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Sleep Disorders

Two Major Categories*


Dyssomnias
Parasomnias

*This classification system is similar to that used


by the American Sleep Disorders Association.

Dyssomnias
The sleep itself is pretty normal.
But the client sleeps too little, too

much, or at the wrong time.


So, the problem is with the amount
(quantity), or with its timing, and
sometimes with the quality of
sleep.

Parasomnias
Something abnormal occurs

during sleep itself, or during the


times when the client is falling
asleep or waking up (e.g., bad
dreams.
The quality, quantity, and timing of
the sleep are essentially normal.

The Sleep Disorders chapter has


four major sections:
I.

Primary Sleep Disorders include all


sleep disorders, except:

II.

Sleep Disorder Related to Another


Mental Disorder
III. Sleep Disorder Due to a General
Medical Condition (GMC)
IV. Substance-Induced Sleep Disorder

I. Primary Sleep Disorders


Dyssomnias

A. Primary Insomnia - too little sleep


(criteria listed on p. 604)

Characteristics

Difficulty initiating or maintaining sleep


Persists for 1 month or longer
This diagnosis is rarely independent of an Axis I or
II disorder or a GMC or substance use.

I. Primary Sleep Disorders (cont.)


A. Primary Insomnia (too little sleep)
Often due to:
Major Depressive Episode, Manic Episode, or
anxiety disorder
Commonly misused substances, as well as some
prescription medicines.
Breathing-related problems

The cause sometimes can not be identified.

I. Primary Sleep Disorders (cont.)


A. Primary Insomnia (too little sleep)
Treatment

Vigorous daytime exercise, not exercising before


sleep

Sexual intercourse, if pleasurable

Metronome or ticking clock- slow, 60 beats per


minute or slower, beat of human heart

Relaxation exercises, practice regularly but


condensed to 5 minutes

Decrease stimulation and increase soothing


environments, such as ear plugs or calm reading

Practice good sleep habits

Read How to Become an Insomniac

I. Primary Sleep Disorders

Dyssomnias

B. Primary Hypersomnia (sleeping too much, as


well as being drowsy at times when client should
be alert) (criteria listed on p. 609)

Characteristics
Excessive sleepiness
Persists for 1 month or longer
Rarely a diagnosis independent of an Axis I or II disorder or a
GMC or substance use.

Specify if: Recurrent.

I. Primary Sleep Disorders (cont.)


B. Primary Hypersomnia (too much sleep)
(cont.)

Often due to:


Major Depressive Episode, Dysthymic Disorder
with atypical features
Use of substances is less likely to produce
hyersomnia than insomnia, but it can happen (e.g.,
sleeping pills overdose)

The cause sometimes can not be identified.


Treatment: Exercise when becoming sleepy

I. Primary Sleep Disorders

Dyssomnias

C. Narcolepsy (Sleeping at the wrong time)


(criteria listed on pg. 615)

Characteristics

Sleep intrudes into wakefulness, causing clients to fall


asleep almost instantly
Sleep is brief but refreshing
May also have sleep paralysis, sudden loss of strength, and
hallucinations as fall asleep or awaken.

Treatment: Stimulants, sometimes antidepressants, with


less success.

I. Primary Sleep Disorders

Dyssomnias

D. Breathing-Related Sleep Disorder


(criteria listed on p. 622)
Characteristics

Sleep disruption (excessive sleepiness or


insomnia)

Due to sleep-related breathing condition (e.g.,


Obstructive Sleep Apnea Syndrome)

I. Primary Sleep Disorders


Dyssomnias

D. Breathing-Related Sleep Disorder


Treatment (Criteria on p. 622)

In mild cases: weight loss, sleeping on ones side,


and avoiding hypnotics and alcohol
(To sleep on side, a tennis ball can be sewn into
back of clients sleep wear)
In more serious cases: a machine that provides
continuous positive airway pressure
Surgery: Few benefits

I. Primary Sleep Disorders

Dyssomnias

E. Circadian Rhythm Sleep Disorder (criteria

on p. 629)
Characteristics

Persistent or recurrent pattern of sleep disruption


leading to excessive sleepiness or insomnia, due
to mismatch between sleep-wake schedule
required by a persons environment and his/her
circadian sleep-wake pattern (e.g., shift work, jet
lag).

I. Primary Sleep Disorders


Dyssomnias

E. Circadian Rhythm Sleep Disorder


Treatment: Difficult to treat, because it has to
involve the entire family

Darken bedroom and use soundproofing


Limit caffeine and hard to digest food.
Ensure all family members learns shift
To help jet lag, exposure to sun helps

Specify type: Delayed Sleep Phase Type, Jet Lag


Type, Shift Work Type, and Unspecified Type

I. Primary Sleep Disorders


Dyssomnias
F. Dyssomnia NOS (listed on p. 629)
This category is for insomnias,
hypersomnias, or circadian rhythm
disturbances that do not meet criteria for
any specific Dyssomnia.

I. Primary Sleep Disorders


Parasomnias
A. Nightmare Disorder (Criteria listed on
p. 634)
Characteristics:

(1) Repeated awakenings from bad dreams

(2) When awakened client becomes


oriented and alert

I. Primary Sleep Disorders

Parasomnias

A. Information about Nightmare Disorder

Usually occurs in early morning when REM sleep


dominates.

The same nightmare may recur repeatedly or


different ones may pop up three times a week.

Stress may induce 60% of nightmares.

Half of the cases of nightmare disorder appear


before age 10; 2/3 before age 20.

Dreams are clearly remembered

Drugs can trigger nightmares.

Suddenly withdrawing REM-suppressant


medications and drugs can cause REM rebound.

I. Primary Sleep Disorders

Parasomnias

B. Sleep Terror Disorder (criteria listed on


pg. 639)
Characteristics:
(1)
Abrupt awakening from sleep, usually
beginning with a panicky scream or cry.
(2)
Intense fear and signs of autonomic
arousal
(3)
Unresponsive to efforts from other to calm
client
(4)
No detailed dream recalled
(5)
Amnesia for episode

I. Primary Sleep Disorders

Parasomnias

B. Sleep Terror Disorder


Usually only children have sleep terror disorder.
The client is not having a nightmare.
The eyes are open, screams erupt.
Usually happens in early evening.
In contrast to nightmares, sleep terrors do not respond to
psychotherapy.
Probably due to brain wave upset, fever, or medications
However, some medications may help.

I. Primary Sleep Disorders

Parasomnias

C. Sleepwalking Disorder (criteria listed


on pg. 644)
Characteristics:
(1)

Rising from bed during sleep and walking about.

(2)

Usually occurs early in the night.

(3)

On awakening, the person has amnesia for episode

I. Primary Sleep Disorders

Parasomnias

C. Sleepwalking Disorder
Most sleepwalking children are psychologically normal.
Runs in families.
Begins between ages 6 and 12 and may be stress-related.
Customarily sleepwalkers exhibit other delta-sleep interruptions.
At some time 1-6% of children sleepwalk; of these, 15% do
so occasionally.
Adult sleepwalking is far less common, usually worse and more
chronic.

I. Primary Sleep Disorders

Parasomnias

C. Sleepwalking Disorder
Treatment:
Relaxation techniques
Biofeedback training
Hypnosis.
May need to sleep on the ground floor, have outside
doors securely locked, and have car keys unavailable.

I. Primary Sleep Disorders

Parasomnias

D. Parasomnia NOS (listed on p. 644)


Characteristics:
Abnormal behavioral or physiological
events during sleep or sleep-wake
transitions, but that do not meet criteria
for a more specific Parasomnia

I. Primary Sleep Disorders

Parasomnias

D. Parasomnia NOS (listed on p. 644)


Examples
Sleep-Talking: Often more annoying to partner than to
sleeper. Has no memory in morning. Can be during REM or
delta sleep. In REM sleep, pronunciation is clear and
understandable; in deep sleep (delta) apt to be mumbled and
unintelligible
Sleep paralysis: inability to perform voluntary movement
during the transition between waking and sleep. Usually
associated with extreme anxiety, and sometimes fear of
impending death.
REM sleep behavior disorder: characterized by agitated and
violent behavior.
Parasomnia is present but unable to determine whether it is
primary, due to GMC, or substance induced.

The Sleep Disorders chapter has


four major sections:
I.

Primary Sleep Disorders include all


sleep disorders, except:

II.

Sleep Disorder Related to Another


Mental Disorder
III. Sleep Disorder Due to a General
Medical Condition (GMC)
IV. Substance-Induced Sleep Disorder

II.

Sleep Disorder Related to


Another Mental Disorder

Two Diagnoses

1. Insomnia Related to Another Mental


Disorder (criteria listed on p. 650)
2. Hypersomnia Related to Another
Mental Disorder (criteria listed on p.
650)

II.

Sleep Disorder Related to


Another Mental Disorder

1. Insomnia Related to Another Mental


Disorder
Characteristics
Difficulty in initiating or maintaining sleep
Persists for at least 1 month

2. Hypersomnia Related to Another


Mental Disorder
Characteristics:
Excessive sleepiness
Persists for at least 1 month

II.

Sleep Disorder Related to


Another Mental Disorder

Two Diagnoses
1. Insomnia Related to another mental
disorder indicate the Axis I or II disorder
(criteria listed on p. 650)
2. Hypersomnia Related toanother
mental disorder indicate the Axis I or II
disorder (criteria listed on p. 650)

III. 327.xx Sleep Disorder Due to a


General Medical Condition
(list the GMC) (criteria on p. 654)
Also GMC on Axis III
Prominent disturbance in sleep that is sufficiently
severe to warrant independent clinical attention.
Evidence has to be present that the sleep
disturbance is a direct physiological
consequence of a general medical condition.
Specify Type:
(1)
.52
Insomnia Type
(2)
.54
Hypersomnia Type
(3)
.59
Parasomnia Type
(4)
.59
Mixed Type

IV. Substance-Induced Sleep


Disorder (Indicate Substance)
(criteria is on p. 660)

Characteristics

Evidence must be present that the sleep disturbance


is a direct physiological consequence of substance
use.
Substance use that produces a sleep disorder severe
enough to warrant independent clinical attention

Code:
291.8 Alcohol; 292.89 Amphetamine; 292.89
Caffeine; 292.89 Cocaine; 292.89 Opioid;
292.89 Sedative, Hypnotic, or Anxiolytic; 292.89
Other (or unknown) Substance

IV. Substance-Induced Sleep


Disorder (Indicate Substance)
(criteria is on p. 660)

Types:
Insomnia Type
Hypersomnia Type
Parasomnia Type
Mixed Type
Specify if:
With Onset During Intoxication
With Onset During Withdrawal

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