically open

Sleepwalking

+repeated episodes of complex

motor behavior initiated during

sleep

+Episodes begin during NREM

+reduced alertness

+blank stare

+unresponsive to

communication

+limited recall afterward

+initial confusion immediately

following

+return to full cognitive

function afterwards

Sleep Terrors

+Repeated occurrence of sudden

awakening from sleep

+Often begins w/ scream/cry

+Automatic arousal

+Intense fear, compulsion to

escape

+Automatic arousal (rapid

breathing, sweating, etc.)

+Unresponsiveness to others

efforts to comfort

+No or little dream imagery

(single scene)

+Amnesia for episode

+Significant stress and

impairment of functioning

+Not due to drug use/

Medication

+Mental and Medical disorders

do not explain episodes

Sleep Related Eating Disorder

+eating w/ amnesia ranging

from no-full awareness

Sleep Related sexual behavior

(sexsomnia)

+Arising from sleep and

participating in sexual activity

w/ no conscious awareness

Common in children

+link w/ major depressive

episodes and obsessive-

compulsive disorder


Nightmare Disorder

Breathing-Related Sleep

Disorders

REM Sleep Behavior

Disorder

Parasomnia Overlap

Syndrome

Sleep-Related Seizures

Alcohol-Induced

Blackouts

Dissociative Amnesia, w/

Dissociative Fugue

Malingering or other

voluntary behavior

occuring during

wakefulness

Medication-Induced

Complex Behaviors

Night Eating Syndrome

+Repeated occurrences of

dream imagery involving

extreme negative emotions

+well remembered

+Alert after dream episode

+Significant distress or

impairment in functioning

Replicative Nightmares

-occur after a traumatic

experience


Sleep Terror Disorder

REM Sleep behavior

Disorder

Bereavement

Narcolepsy

Nocturnal Seizures

Breathing-Related Sleep

Disorders

Panic Disorder

Sleep-Related Dissociative

Disorders

Medication or Substance

Abuse

+Repeated episodes of

arousal during sleep

+Vocal and/or complex

motor behaviors in

response to threats “dream

enacting behaviors”

+Motor behaviors can be

violent

+Happen in REM sleep

(90 mins into sleep onset)

+Awaken alert and NOT

confused/disoriented

+Causes significant

distress and/or impairment

of functioning

+Present in 30% of

narcoleptics


Other Parasomnias

Nocturnal Seizures

Obstructive Sleep Apnea

Other Specified

Dissociative Disorder

Malingering

+desire to move the legs or

arms due to uncomfortable

feelings

+Urge to move

-worsens during rest

-is relieved by

movement

-worse in evening

+3x/week

+At least 3 months

+Causes significant

distress and/or impairment

of functioning


Substance Intoxication or

withdrawal

Delirium


Sleep Disorder due to

another medical condition


Substance/

Medication-

Induced Sleep

Disorder

(DSM-5 pp 417-8)Code: 780.52 (G47.00)

1.Alcohol

(291.82)

2.Caffeine

(292.85)

3.Cannabis

(292.85)

4. Opiods

(292.85)

5. Sedative,

hypnotic, or

anxiolytic

(292.85)

6.Amphetamine

(or other

stimulant)

(292.85)

7. Tobacco

(292.85)

8. Other (or

unknown)

Substance

(292.5)

Prominent/severe

disturbance in sleep

-develop during/after

intoxication or

-after withdrawal

and

-Substance is capable of

sleep disturbance

+Sleep disorders are ruled

out

+does not occur during

delirium

+Symptoms cause

significant distress

or

Impairment of functioning


Substance intoxication or

withdrawal

Delirium


Sleep Disorder due to

another medical condition

+often occurs

with insomnia

type

+Extremely

disrupted sleep

First half of night

+Immediate/

short lived

sedative effect

+increased

intensity of REM

sleep (vivid

dreams- alcohol

withdrawal

delirium)

Second half of

night

+Restlessness

+can aggravate

breathing-related

sleep disorder

+fragmented

sleep can last for

weeks/years in

chronic alcohol

users

+produces

insomnia

+signs of

withdrawal =

daytime

sleepiness

+may shorten

sleep latency

+enhances slow

wave sleep /sleep

inducing

+Chronic users

develop

tolerance to sleep

effects

+ Withdrawal

signs sleep

difficulties and

unpleasant

dreams

-may last for

weeks

-Increase in

sleepiness and

sleep depth

-W/ chronic use

tolerance

develops and

insomnia

-Respiratory

depressant effects

worsen sleep

apnea

+Similar to

Opiods

+Increases

sleepiness

+Decreases

wakefulness

+W/ chronic use

tolerance develops

and insomnia

+Daytime

sleepiness

+Insomnia during

intoxication

+Excessive

Sleepiness during

withdrawal

+MDMA

-restlessness and

disturbed sleep

within 48

hrs.

-frequent use is

connected with

anxiety, depression,

steep disturbances

even during pds. of

non use

+Insomnia

+Decreased slow-

wave sleep

+Reduction of

sleep efficiency

+Increased

daytime

sleepiness

+Withdrawal

-impaired sleep

+Heavy smokers

may awake at

night due to

cravings

+Medications

affecting

central. and/or

automatic

nervous

systems may

cause sleep

disturbances


Other Specified

Insomnia Disorder

Code: 780.52(G47.09)

Unspecified

Insomnia Disorder

Code: 780.52 (G47.00)

Other Specified

Hypersomnolence

Disorder

Code: 780.54 (G47.19)

Unspecified

Hypersomnolence

Disorder

Code: 780.54 (G47.10)

Other Specified

Sleep-Wake

Disorder

Code: 780.59 (G47.8)

Unspecified Sleep-

Wake Disorder

Code: 780.59 (G47.9)

+Does not meet full

diagnostic criteria for

Insomnia/sleep-wake

disorders

+Used when clinician

CHOOSES TO SPECIFY

reason why criteria is not

met for insomnia/sleep-wake

disorders

+insomnia disorder

symptoms cause significant

distress

or

Impair areas of functioning

+Brief Insomnia Disorder

-pd. less than 3 mos.

+Restricted to nonrestorative

sleep

+Does not meet full


Insomnia/sleep-wake

disorders

+Used when a clinician

CHOOSES NOT TO

SPECIFY a reason criteria

are not met for

insomnia/sleep-wake

disorders

+insomnia disorder


distress

or

Impair areas of functioning

+Insufficient information to

make a more specific

diagnosis

+Does not meet full


Hypersomnolence/sleep-

wake disorders


CHOOSES TO SPECIFY


met for hypersomnolence/

sleep-wake disorders

+Hypersomnolence disorder


distress

or


(e.g., brief-duration

hypersomnolence)

+Does not meet full


Hypersomnolence/sleep-

wake disorders


CHOOSES NOT TO


are not met for

hypersomnolence/sleep-

wake disorders

+Hypersomnolence disorder


distress

or




diagnosis

+Does not meet full

diagnostic criteria for sleep-

wake/other specified

insomnia/ other specified

hypersomnolence disorders


CHOOSES TO SPECIFY


met for sleep-wake/other

specified insomnia/ other

specified hypersomnolence

disorders

+Sleep-Wake Disorder


distress

or


+Does not meet full

diagnostic criteria for sleep-





CHOOSES NOT TO


are not met for sleep-




+Sleep-Wake Disorder


distress

or




diagnosis

Diagnosis Assessment Treatment

Diagnostic Criteria

• A predominant compliant of dissatisfaction with sleep

quantity/quality, along with at least one of the following:

1. Difficulty initiating sleep (In children, may be without caregiver

intervention)

2. Difficulty maintaining sleep due to frequent awakenings or

problems returning to sleep after reawakenings (In children, may

be difficulty returning to sleep without caregiver intervention)

3. Early-morning reawakening with inability to return to sleep

• Causes clinically significant distress or impairment in functioning

• The sleep difficulty occurs at least 3 nights per week

• Is present for at least 3 months

• Occurs despite adequate opportunity for sleep

• Specify if:

With non-sleep disorder mental comorbidity, including

substance use disorders

With other medical comorbidity

With other sleep disorder

• Specify if:

Episodic: Symptoms last at least a month but less than 3

months

Persistent: Symptoms last 3 months or longer

Recurrent: Two (or more) episodes within the space of a year

Differential Diagnosis

• Normal sleep variations

• Situational/acute insomnia

• Delayed sleep phase and shift work types of circadian rhythm

sleep-wake disorder

• Restless legs syndrome

• Breathing-related sleep disorders

• Narcolepsy

• Parasomnias

• Substance/medication-induced sleep disorder, insomnia type

• Traditional clinical

interview (Kress &

Paylo, 2015)

• Referral to a sleep

disorder center or to a

sleep disorder specialist

for use of laboratory

examinations (Kress &

Paylo, 2015)

• CBT

• Behavior Therapy

(BT)

Psychopharmacotherapy

• Sedative-hypnotics

• Benozodiazepines

Sleep-Wake Disorders

•Insomnia Disorder (DSM Pages 362-368)


Diagnostic Criteria

• Self-reported excessive sleepiness despite a main sleep period

lasting at least 7 hours, with at least one of the following:

1. Recurrent periods of sleep or lapses into sleep within the same day

2. A prolonged main sleep episode of more than 9 hours per day that

is nonrestorative

3. Difficulty being fully awake after abrupt awakening

• Occurs at least 3 times per week for at least 3 months

• Accompanied by significant distress or impairment in functioning

• Specify if:

With non-sleep disorder mental comorbidity, including

substance use disorders

With medical condition

With other sleep disorder

• Specify if:

Acute: Duration of less than 1 month

Subacute: Duration of 1-3 months

Persistent: Duration of more than 3 months

• Specify current severity:

Mild: Difficulty maintaining daytime alertness 1-2days/week

Moderate: Difficulty maintaining daytime alertness 3-4

days/week

Severe: Difficulty maintaining daytime alertness 5-7 days/week


• Normative variation in sleep

• Poor sleep quality and fatigue

• Breathing-related sleep disorders

• Circadian rhythm sleep-wake disorders

• Parasomnias

• Other mental disorders


interview (Kress &

Paylo, 2015)






Paylo, 2015)

• Medical evaluation and

consultation (Kress &

Paylo, 2015)

• BT


• Stimulants

(Amphetamines)

(Mazindol, Modafinil)

• Antidepressants

•Hypersomnolence Disorder (DSM Pages 368-372)


Diagnostic Criteria

• Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring with the same day; occurring at least 3 times per week over the past 3 months

• Presence of at least one of the following:

1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month:

a. In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are

precipitated by laughter or joking

b. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any

obvious emotional triggers

1. Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less than or equal to one-third of values obtained in healthy subjects tested

using the same assay, or les than or equal to 110 pg/mL) not observed in the context of acute brain injury, inflammation, or infection

2. Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep latency less

than or equal to 8 minutes and tow or more sleep-onset REM periods

• Specify whether:

347.00 Narcolepsy without cataplexy but with hypocretin deficiency: Criterion B requirements of low CSF hypocretin-1 levels and positive polysomnography/multiple sleep latency

test are met, but no cataplexy is present (Criterion B1 not met)

347.01 Narcolepsy with cataplexy but without hypocretin deficiency: In this rare subtype (less than 5 % of narcolepsy cases), Criterion B requirements of cataplexy and positive

polysomnography/multiple sleep latency test are met, but CSF hypocretin-1 levels are normal (Criterion B2 not met)

347.00 Autosomal dominant cerebellar ataxia, deafness, and narcolepsy: This subtype is caused by exon 21 DNA (cystosine-5)-methyltransferase-1 mutations and is characterized by

late-onset (age30-40 years) narcolepsy (with low or intermediate CSF hypocretin-1 levels), deafness, cerebellar ataxia, and eventually dementia

347.00 Autosomal dominant narcolepsy, obesity, and type 2 diabetes: Narcolepsy, obesity, and type 2 diabetes and low CSF hypcretin-1 levels have been described in rare cases and

are associated with a mutation in the myelin oligodendrocyte glycoprotein gene

347.10 Narcolepsy secondary to another medical condition: This subtype is for narcolepsy that develops secondary to medical conditions that cause infectious (e.g., Whipple’s

disease, sarcoidosis), traumatic, or tumoral destruction of hypocretin nuerons


Mild: Infrequent cataplexy (less than once per week), need for naps only once or twice per day, and less disturbed nocturnal sleep

Moderate: Cataplexy at least once daily or every few days, disturbed nocturnal sleep, and need for multiple naps daily

Severe: Drug-resistant cataplexy with multiple attacks daily, nearly constant sleepiness, and disturbed nocturnal sleep


• Other hypersomnias

• Sleep deprivation and insufficient nocturnal sleep

• Sleep apnea syndromes

• Major depressive disorder

• Conversion disorder

• ADHD or other behavioral problems

• Seizures

• Chorea and movement disorders

• Schizophrenia

• Traditional clinical interview (Kress & Paylo, 2015)

• Referral to a sleep disorder center or to a sleep disorder

specialist for use of laboratory examinations (Kress & Paylo,

2015)

• Medical evaluation and consultation (Kress & Paylo, 2015)

• BT


• Stimulants (Amphetamines)

(Mazindol, Modafinil)

• Antidepressants

Narcolepsy (DSM Pages 372-378)


Diagnostic Criteria

• Either (1) or (2):

1. Evidence of polysomnography of at least 5 obstructive apneas or

hypopneas per hour of sleep and either of the following sleep

symptoms:

a. Nocturnal breathing disturbances: snoring, snortin/gasping, or

breathing pauses during sleep

b. Daytime sleepiness, fatigue, or unrefreshing sleep despite

sufficient opportunities to sleep that is not better explained by

another mental disorder and is not attributable to another medical

condition

1. Evidence by polysomnography of 15 or more obstructive apneas

and/or hypopneas per hour of sleep regardless of accompanying

symptoms


Mild: Apnea hypopnea index is less than 15

Moderate: Apnea hypopnea index is 15-30

Severe: Apnea hypopnea index is greater than 30


• Primary snoring and other sleep disorders

• Insomnia disorder

• Panic attacks

• ADHD

• Substance/medication-induced insomnia or hypersomnia


interview (Kress &

Paylo, 2015)






Paylo, 2015)

• Behavioral

interventions

• Reducing alcohol

consumption and

smoking

• Weight loss and

dieting

• Utilizing oral

applications and

continuous positive

airway pressure

(CPAP)

• Oral surgery

procedures

• Maxillomandibular

Advancement

(MMA)

Breathing-Related Sleep Disorders

•Obstructive Sleep Apnea Hypopnea (DSM Pages 378-383)


Diagnostic Criteria

• Evidence by polysomnography of five or more central

apneas per hour of sleep


327.21 Idiopathic central sleep apnea: Repeated episodes

of apneas and hypopneas during sleep caused by

variability in respiratory effort but without evidence of

airway obstruction

786.04 Cheyne-Stokes breathing: A pattern of periodic

crescendo-decrescendo variation in tidal volume that

results in central apneas and hypopneas at a frequency of

a least five events per hour, accompanied by frequent

arousal

780.57 Central sleep apnea comorbid with opiod use:

Attributed to the effects of opiods on the respiratory

rhythm generators in the medulla as well as the

differential effects on hypoxic versus hypercapnic

respiratory drive


Severity of central sleep apnea is graded according to the

frequency of the breathing disturbances as well as the

extent of associated oxygen desturation and sleep

fragmentation that occur as a consequence of repetitive

respiratory disturbances


• Other breathing-related sleep disorders and sleep

disorders


interview (Kress &

Paylo, 2015)






Paylo, 2015)

• CPAP


• Respiratory stimulants

(theophylline,

acetazolamide)

• Nonbenzodiazepine

hypnotics

Central Sleep Apnea (DSM Pages 383-386)


Diagnostic Criteria

• Polysomnography demonstrates episodes of decreased

respiration associated with eleveated CO2 levels


327.24: Idiopathic hypoventilation: Not attributable to any

readily identified condition

327.25 Congential central alveolar hypoventilation: Rare

congenital disorder in which the individual typically

presents in the perinatal period with shallow breathing, or

cyanosis and apnea during sleep

327.26 Comorbid sleep-related hypoventilation: Occurs as a

consequence of a medical condition, such as pulmonary

disorder or a neuromuscular or chest wall disorder, or

medications; also occurs with obesity, where it reflects a

combination of increased work of breathing due to reduced

chest wall compliance and ventilation-perfusion mismatch

and variably reduced ventilator drive; usually characterized

by body mass index of greater than 30 and hypercapnia

during wakefulness, without other evidence of

hypoventilation


Severity is graded according to the degree of hypoxemia and

hyper carbia present during sleep and evidence of end organ

impairment due to these abnormalities; presence of blood

gas abnormalities during wakefulness is an indicator of

greater severity


• Other medical conditions affecting ventilation

• Other breathing-related sleep disorders


interview (Kress & Paylo,

2015)






Paylo, 2015)

• Thorough substance

assessment

• Noninvasive

ventilation

• Positive pressure

ventilation

Sleep-Related Hypoventilation (DSM Pages 387-390)

References

American Psychiatric Association. (2013). Diagnostic and

statistical manual of mental disorders (5th ed.). Washington, DC:

Author.

Kress, V. E., & Paylo, M. J. (2015). Treating those with mental

disorders: A comprehensive approach to case conceptualization

and treatment. Upper Saddle Ridge, New Jersey: Pearson

Education, Inc.

Documents

Sleep-Wake Disorders · 2018-09-02 · Sleep Behavior Disorder Code: 327.42 (G47.52) Restless Leg Syndrome Code: 333.94 (G25.81) Abnormal behavioral, experiential or physiological