SLEEP/WAKE DISORDERS
Nicole Depasquale
CNPY 518
SLEEP WAKE DISORDERS:
• Insomnia Disorder • Circadian Rhythm Sleep-Wake
• Other Specified Insomnia Disorder
Disorders
• Unspecified Insomnia Disorder • Other Specified Sleep-wake Disorder
• Unspecified Sleep-wake Disorder
• Hypersomnolence Disorder
• Other Specified Hypersomnolence • Parasomnias
Disorder • Non–Rapid Eye Movement Sleep Arou
• Unspecified Hypersomnolence Disorder Disorders
• Nightmare Disorder
• Narcolepsy
• Rapid Eye Movement Sleep Behavior
• Breathing-Related Sleep Disorders Disorder
• Obstructive Sleep Apnea Hypopnea • Restless Legs Syndrome
• Central Sleep Apnea
• Substance/Medication-induced
• Sleep-Related Hypoventilation Sleep Disorder
IMPORTANCE OF SLEEP/WAKE CYCLES
• Healthy Sleep Is Required For Restoring Functioning And Vitality
• Promotes Memory Consolidation
• Maintains Immune Function
• Approximately 60 Million Americans Suffer With Sleep Disorders
• Estimated Costs Of About $16 Billion Each Year In Medical Care
• Khurshid, 2015
DSM-IV TO DSM-V CHANGES:
• DSM-5 Sleep-Wake Disorders Are Now More In Sync With Medical Sleep
Disorders Classification Systems
• Dsm-5 Takes Into Consideration Pathological And Etiological Factors - Based
On Knowledge Gained From Sleep Studies
• Increases Uniformity And Consistency Among Assessment And Treatment
CHANGES
• Insomnia • Narcolepsy
• Hypocretin Deficiency Added To
• No Longer A Distinction Between Primary
Diagnostic Criteria
& Secondary Insomnia
• 5 Sub-types Added
• Narcolepsy Without Cataplexy But
• Hypersomnolance Disorder Hypocretin Deficiency
• Used to be “Hypersomnia”
• Narcolepsy With Cataplexy But Wit
• Distinction Of Duration Hypocretin Deficiency
• Acute (Less Than 1 Month) • Autosomal Dominant Cerebellar At
Deafness, And Narcolepsy
• Subacute (1 To 3 Months)
• Autosomal Dominant Narcolepsy,
• Chronic (Longer Than 3 Months)
Obesity, And Type 2 Diabetes Mellit
• Narcolepsy Secondary To Another
Medical Disorder
CHANGES CONT.
• Circadian Rhythm Sleep-Wake • Parasomnias
Disorders • Divides NREM Sleep Arousal Disorders
• Removed Jet-lag • Sleepwalking Type & Sleep Terror T
• New Subtypes Include: • Sub-divides Sleepwalking into:
• Advanced Sleep-phase Type • Sleepwalking
• Irregular Sleep-wake Type • Sleep-related Eating
• Non–24-hour Sleep-wake Type • Sleep-related Sexual Behavior
(Sexsomnia)
CHANGES CONT.
• Substance/Medication Induced • Breathing Related Sleep Disorde
Sleep Disorder • Pathophysiologic Basis Of These Disor
• Now Includes Medication-induced Sleep • Obstructive Sleep Apnea Hypopnea
Disorder
• Central Sleep Apnea
• Restless Legs Syndrome
• Sleep-related Hypoventilation
• Now Its Own Diagnosis
TREATMENT
• Narcolepsy
• Insomnia
• Pharmacology
• Behavioral Controls Show Great Treatment
• Stimulants
• Stimulus Control Therapy
• Amphetamines
• Multi-component CBT (CBT-I)
• Finils
• Relaxation
• SSRI’s - Antidepressants
• Bio-feedback
• Stimulus Control Therapy
• Sleep-hygiene
• Psychotherapy
• Hypersomnolence Disorder
• Pharmacology
• Stimulant
• Amphetamines
• Adjunctive Behavior Therapy
TREATMENT CONT.
• Circadian Rhythm Sleep-wake • Parasomnias
Disorders • Can Be Caused By Anti-depressants &
• Strategically Timed Melatonin SSRI’s
• Light Therapy • Benzodiazepines & Anticonvulsants
• Behavioral Interventions For Children & • Hypnosis
Adults With Dementia • Relaxation/Meditation
• Against Sleep Inducing Medications For
Elderly With Dementia
• Breathing Related Sleep Disorders
• CPAP Machine
• Surgery
TREATMENT CONT.
• Substance/Medication Induced • Restless Legs Syndrome
Sleep Disorder • Still Researching
• Often A Factor In Alcohol, Opioids & • Anxiety & Depression Therapy
Methadone Use/Recovery
• Pharmaceutical & Vitamin C
• Substance Abuse Induced
• Vibration Pads & Physical Therapy
• Recovery Process
• Sleep Inducing Medications
• Wake Inducing Medication
NON-PHARMACEUTICAL THERAPIES
CBT-I : CBT For Insomnia • OMT: Orofacial Myofunctional
Therapy For Sleep Apnea
• Sleep Restriction Therapy:
• Dictates When You Can Sleep • Requires Dental Intervention
• Napping/Hours For Sleep • Scans, Evaluation, And Electrical Impu
Stimulation To Determine Physical C
• Stimulus Control Instructions:
• Changes The Sleep/Wake Environment • Behavioral Modifications & Specialized
• Bedroom Only For Sleeping Exercises To Change Muscular Patter
• Leave When Unable To Sleep
• Sleep Hygiene Education
• Do’s & Don’ts Of Sleep/Wake Cycle
• Do – Cool/Dark
• Don’t – Caffeine/Tabaco/Alcohol
• Relapse Prevention
• Sleep Diary
• Immediate Return To Therapy
NON-PHARMACEUTICAL THERAPIES
• Bio-Feedback Therapy: • Adjunctive Therapies:
• Uses sensors to monitor muscle tension & • Hypnosis
brain rhythms
• Used Often For Nightmare Disorders
• Monitors heart rate, tension levels,
somatic reactions • Placebo Effect
• Requires client to become aware of • Possible Psychological Damage
physical reactions • Meditation
• Used in conjunction with relaxation • Used Often For Insomnia And Nightm
techniques Disorders
• Light Therapy
• Resets Circadian Rhythm
• Time Commitment
• Possible Side-effects (Dry Eye/Headach
• Can Be Used As Alarm
REFERENCES
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implications for myofunctional therapy. International Journal of Pediatric Otorhinolaryngology,90, 5-11. doi:10.1016/j.ijporl.2016.08.019
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