Professional Documents
Culture Documents
Elliot Matoga
Stanley Tepeka
Symon Nyondo
Themba Luwe
OUTLINE
Normal physiology of sleep
Classification of sleep disorders according to DSM IV
Dyssomnias
Parasomnias
Sleep disorders related to another mental disorder
Other sleep disorders
CLASSIFICATION OF SLEEP
DISORDERS ACCORDING TO
DSM IV
DYSOMINIAS
1. Primary insomnia
2. Primary hypersomnia
3. Narcolepsy
4. Breathing related sleep disorder
5. Circardium rhythm sleep disorder
6. Dyssomnias NOS
PARASOMNIAS
Nightmare disorder(dream anxiety disorder)
Sleep terror disorder
Sleep walking disorder
Parasomnias NOS
SLEEP DISORDER RELATED
TO ANOTHER MENTAL
DISORDER
Insomnia
hypersomnia
OTHER SLEEP DISORDERS
Secondary sleep disorder due to GMC
Substance induced sleep disorder
1. PRIMARY INSOMNIA
Difficult in initiating & maintaining sleep or non
restorative sleep that last for @ least 1 month(DCM IV)
Def excludes all insomnias due to external factors
CLINICAL FEATURES
The primary insomniac goes to bed & is unable to fall
asleep due to conditioned arousal.
This cause the patient to be increasingly alert which further
inhibit the ability to fall asleep and therefore increases the
anxiety
MANAGEMENT
1. Pyschoeducation
2. Sleep restriction
Reduction of time spent on bed
Prescription of bed time
3. Sleep hygiene
Removing all entertainment
No caffeine ,smoking
Reduction of day sleep
Sleep in familiar & comfortable environment
Retire @ the same time in a comfortable bed warm
Mgt cont..
4. Hypnotic drugs
Non-benzodiazines e.g. zopiclone
Benzodiazepines e.g. temazepam
2. PRIMARY
HYPERSOMNIA
DEF
Feature is excessive sleepiness for @ least 1 month as
evidenced either by prolonged sleep episodes, or by
daytime sleep episodes occurring almost daily(DSM IV)
This is a diagnosis of exclusion
CAUSES
Insufficient night time sleep
Unsatisfactory sleep routines or circumstances
Circadium rhythm sleep disorder
Frequent parasomnias
Chronic physical illness
Narcolepsy
Drug effects
MANAGEMENT
As in narcolepsy
NARCOLEPSY
DEF
Features of repeated irresistible attacks of refreshing
sleep, cataplexy and recurrent intrusion of REM sleep into
the transition period between sleep and wakefulness(DSM
IV)
ONSET AND CAUSES
Between 10 & 20 yrs
associated with genetic predisposition
Abnormalities in neurotransmitters eg hypocretin
CLINICAL FEATURES
4 MAJOR SYMPTOMS
1.Sleep attacks
2.Sleep hallucinations
hypnogogic hallucinations and hypnopompic
hallucinations
3. Sleep paralysis
Paralysis of the entire body on waking up from
sleep episode
4.cataplexy
Sudden loss of muscle tone either throughout or
isolated to the jaw muscles
MANAGEMENT
Stimulants e.g. pemolne
Scheduled naps to alleviate the sleepiness for a few hrs
Antidepressants for cataplexy i.e. clomipramine
No treatment for sleep paralysis & hallucinations
4. BREATHING - RELATED
SLEEP DISORDERS
DEF
Essential feature is sleep disruption leading to excessive
sleepiness or insomnia that is judged to be due to
abnormalities of ventilation during sleep(DSM IV)
RISK FACTORS
Nasal obstruction/blockade
Obesity
Abnormality with the soft palate and tongue
CLINICAL FEATURES
Severe snoring
Gasping
Apnoea
Sweating
Heart burn @night
MANAGEMENT
Treatment depends on severity of the apnoea
Nasal continuous positive airway pressure(CPAP)
Mild obstructions
Weight reduction
Medical & nasal decongestants
Surgery on nasal passages
Mouth guards
5. CIRCARDIUM RHYTHM
SLEEP DISORDER
Essential feature is persistent & recurrent pattern of sleep
disruption(DSM IV)
The body clock controlling sleep-wake cycle is usually
synchronized to the 24hr light-dark cycle
CAUSES
JET LAG
Disturbance is proportional to the
number of time zones crossed eg on
eastwards flights-the day is shortened
while westwards its lengthened
MANAGEMENT
Jet lag
Self limiting
Bright light
Melatonin-hormone
Hypnotics
Short acting BZ eg lorazepam/triazoram
Non-BZ
6. DYSSOMNIAS NOS
Sleep disorders not fitting in the above
Management is according to the cinical presentation
PARASOMNIAS
Essential feature is occurrence of repeated frightening dreams
that lead to awakenings from sleep(DSM IV)
Occurs during 2
nd
half of the night & are associated with REM
sleep
Recall of dream is typically intact
These sleep disorders are characterized by abnormal behaviour
or physiological events occurring in association with sleep,
specific sleep stages or sleep-wake transitions.
ONSET AND CAUSES
Peak frequency 5-6yrs
Idiopathic but associated
withPTSD,depression&medicatin withdrawal
Frightening experiences during the day
MANAGEMENT
Antidepressants
Hypnotics
Alcohol
Psychosocial stresssors must be addressed
SLEEP TERROR
DISORDER
Repeated occurrence in the 1
st
half of the night of sudden
awakenings from sleep with a scream and increased motor
& autonomic activity as if terrified.
Occurs in 3
rd
& 4
th
stage of NREM sleep
ONSET AND CAUSES
Common in children
Genetic predisposition-familiar
MANAGEMENT
Improved sleep hygiene
BZ
Antidepressants eg imipramine
hypnotics
SLEEP WALKING
DISORDER
Essential feature is repeated episode of complex motor
behaviour initiated during sleep(DSM IV)
It is an automatism occuring during deep non-REM sleep
usually in the early part of the night
ONSET AND CAUSES
Common in children 5-12 yrs
Genetic predisposition-familiar
MANAGEMENT
Safety
Avoidance of sleep deprivation & other circumstances that
can make them sleep eg alcohol
PARASOMNIAS NOS
These are sleep disorders that does not fit in the explained
categories
Treatment is based on the clinical judgement
SLEEP DISORDERS RELATED TO
ANOTHER METAL DISORDER
INSOMNIA/HYPERSOMNIA
Disturbance of sleep is common in a range of psychiatric
illnesses including:
a) Depression
b) Anxiety
c) psychosis
MANAGEMENT
Management is according to the cause
OTHER SLEEP
DISORDERS
Secondary sleep disorder due to GMC and substance
induced sleep disorders
SECONDARY SLEEP
DISORDER DUE TO GMC
Medical conditions often cause sleep disturbance which
may be either insomnia or hypersomnia
Especially GMC associated with pain
E.g. of GMC with sleep disorder;
Neoplasm
Angina
Epilepsy
trauma
MANAGEMENT
Management is usually according to the cause
SUBSTANCE INDUCED SLEEP
DISORDERS
Sleep disorder may follow the use or abuse of psychoactive
substances
Examples are:
Depressants leading to sedation & hypersomnia
Alcohol
BZ
Those which cause and lead to hypersomnia
Cocaine
amphetamines
Thanks but dont sleep u will
be diagnosed