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Sleep-Disorders , symptoms , management.ppt
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- 2. Two Major Categories* TwoMajor Categories* Dyssomnias Dyssomnias Parasomnias Parasomnias * *This classification system is similar to that used This classification system is similar to that used by the American Sleep Disorders Association. by the American Sleep Disorders Association.
- 3. Dyssomnias Dyssomnias The sleep itselfis pretty normal. The sleep itself is pretty normal. But the client sleeps too little, too But the client sleeps too little, too much, or at the wrong time. much, or at the wrong time. So, the problem is with the amount So, the problem is with the amount (quantity), or with its timing, and (quantity), or with its timing, and sometimes with the quality of sometimes with the quality of sleep. sleep.
- 4. Parasomnias Parasomnias Something abnormal occursduring Something abnormal occurs during sleep itself, or during the times sleep itself, or during the times when the client is falling asleep or when the client is falling asleep or waking up (e.g., bad dreams. waking up (e.g., bad dreams. The quality, quantity, and timing of The quality, quantity, and timing of the sleep are essentially normal. the sleep are essentially normal.
- 5. The Sleep Disorderschapter has The Sleep Disorders chapter has four major sections: four major sections: I. Primary Sleep Disorders include all I. Primary Sleep Disorders include all sleep disorders, sleep disorders, except except: : II. Sleep Disorder Related to Another II. Sleep Disorder Related to Another Mental Disorder Mental Disorder III. Sleep Disorder Due to a General III. Sleep Disorder Due to a General Medical Condition (GMC) Medical Condition (GMC) IV. Substance-Induced Sleep Disorder IV. Substance-Induced Sleep Disorder
- 6. I. Primary SleepDisorders I. Primary Sleep Disorders Dyssomnias Dyssomnias A. A. Primary Insomnia Primary Insomnia - too little sleep - too little sleep Characteristics Characteristics • Difficulty initiating or maintaining sleep Difficulty initiating or maintaining sleep • Persists for 1 month or longer Persists for 1 month or longer • This diagnosis is rarely independent of an Axis I or This diagnosis is rarely independent of an Axis I or II disorder or a GMC or substance use. II disorder or a GMC or substance use.
- 7. I. Primary SleepDisorders (cont.) I. Primary Sleep Disorders (cont.) A. Primary Insomnia (too little sleep) A. Primary Insomnia (too little sleep) Often due to: Often due to: • Major Depressive Episode, Manic Episode, or Major Depressive Episode, Manic Episode, or anxiety disorder anxiety disorder • Commonly misused substances, as well as some Commonly misused substances, as well as some prescription medicines. prescription medicines. • Breathing-related problems Breathing-related problems The cause sometimes can not be identified. The cause sometimes can not be identified.
- 8. I. Primary SleepDisorders (cont.) I. Primary Sleep Disorders (cont.) A. A. Primary Insomnia (too little sleep) Primary Insomnia (too little sleep) Treatment Treatment Vigorous daytime exercise, not exercising before Vigorous daytime exercise, not exercising before sleep sleep Sexual intercourse, if pleasurable Sexual intercourse, if pleasurable Metronome or ticking clock- slow, 60 beats per Metronome or ticking clock- slow, 60 beats per minute or slower, beat of human heart minute or slower, beat of human heart Relaxation exercises, practice regularly but Relaxation exercises, practice regularly but condensed to 5 minutes condensed to 5 minutes Decrease stimulation and increase soothing Decrease stimulation and increase soothing environments, such as ear plugs or calm reading environments, such as ear plugs or calm reading Practice good sleep habits Practice good sleep habits Read “How to Become an Insomniac” Read “How to Become an Insomniac”
- 9. I. Primary SleepDisorders I. Primary Sleep Disorders Dyssomnias Dyssomnias B. B. Primary Hypersomnia Primary Hypersomnia (sleeping too much, as (sleeping too much, as well as being drowsy at times when client should well as being drowsy at times when client should be alert) (criteria listed on p. 609) be alert) (criteria listed on p. 609) Characteristics Characteristics • Excessive sleepiness Excessive sleepiness • Persists for 1 month or longer Persists for 1 month or longer • Rarely a diagnosis independent of an Axis I or II disorder or a Rarely a diagnosis independent of an Axis I or II disorder or a GMC or substance use. GMC or substance use. Specify if: Recurrent. Specify if: Recurrent.
- 10. I. Primary SleepDisorders (cont.) I. Primary Sleep Disorders (cont.) B. Primary Hypersomnia (too much sleep) B. Primary Hypersomnia (too much sleep) (cont.) (cont.) Often due to: Often due to: • Major Depressive Episode, Dysthymic Disorder Major Depressive Episode, Dysthymic Disorder with atypical features with atypical features • Use of substances is less likely to produce Use of substances is less likely to produce hyersomnia than insomnia, but it can happen (e.g., hyersomnia than insomnia, but it can happen (e.g., sleeping pills overdose) sleeping pills overdose) The cause sometimes can not be identified. The cause sometimes can not be identified. Treatment: Exercise when becoming sleepy Treatment: Exercise when becoming sleepy
- 11. I. Primary SleepDisorders I. Primary Sleep Disorders Dyssomnias Dyssomnias C. Narcolepsy C. Narcolepsy (Sleeping at the wrong time) (Sleeping at the wrong time) (criteria listed on pg. 615) (criteria listed on pg. 615) Characteristics Characteristics • Sleep intrudes into wakefulness, causing clients to fall Sleep intrudes into wakefulness, causing clients to fall asleep almost instantly asleep almost instantly • Sleep is brief but refreshing Sleep is brief but refreshing • May also have sleep paralysis, sudden loss of strength, and May also have sleep paralysis, sudden loss of strength, and hallucinations as fall asleep or awaken. hallucinations as fall asleep or awaken. Treatment: Stimulants, sometimes antidepressants, with Treatment: Stimulants, sometimes antidepressants, with less success. less success.
- 12. I. Primary SleepDisorders I. Primary Sleep Disorders Dyssomnias Dyssomnias D. Breathing-Related Sleep Disorder D. Breathing-Related Sleep Disorder (criteria listed on p. 622) (criteria listed on p. 622) Characteristics Characteristics Sleep disruption (excessive sleepiness or Sleep disruption (excessive sleepiness or insomnia) insomnia) • Due to sleep-related breathing condition (e.g., Due to sleep-related breathing condition (e.g., Obstructive Sleep Apnea Syndrome) Obstructive Sleep Apnea Syndrome)
- 13. I. Primary SleepDisorders I. Primary Sleep Disorders Dyssomnias Dyssomnias D. D. Breathing-Related Sleep Disorder Breathing-Related Sleep Disorder Treatment Treatment (Criteria on p. 622) (Criteria on p. 622) In mild cases: weight loss, sleeping on one’s side, In mild cases: weight loss, sleeping on one’s side, and avoiding hypnotics and alcohol and avoiding hypnotics and alcohol (To sleep on side, a tennis ball can be sewn into (To sleep on side, a tennis ball can be sewn into back of client’s sleep wear) back of client’s sleep wear) In more serious cases: a machine that provides In more serious cases: a machine that provides continuous positive airway pressure continuous positive airway pressure Surgery: Few benefits Surgery: Few benefits
- 14. I. Primary SleepDisorders I. Primary Sleep Disorders Dyssomnias Dyssomnias E. E. Circadian Rhythm Sleep Disorder Circadian Rhythm Sleep Disorder (criteria on p. 629) (criteria on p. 629) Characteristics Characteristics • Persistent or recurrent pattern of sleep disruption Persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia, due leading to excessive sleepiness or insomnia, due to mismatch between sleep-wake schedule to mismatch between sleep-wake schedule required by a person’s environment and his/her required by a person’s environment and his/her circadian sleep-wake pattern (e.g., shift work, jet circadian sleep-wake pattern (e.g., shift work, jet lag). lag).
- 15. I. Primary SleepDisorders I. Primary Sleep Disorders Dyssomnias Dyssomnias E. E. Circadian Rhythm Sleep Disorder Circadian Rhythm Sleep Disorder Treatment: Difficult to treat, because it has to Treatment: Difficult to treat, because it has to involve the entire family involve the entire family Darken bedroom and use soundproofing Darken bedroom and use soundproofing Limit caffeine and hard to digest food. Limit caffeine and hard to digest food. Ensure all family members learns shift Ensure all family members learns shift To help jet lag, exposure to sun helps To help jet lag, exposure to sun helps Specify type: Delayed Sleep Phase Type, Jet Lag Specify type: Delayed Sleep Phase Type, Jet Lag Type, Shift Work Type, and Unspecified Type Type, Shift Work Type, and Unspecified Type
- 16. I. Primary SleepDisorders I. Primary Sleep Disorders Dyssomnias Dyssomnias F. F. Dyssomnia NOS Dyssomnia NOS (listed on p. 629) (listed on p. 629) This category is for insomnias, This category is for insomnias, hypersomnias, or circadian rhythm hypersomnias, or circadian rhythm disturbances that do not meet criteria for disturbances that do not meet criteria for any specific Dyssomnia. any specific Dyssomnia.
- 17. I. Primary SleepDisorders I. Primary Sleep Disorders Parasomnias Parasomnias A. A. Nightmare Disorder ( Nightmare Disorder (Criteria listed on p. Criteria listed on p. 634) 634) Characteristics: Characteristics: (1) Repeated awakenings from bad dreams (1) Repeated awakenings from bad dreams (2) When awakened client (2) When awakened client becomes becomes oriented and alert oriented and alert
- 18. I. Primary SleepDisorders I. Primary Sleep Disorders Parasomnias Parasomnias A. A. Information about Information about Nightmare Disorder Nightmare Disorder Usually occurs in early morning when REM sleep Usually occurs in early morning when REM sleep dominates. dominates. The same nightmare may recur repeatedly or The same nightmare may recur repeatedly or different ones may pop up three times a week. different ones may pop up three times a week. Stress may induce 60% of nightmares. Stress may induce 60% of nightmares. Half of the cases of nightmare disorder appear Half of the cases of nightmare disorder appear before age 10; 2/3 before age 20. before age 10; 2/3 before age 20. Dreams are clearly remembered Dreams are clearly remembered Drugs can trigger nightmares. Drugs can trigger nightmares. Suddenly withdrawing REM-suppressant Suddenly withdrawing REM-suppressant medications and drugs can cause REM rebound. medications and drugs can cause REM rebound.
- 19. I. Primary SleepDisorders I. Primary Sleep Disorders Parasomnias Parasomnias B. B. Sleep Terror Disorder Sleep Terror Disorder (criteria listed on (criteria listed on pg. 639) pg. 639) Characteristics: Characteristics: (1) (1) Abrupt awakening from sleep, usually Abrupt awakening from sleep, usually beginning with a panicky scream or cry. beginning with a panicky scream or cry. (2) (2) Intense fear and signs of autonomic Intense fear and signs of autonomic arousal arousal (3) (3) Unresponsive to efforts from other to calm Unresponsive to efforts from other to calm client client (4) (4) No detailed dream recalled No detailed dream recalled (5) (5) Amnesia for episode Amnesia for episode
- 20. I. Primary SleepDisorders I. Primary Sleep Disorders Parasomnias Parasomnias B. B. Sleep Terror Disorder Sleep Terror Disorder Usually only children have sleep terror disorder. Usually only children have sleep terror disorder. The client is not having a nightmare. The client is not having a nightmare. The eyes are open, screams erupt. The eyes are open, screams erupt. Usually happens in early evening. Usually happens in early evening. In contrast to nightmares, sleep terrors do not respond to In contrast to nightmares, sleep terrors do not respond to psychotherapy. psychotherapy. Probably due to brain wave upset, fever, or medications Probably due to brain wave upset, fever, or medications However, some medications may help. However, some medications may help.
- 21. I. Primary SleepDisorders I. Primary Sleep Disorders Parasomnias Parasomnias C. C. Sleepwalking Disorder Sleepwalking Disorder (criteria listed (criteria listed on pg. 644) on pg. 644) Characteristics: Characteristics: (1) (1) Rising from bed during sleep and walking about. Rising from bed during sleep and walking about. (2) (2) Usually occurs early in the night. Usually occurs early in the night. (3) (3) On awakening, the person has amnesia for episode On awakening, the person has amnesia for episode
- 22. I. Primary SleepDisorders I. Primary Sleep Disorders Parasomnias Parasomnias C. C. Sleepwalking Disorder Sleepwalking Disorder Most sleepwalking children are psychologically normal. Most sleepwalking children are psychologically normal. Runs in families. Runs in families. Begins between ages 6 and 12 and may be stress-related. Begins between ages 6 and 12 and may be stress-related. Customarily sleepwalkers exhibit other delta-sleep Customarily sleepwalkers exhibit other delta-sleep interruptions. interruptions. At some time 1-6% of children sleepwalk; of these, 15% do At some time 1-6% of children sleepwalk; of these, 15% do so occasionally. so occasionally. Adult sleepwalking is far less common, usually worse and more Adult sleepwalking is far less common, usually worse and more chronic. chronic.
- 23. I. Primary SleepDisorders I. Primary Sleep Disorders Parasomnias Parasomnias C. C. Sleepwalking Disorder Sleepwalking Disorder Treatment: Treatment: Relaxation techniques Relaxation techniques Biofeedback training Biofeedback training Hypnosis. Hypnosis. May need to sleep on the ground floor, have outside May need to sleep on the ground floor, have outside doors securely locked, and have car keys unavailable. doors securely locked, and have car keys unavailable.
- 24. I. Primary SleepDisorders I. Primary Sleep Disorders Parasomnias Parasomnias D. Parasomnia NOS D. Parasomnia NOS (listed on p. 644) (listed on p. 644) Characteristics: Characteristics: Abnormal behavioral or physiological Abnormal behavioral or physiological events during sleep or sleep-wake events during sleep or sleep-wake transitions, but that do not meet criteria transitions, but that do not meet criteria for a more specific Parasomnia for a more specific Parasomnia
- 25. I. Primary SleepDisorders I. Primary Sleep Disorders Parasomnias Parasomnias D. Parasomnia NOS D. Parasomnia NOS (listed on p. 644) (listed on p. 644) Examples Examples Sleep-Talking: Often more annoying to partner than to Sleep-Talking: Often more annoying to partner than to sleeper. Has no memory in morning. Can be during REM or sleeper. Has no memory in morning. Can be during REM or delta sleep. In REM sleep, pronunciation is clear and delta sleep. In REM sleep, pronunciation is clear and understandable; in deep sleep (delta) apt to be mumbled and understandable; in deep sleep (delta) apt to be mumbled and unintelligible unintelligible Sleep paralysis: inability to perform voluntary movement Sleep paralysis: inability to perform voluntary movement during the transition between waking and sleep. Usually during the transition between waking and sleep. Usually associated with extreme anxiety, and sometimes fear of associated with extreme anxiety, and sometimes fear of impending death. impending death. REM sleep behavior disorder: characterized by agitated and REM sleep behavior disorder: characterized by agitated and violent behavior. violent behavior. Parasomnia is present but unable to determine whether it is Parasomnia is present but unable to determine whether it is primary, due to GMC, or substance induced. primary, due to GMC, or substance induced.
- 26. The Sleep Disorderschapter has The Sleep Disorders chapter has four major sections: four major sections: I. Primary Sleep Disorders include all I. Primary Sleep Disorders include all sleep disorders, sleep disorders, except except: : II. Sleep Disorder Related to Another II. Sleep Disorder Related to Another Mental Disorder Mental Disorder III. Sleep Disorder Due to a General III. Sleep Disorder Due to a General Medical Condition (GMC) Medical Condition (GMC) IV. Substance-Induced Sleep Disorder IV. Substance-Induced Sleep Disorder
- 27. II. II. Sleep DisorderRelated to Sleep Disorder Related to Another Mental Disorder Another Mental Disorder Two Diagnoses Two Diagnoses 1. 1. Insomnia Related to Another Mental Insomnia Related to Another Mental Disorder (criteria listed on p. 650) Disorder (criteria listed on p. 650) 2. Hypersomnia Related to Another 2. Hypersomnia Related to Another Mental Disorder (criteria listed on p. Mental Disorder (criteria listed on p. 650) 650)
- 28. II. II. Sleep DisorderRelated to Sleep Disorder Related to Another Mental Disorder Another Mental Disorder 1. 1. Insomnia Related to Another Mental Insomnia Related to Another Mental Disorder Disorder Characteristics Characteristics • Difficulty in initiating or maintaining sleep Difficulty in initiating or maintaining sleep • Persists for at least 1 month Persists for at least 1 month 2. Hypersomnia Related to Another 2. Hypersomnia Related to Another Mental Disorder Mental Disorder Characteristics: Characteristics: • Excessive sleepiness Excessive sleepiness • Persists for at least 1 month Persists for at least 1 month
- 29. II. II. Sleep DisorderRelated to Sleep Disorder Related to Another Mental Disorder Another Mental Disorder Two Diagnoses Two Diagnoses 1. 1. Insomnia Related to… another mental Insomnia Related to… another mental disorder – indicate the Axis I or II disorder disorder – indicate the Axis I or II disorder (criteria listed on p. 650) (criteria listed on p. 650) 2. Hypersomnia Related to…another 2. Hypersomnia Related to…another mental disorder – indicate the Axis I or II mental disorder – indicate the Axis I or II disorder (criteria listed on p. disorder (criteria listed on p. 650) 650)
- 30. III. 327.xx SleepDisorder Due to … a III. 327.xx Sleep Disorder Due to … a General Medical Condition General Medical Condition (list the GMC) (criteria on p. 654) (list the GMC) (criteria on p. 654) Also GMC on Axis III Also GMC on Axis III Prominent disturbance in sleep that is sufficiently Prominent disturbance in sleep that is sufficiently severe to warrant independent clinical attention. severe to warrant independent clinical attention. Evidence has to be present that the sleep Evidence has to be present that the sleep disturbance is a direct physiological disturbance is a direct physiological consequence of a general medical condition. consequence of a general medical condition. Specify Type: Specify Type: (1) .52 (1) .52 Insomnia Type Insomnia Type (2) .54 (2) .54 Hypersomnia Type Hypersomnia Type (3) .59 (3) .59 Parasomnia Type Parasomnia Type (4) .59 (4) .59 Mixed Type Mixed Type
- 31. IV. Substance-Induced Sleep IV.Substance-Induced Sleep Disorder (Indicate Substance) Disorder (Indicate Substance) (criteria is on p. 660) (criteria is on p. 660) Characteristics Characteristics Evidence must be present that the sleep disturbance Evidence must be present that the sleep disturbance is a direct physiological consequence of substance is a direct physiological consequence of substance use. use. Substance use that produces a sleep disorder severe Substance use that produces a sleep disorder severe enough to warrant independent clinical attention enough to warrant independent clinical attention Code: Code: 291.8 Alcohol; 292.89 Amphetamine; 292.89 291.8 Alcohol; 292.89 Amphetamine; 292.89 Caffeine; 292.89 Cocaine; 292.89 Opioid; Caffeine; 292.89 Cocaine; 292.89 Opioid; 292.89 Sedative, Hypnotic, or Anxiolytic; 292.89 292.89 Sedative, Hypnotic, or Anxiolytic; 292.89 Other (or unknown) Substance Other (or unknown) Substance
- 32. IV. Substance-Induced Sleep IV.Substance-Induced Sleep Disorder (Indicate Substance) Disorder (Indicate Substance) (criteria is on p. 660) (criteria is on p. 660) Types: Types: Insomnia Type Insomnia Type Hypersomnia Type Hypersomnia Type Parasomnia Type Parasomnia Type Mixed Type Mixed Type Specify if: Specify if: With Onset During Intoxication With Onset During Intoxication With Onset During Withdrawal With Onset During Withdrawal