S|eep D|sorders: Cther S|eep

D|sorders
1eolo Lee-Chlong Mu
rofessor of Medlclne
nauonal !ewlsh PealLh
unlverslLy of Colorado
uenver, Colorado

8esearch fundlng: hlllps 8esplronlcs
Consulung: Llsevler, CareCore nauonal
Chlef Medlcal Llalson: hlllps 8esplronlcs
D|sc|osure
Learn|ng Cb[ecnves
Learn how Lo evaluaLe and manage pauenLs
presenung wlLh lnsomnla or excesslve sleeplness
8ecognlze Lhe causes of abnormal sleep-relaLed
behavlors
ldenufy Lhe dlerenL clrcadlan rhyLhm sleep
dlsorders
uesnon
Whlch of Lhe followlng causes of lnsomnla ls
characLerlzed by sub[ecuve reporLs of very mlnlmal
or no sleep durlng mosL nlghLs buL normal sleep
quallLy and archlLecLure durlng ob[ecuve Lesung?

a. ldlopaLhlc lnsomnla
b. sychophyslologlc lnsomnla
c. aradoxlcal lnsomnla
d. Ad[usLmenL lnsomnla
uesnon
Whlch ls Lhe mosL common Lrlgger for caLaplexy?

a. Sex
b. Anger
c. SLress
d. LaughLer
uesnon
1he mosL eecuve LreaLmenL for 8LM sleep behavlor
dlsorder ls:

a. Modanll
b. Clonazepam
c. uopamlnerglc agenLs
d. venlafaxlne
uesnon
lree-runnlng clrcadlan rhyLhm sleep-wake dlsorders ls
Lyplcally encounLered ln persons wlLh:

a. 8llndness
b. uepresslon
c. SubsLance abuse
d. oor sleep hyglene
Insomn|a
Insomn|a: Dehn|non
Cllnlcal denluon
8epeaLed dlmculLy wlLh
elLher falllng or sLaylng
asleep
AssoclaLed wlLh
lmpalrmenL of dayume
funcuon
SC denluon
SCL 30 mlnuLes
WASC 30 mlnuLes
SL < 83
1S1 < 6-6.3 hours

Aglng
Lower socloeconomlc sLaLus or unemploymenL
MarlLal sLaLus (dlvorced or wldowed)
oor healLh sLaLus and physlcal dlsablllLy
Medlcal, neurologlcal and psychlaLrlc dlsorders
(resplraLory dlsorders)
Cender: l > M

Insomn|a: k|sk Iactors
Cld, poor, dlvorced, frall, slck woman
lboto ftom tbe Nouoool lopoltet
lncreased rlsk of developlng a psychlaLrlc lllness
(depresslon)
Cognluve lmpalrmenL
lmpalred academlc and occupauonal performance
CreaLer healLhcare use
Insomn|a: Consequences
Ad[usLmenL lnsomnla
ldlopaLhlc lnsomnla
lnadequaLe sleep hyglene
aradoxlcal lnsomnla
sychophyslologlc lnsomnla
Insomn|a: Spec|hc Causes
Sleep dlsLurbance due Lo an acuLe sLressor
MomenLous llfe evenL
Change ln sleeplng envlronmenL
AcuLe lllness
Sleep lmproves wlLh resoluuon of acuLe sLressor or
wlLh adapLauon
Ad[ustment Insomn|a
no ldenuable euology
CnseL durlng lnfancy or early chlldhood
Chronlc llfe-long course
Id|opath|c Insomn|a
uue Lo acuvlues or behavlor LhaL lncrease arousal or
decrease sleep propenslLy
Acuvlues and behavlor are under a person's conLrol
Inadequate S|eep nyg|ene
Sleep sLaLe mlspercepuon
Sub[ecuve reporLs of very mlnlmal or no sleep
durlng mosL nlghLs buL normal sleep quallLy and
archlLecLure durlng SC
no dayume napplng or lmpalrmenL of dayume
funcuonlng
aradox|ca| Insomn|a
uue Lo helghLened cognluve and somauc arousal aL
bedume
8umlnauon
lncreased aglLauon and muscle Lone
Learned maladapuve sleep-prevenung behavlor
Lxcesslve anxleLy abouL lnablllLy Lo sleep
sychophys|o|og|c Insomn|a
Causes of Insomn|a: C|ues
Acute stressor Adjustment insomnia

Lifelong insomnia Idiopathic insomnia

Bad habits Inadequate sleep hygiene

Very minimal/no sleep for
several days
Paradoxical insomnia

Rumination and intrusive
thoughts
Psychophysiologic insomnia

PlsLory and sleep dlary
SC, acugraphy and laboraLory LesLs are noL
rouunely lndlcaLed
osslble lndlcauons for SC - Lo exclude CSA, LMu
or paradoxlcal lnsomnla
Insomn|a: Lva|uanon
ShorL-Lerm beneLs are comparable Lo
pharmacologlc Lherapy
More eecuve Lhan pharmacoLherapy aL long-Lerm
follow-up


Insomn|a: Cogn|nve 8ehav|ora|
1reatments
8eneLs of non-pharmacologlc LreaLmenLs for
lnsomnla
SCL (more eecuve Lhan pharmacoLherapy)
1S1 (less eecuve Lhan pharmacoLherapy)
Insomn|a: Cogn|nve 8ehav|ora|
1reatments
uesnon
Whlch C81 Lechnlque ls deslgned Lo lncrease
homeosLauc sleep drlve?

a. Cognluve Lherapy
b. aradoxlcal lnLenuon
c. Sleep resLrlcuon
d. Sumulus conLrol

Insomn|a: Cogn|nve 8ehav|ora|
1reatments
MosL eecuve of Lhe non-pharmacologlc LreaLmenLs
for lnsomnla
Sumulus conLrol
Sleep resLrlcuon
SLrengLhens Lhe assoclauon of Lhe bedroom and
bedume Lo a condluoned response for sleep
use Lhe bed only for sleep or sex
Lle down Lo sleep only when sleepy
lf unable Lo fall asleep, geL ouL of bed and go Lo
anoLher room
Lngage ln a resuul acuvlLy, and reLurn Lo bed only
when sleepy
Insomn|a: Snmu|us Contro|
8educlng ume spenL awake ln bed Lo enhance
homeosLauc sleep drlve
1lme ln bed ls subsequenLly lncreased once sleep
emclency lmproves
Advance or delay ln bedume based on calculaLed
sleep emclency
Insomn|a: S|eep kestr|cnon
SL = 1S1/1lme ln bed
lf SL > 90: Larller bedume
lf SL 80-90: Same bedume
lf SL < 80: LaLer bedume
Insomn|a: S|eep kestr|cnon

1lme ln 8ed - MlnuLes
1lme Awake 1lme Asleep
W W W S S S
W S
8ase||ne
Step 1
Step 2
Same wake up ume every mornlng
no dayume napplng


Insomn|a: S|eep kestr|cnon
Whlch of Lhe followlng hypnouc agenLs has Lhe shorLesL
half-llfe?

a. Zolpldem
b. 8amelLeon
c. 1emazepam
d. 1rlazolam
uesnon
May enhance sleep buL oen do noL lmprove
dayume performance
Mlnlmal long-Lerm beneclal eecL on sleep
followlng drug dlsconunuauon
Insomn|a: harmacotherapy
Less Lhan 1 hour
8amelLeon
Zaleplon
2 Lo 3 hours
Lszoplclone
1rlazolam
Zolpldem
3 Lo 24 hours
uoxepln (low-dose)
LsLazolam
1emazepam
CreaLer Lhan 40 hours
llurazepam
Cuazepam

L||m|nanon na|f-L|ves of nypnonc Agents
ShorL-acung agenLs - for sleep-onseL lnsomnla
8amelLeon and zaleplon
lnLermedlaLe-acung agenLs - for concurrenL sleep-
onseL and sleep-malnLenance lnsomnla
8enzodlazeplnes, doxepln, eszoplclone and zolpldem
Long-acung agenLs - for early mornlng awakenlngs
and dayume anxleLy
8enzodlazeplnes
Se|ecnon of nypnonc Agents
Lszoplclone, zaleplon, zolpldem
Compared Lo convenuonal benzodlazeplnes
Slmllar hypnouc acuon
no muscle relaxanL, anuconvulsanL or anxlolyuc properues
Less llkely Lo cause rebound lnsomnla, wlLhdrawal
sympLoms or Lolerance
Less llkely Lo alLer sleep archlLecLure
Non-8enzod|azep|ne 8enzod|azep|ne
keceptor Agon|sts
8amelLeon
Selecuve agonlsL for Lhe SCn melaLonln recepLor
ShorL half-llfe - lndlcaLed for sleep-onseL lnsomnla
ConLralndlcauons - use of uvoxamlne and hepauc
lmpalrmenL
Me|aton|n keceptor Agon|st
nypersomn|a

lnablllLy Lo conslsLenLly achleve and susLaln
wakefulness and alerLness Lo accompllsh Lhe Lasks of
dally llvlng
ManlfesLauons
lrequenL napplng
Sleep auacks
Mlcrosleep eplsodes
PyperacuvlLy (ln chlldren)
AuLomauc behavlor
Lxcess|ve S|eep|ness
CreaLer rlsk of accldenLs
lmpalred work and academlc performance
Mood dlsorder
LDS: Consequences
Causes of LDS: 1he 1en D's
ueprlvauon (sleep)
ulsorder (sleep)
narcolepsy
ldlopaLhlc hypersomnla
CSA
LMu
uelayed sleep phase
dlsorder - mornlng
sleeplness
uepresslon
ulsease
Pepauc fallure
PypoLhyroldlsm
Sleeplng slckness
uope (llllclL subsLance)
urlnklng (acuLe L1CP
use)
urugs (medlcauons)
uellrlum
urama (mallngerlng)
1he mosL common cause of LuS
Sleeplness due Lo chronlc volunLary, buL
unlnLenuonal, Su
ulagnosls ls based on cllnlcal hlsLory and sleep
dlarles
SC ls noL lndlcaLed
1herapy lnvolves sleep exLenslon
Insumc|ent S|eep Syndrome
neurologlcal dlsorder characLerlzed by Lhe cllnlcal
LeLrad of
Lxcesslve sleeplness
CaLaplexy
Sleep paralysls
Sleep halluclnauons
Cnly 10-13 of pauenLs demonsLraLe Lhls full LeLrad
enLad = + Sleep dlsLurbance
Narco|epsy
A useful mnemonlc for narcolepsy ls CPlS
1hlnk orexln (appeuLe) chlps
CaLaplexy
Palluclnauons
lnsomnla (sleep dlsLurbance)
aralysls
Sleeplness
Narco|epsy
100
80
70
65
0 20 40 60 80 100 120
EDS
Cataplexy
Hallucination
Paralysis
Features
Narco|epsy: C||n|ca| Ieatures
llrsL, prlmary and mosL dlsabllng sympLom of
narcolepsy
8rlef naps (10-20 mln) occur repeaLedly LhroughouL
Lhe day
LuS LranslenLly lmproves aer naps
Narco|epsy: Lxcess|ve S|eep|ness
1he only paLhognomonlc sympLom of narcolepsy
1ranslenL eplsodes of muscle aLonla-hypoLonla
preclplLaLed by lnLense emouon
Narco|epsy: Catap|exy
22
54
68
87
0 20 40 60 80 100
Sex
Stress
Anger
Laughter
Triggers %
Catap|exy: 1r|ggers
Sparlng of resplraLory and oculomoLor muscles
Memory and consclousness are unaecLed
8ecovery ls lmmedlaLe and compleLe
Cenerally < 2 mlnuLes ln durauon

Narco|epsy: Catap|exy
0 50 100
Generalized
Slurring of
Speech
Jaw Weakness
Leg Weakness
Muscles Affected %
Catap|exy: 8ody Areas Aected
Narco|epsy: C||n|ca| Ieatures
Sleep halluclnauons
May be vlsual, audlLory,
Lacule or klneuc
May be accompanled by
sleep paralysls
Sleep paralysls
LasLs a few seconds or
mlnuLes
AecLs volunLary muscles
Sparlng of resplraLory,
oculomoLor and sphlncLer
muscles
Sensorlum ls unaecLed
Narco|epsy: C||n|ca| Ieatures
Sleep dlsLurbance
8epeuuve arousals and
awakenlngs
May resulL ln sleep-
malnLenance lnsomnla
CLher feaLures
Memory lmpalrmenL
AuLomauc behavlor
PyperacuvlLy and learnlng
dlsablllLy (ln chlldren)

revalence of 0.03 ln Lhe u.S
Cender: M > l
Narco|epsy: Demograph|cs
Loss of hypoLhalamlc hypocreun neurons
uefecuve chollnerglc sysLem regulaung 8LM sleep
lmpalrmenL of noreplnephrlne and dopamlne
sysLems
Narco|epsy: athophys|o|ogy
noL assoclaLed wlLh caLaplexy
CaLaplexy-llke sympLoms may be presenL
rolonged eplsodes of uredness
Muscle weakness assoclaLed wlLh aLyplcal Lrlggers
AccounLs for 10-30 of cases of narcolepsy
MosL have normal CSl hypocreun-1 levels
Narco|epsy W|thout Catap|exy
Cllnlcal hlsLory
narcolepsy wlLh caLaplexy can be dlagnosed by hlsLory
alone
SC followed by MSL1 - when caLaplexy ls absenL,
aLyplcal or equlvocal
Narco|epsy: Lva|uanon
Mean SCL < 8 mlnuLes
2 SC8LMs
ShorLened SCL and SC8LMs ls presenL ln 60-83 of
cases
Narco|epsy: Mu|np|e S|eep Latency 1est
May be used Lo monlLor LreaLmenL response Lo
sumulanL medlcauons used for LuS
Narco|epsy: Ma|ntenance of Wakefu|ness
1est
< 110 pg/mL, or
< 1/3 of mean normal conLrol values


Narco|epsy: CSI nypocrenn 1
90%
60%
38%
25%
12%
0% 50% 100%
With Cataplexy
Without Cataplexy
Normal African American
Normal Caucasian
Normal Japanese
DQB1*0602
Narco|epsy: nLA 1yp|ng
Modanll, armodanll (schedule lv drug)
uexLroampheLamlne
MeLhylphenldaLe (schedule ll drug)
Narco|epsy: 1reatment of Lxcess|ve
S|eep|ness
Pypnouc agenLs
-hydroxybuLyraLe (sodlum oxybaLe)
Narco|epsy: 1reatment of S|eep
D|sturbance
8LM sleep suppressanL agenLs:
SS8l
1CA
venlafaxlne
MACl
-hydroxybuLyraLe
Narco|epsy: 1reatment of Catap|exy
ConsLanL sleeplness desplLe sumclenL, or even
lncreased, amounLs of nlghmme sleep and dayume
napplng
no ldenuable cause

Id|opath|c nypersomn|a
Narco|epsy vs. Id|opath|c
nypersomn|a
Narcolepsy

Idiopathic
hypersomnia

Cataplexy May be present Absent
Daytime napping Transiently
refreshing
Not refreshing
Nighttime sleep Sleep disturbance
common, SOL,
REM SL
May be normal or
prolonged in
duration
Narco|epsy vs. Id|opath|c
nypersomn|a
Narcolepsy

Idiopathic
hypersomnia

MSLT SOL, SOREMPs
present
SOL, SOREMPs
may be present
HLA typing DQB1*0602 CW2
CSF hypocretin

Low levels
(narcolepsy with
cataplexy)
Normal levels (in
some narcolepsy
without cataplexy)

Normal levels
Narco|epsy vs. Id|opath|c
nypersomn|a
Narcolepsy

Idiopathic
hypersomnia

Response to
stimulant therapy
More predictable
improvement





Less predictable
improvement
8ecurrenL eplsodes of hypersomnla occurrlng weeks
or monLhs aparL
normal sleep and alerLness beLween eplsodes
Lxamples:
kleln Levln Syndrome
MensLrual 8elaLed Pypersomnla
kecurrent nypersomn|a
Sleeplness - eplsodes usually lasL abouL 1-2 weeks
Pyperphagla
PypersexuallLy
Aggresslveness and abnormal behavlor
uepressed mood, lrrlLablllLy, and cognluve
lmpalrmenL
Cender: M > l
CnseL durlng early adolescence
k|e|ne-Lev|n Syndrome
useful mnemonlc ls SLx?
Sleeplness
Laung
xLacy
?oung men
k|e|ne-Lev|n Syndrome
nypersomn|a
Medlcal dlsorders
Pepauc encephalopaLhy
PypoLhyroldlsm
rader-Wllll syndrome
8enal fallure
CnS lnfecuons or Lumor
Pead Lrauma
neurologlc and
psychlaLrlc dlsorders
arklnson dlsease
SLroke
ALyplcal depresslon
8lpolar Lype ll mood
dlsorder
Seasonal aecuve dlsorder
Sleep hlsLory
Sleep dlary +/- acugraphy
Sub[ecuve LesLs of sleeplness (LpworLh sleeplness
scale)
SC - Lo exclude CSA and LMu
MSL1 - mean SCL < 8 mlnuLes
MW1 - mean SCL < 40 mlnuLes
LDS: Lva|uanon
Sleep exLenslon (for lnsumclenL sleep syndrome)
napplng
Caelne: Caelne and napplng have addluve eecLs
SumulanL agenLs: AmpheLamlnes, meLhylphenldaLe
or modanll / armodanll
LDS: 1herapy
Whlch of Lhe followlng parasomnlas Lyplcally occurs
durlng 8LM sleep?

a. Confuslonal arousals
b. Sleep Lerrors
c. nlghLmares
d. Sleepwalklng
uesnon:
arasomn|as

hyslcal or experlenual phenomena LhaL occur
durlng sleep
arasomnlas occurrlng durlng n8LM sleep
Confuslonal arousals
Sleep Lerrors
Sleepwalklng
arasomnlas occurrlng durlng 8LM sleep
nlghLmares
8LM sleep behavlor dlsorder
arasomn|as
arasomn|as
nlghLmares

Sleep Lerrors

88u

1lme of nlghL Lauer half of Lhe
nlghL

llrsL half of Lhe
nlghL

Lauer half of Lhe
nlghL

Sleep sLage 8LM sleep


n3 sleep

8LM sleep

Level of
consclousness
Awake and alerL

Confused and
dlsorlenLed

Asleep

Memory of
eplsode
lull recall

arual or
compleLe
amnesla

varlable

SubsequenL

uelayed

8apld

8epeuuve bouLs of eaung or drlnklng durlng
arousals from sleep
Lack of awareness of Lhe abnormal behavlor
1oLal or parual amnesla
8lsk facLors lnclude CSA, sleepwalklng and
medlcauons (zolpldem)
S|eep-ke|ated Lanng D|sorder
Avoldance of sleep deprlvauon
1rlal of sleep exLenslon
1herapy of 8LM sleep behavlor dlsorder
Low-dose clonazepam aL bedume
MelaLonln aL bedume
LnvlronmenLal precauuons
1herapy of arasomn|as
kest|ess Legs Syndrome

An urge Lo move, or unpleasanL sensauons, ln Lhe
legs (less commonly Lhe arms) LhaL
8egln or worsen durlng perlods of resL or lnacuvlLy
Are relleved LranslenLly by movemenL
Are worse, or occur only, aL nlghL
kest|ess Legs Syndrome
useful mnemonlc: luLL
lnacuvlLy
ulscomforL
Legs
Lvenlng
lnacuvlLy causes dlscomforL ln Lhe legs ln Lhe
evenlng
kest|ess Legs Syndrome
revalence of 3-13 of Lhe general populauon
lncreased prevalence wlLh anemla, uremla,
pregnancy and aglng
Cender: l > M
kLS: Demograph|cs
70-90 of persons have LMS
Cne-Lhlrd of persons wlLh LMS have 8LS
Sleep-relaLed complalnLs
Sleep-onseL and sleep-malnLenance lnsomnla
Sleeplness due Lo sleep fragmenLauon

kLS: C||n|ca| Course
Cllnlcal hlsLory
LaboraLory evaluauon
SC ls noL rouunely lndlcaLed
kLS: Lva|uanon
1reaLmenL of underlylng causes or preclplLaung
facLors
lron supplemenLauon lf serum ferrlun < 30 g/L
uopamlnerglc agenLs (levodopa, pramlpexole,
roplnlrole)

kLS: 1herapy
8ecurrenL leg movemenLs (parual exlon of Lhe
ankle, knee and hlp wlLh exLenslon of Lhe blg Loe)
accompanled by complalnLs of sleep dlsLurbance or
LuS
lnvolvemenL of Lhe upper exLremlLy - exlon aL Lhe
elbow
er|od|c L|mb Movement D|sorder
Share many of Lhe rlsk facLors of 8LS
SC ls requlred for dlagnosls
erlodlc llmb movemenL lndex (LMl) ls abnormal lf
> 3 ln chlldren
> 13 ln adulLs
er|od|c L|mb Movement D|sorder
1herapy of LMu ls slmllar Lo LhaL of 8LS
Speclc Lherapy ls noL lndlcaLed for asympLomauc
LMs
er|od|c L|mb Movement D|sorder
C|rcad|an khythm S|eep
D|sorders
Caused by a recurrenL or perslsLenL mlsallgnmenL
beLween Lhe deslred sleep schedule and Lhe
clrcadlan sleep-wake rhyLhm
Can be assoclaLed wlLh lnsomnla or sleeplness (or
boLh)
ulagnosls - hlsLory and sleep dlary or acugraphy

C|rcad|an khythm S|eep D|sorders
Mornlng lark - early bedume (6-9 pm) and early
wake ume (2-3 am)
Sleep-relaLed complalnLs
Lxcesslve sleeplness ln Lhe laLe aernoon or early evenlng
Mornlng awakenlng LhaL ls earller Lhan deslred
CnseL ls commonly durlng mlddle age or older
1herapy
Larly evenlng brlghL llghL Lherapy
Advanced S|eep hase Syndrome
Moote k et ol. 5leep. A comptebeoslve booJbook. wlley 2006
8 M 2 AM
nlghL owl - laLe bedume (1-6 am) and delayed wake
ume (10 am Lo 2 pm)
8oLh sleep-onseL lnsomnla and mornlng sleeplness
CnseL ls oen durlng adolescence
1herapy:
1lmed early mornlng llghL (aer C1mln)
MelaLonln admlnlsLered ln Lhe early evenlng
ChronoLherapy (progresslve phase delay or advancemenL)
De|ayed S|eep hase Syndrome
Moote k et ol. 5leep. A comptebeoslve booJbook. wlley 2006
4 AM 12 M
rogresslve dally delay ln sleep-onseL and wake
umes
Ma[or sleep perlod progresslvely marches"
LhroughouL Lhe day, aernoon and evenlng
8esulL ln petloJlcolly tecottloq problems of lnsomnla
or LuS
MosL aecLed pauenLs are LoLally bllnd and lack
phouc enLralnmenL
1reaLmenL - evenlng admlnlsLrauon of melaLonln
Iree-kunn|ng C|rcad|an D|sorder
Moote k et ol. 5leep. A comptebeoslve booJbook. wlley 2006
no sLable clrcadlan sleep-wake rhyLhms
varlable, lnconslsLenL and muluple sleep and wake
perlods LhroughouL Lhe day and from one day Lo
anoLher
normal aggregaLe sleep ume over a 24-hour perlod
MosL frequenLly seen ln assoclauon wlLh demenua
or menLal reLardauon
1herapy - evenlng admlnlsLrauon of melaLonln
Irregu|ar S|eep-Wake khythm
Moote k et ol. 5leep. A comptebeoslve booJbook. wlley 2006
Summary of key o|nts
Many pauenLs presenL wlLh dlsLurbances ln durauon,
umlng or quallLy of sleep
Lvaluauon of sleep complalnLs relles chley on a
comprehenslve sleep hlsLory
lrequenL follow-up ls recommended Lo deLermlne
response Lo Lherapy as well as developmenL of new
sleep complalnLs
uesnons
Abbrev|anons
AA - auLo-uLraung posluve alrway pressure
ASS - advanced sleep phase syndrome
C81 - cognluve behavloral Lherapy
CSl - cerebrosplnal uld
CCu - chronlc obsLrucuve pulmonary dlsease
C8Su - clrcadlan rhyLhm sleep dlsorder
C1mln - mlnlmum core body LemperaLure
uSS - delayed sleep phase syndrome
LuS - excesslve dayume sleeplness

Abbrev|anons
LSS - LpworLh sleeplness scale
L1CP - alcohol
l8u - free runnlng dlsorder
CL8 - gasLroesophageal reux
PLA - human leukocyLe anugen
lSW8 - lrregular sleep wake rhyLhm
MACl - monoamlne oxldase lnhlblLor
MSL1 - muluple sleep laLency LesL
MW1 - malnLenance of wakefulness LesL

Abbrev|anons
n8LM - non-rapld eye movemenL sleep
C2 - oxygen
CSA - obsLrucuve sleep apnea
A - pulmonary arLery
LMu - perlodlc llmb movemenL dlsorder
LMl - perlodlc llmb movemenL lndex
LMS - perlodlc llmb movemenLs durlng sleep
SC - polysomnography
88u - 8LM sleep behavlor dlsorder

Abbrev|anons
8LM - rapld eye movemenL
8LM SL - rapld eye movemenL sleep laLency
8LS - resLless legs syndrome
SCn - suprachlasmauc nucleus
Su - sleep deprlvauon
SL - sleep emclency
SCL - sleep onseL laLency
SC8LM - sleep onseL 8LM perlod

Abbrev|anons
SLC1 - slngle phoLon emlsslon compuLed
Lomography
SS8l - selecuve seroLonln reupLake lnhlblLor
1CA - Lrlcycllc anudepressanL
1S1 - LoLal sleep ume
v/C - venulauon-perfuslon
WASC - wake ume aer sleep onseL