Sleep Disorder Diagnosis

0:00 this talk is an overview of the diagnosis of sleep disorders this talk will review the diagnosis in the DSM chapter titled sleep wake disorders with visual organizers and pneumonics to help you remember the criteria specifically I'll review what I consider to be the core Sleep Disorders listed here on the left then move on to the Sleep behavior disorders and sleep breathing disorders on the right let's start with insomnia disorder insomnia disorder involves poor sleep quantity or quality despite adequate opportunity for sleep in other words even though the patient has adequate time and space to sleep they are unable to get restorative sleep these sleep problems generally fall into one of three categories depending on where in the Sleep Cycle the problems occur early insomnia involves problems with sleep onset in other words problems

0:45 with falling asleep middle insomnia involves problems with sleep maintenance in other words waking up in the middle of the night late insomnia involves problems with waking from sleep that is waking up too early for example this might involve consistent ly waking up before your alarm moving on hypersomnolence disorder involves excess sleepiness despite getting an adequate amount of sleep that is at least 7 hours of sleep per night this is associated with at least one of the following symptoms a non-restorative main sleep period of more than 9 hours recurrent lapses into sleep in other words frequent naps throughout the day or difficulty being fully awake after abruptly Awakening from sleep next narcolepsy involves recurrent lapses into sleep associated with with one of three characteristics cataplexy episodes

1:33 which refer to a sudden loss of muscle tone deficiency of hypocretin a neuropeptide that promotes wakefulness or a sleep study showing a REM sleep latency of less than 15 minutes in other words the patient passes very quickly into REM sleep for each of these disorders the Sleep problem must occur at least three times per week for 3 months next the Circadian rhythm disorders involve a persistent alteration in circadian rhythm and sleep schedule a associated with excess sleepiness or insomnia this can take one of several forms in the delayed type the patient falls asleep and wakes up late whereas in the advanced type the patient falls asleep and wakes up early in the irregular type the sleep schedule is variable in the non- 24-hour type the sleep schedule does not follow a usual

2:19 24-hour cycle for example they may sleep every 12 hours or only sleep once every 36 hours and in the shift work type the sleep schedule adjusts to shift work so for example they may be awake at night and asleep during the day these are the core Sleep Disorders let's next cover the Sleep behavior disorders also known as the parasomnias REM sleep behavior disorder involves midnight arousals with vocalizations or Complex Motor behaviors such as acting out dreams kicking thrashing or shouting the patient may awaken during these episodes and when they do they are rapidly alert and oriented pathologically this disorder involves REM sleep without the usual muscle a Tonia and is associated with Alpha clean diseases such as Parkinson's disease non-rem sleep arousal disorder

3:06 involves sleep Terrors which are sudden arousals from sleep involving sitting up intense fear screaming and autonomic activation and sleepwalking which includes elaborate and apparently gold Ed Complex Motor behaviors such as walking while still asleep when the patient awakens in the morning their dreams and sleep behaviors are not recalled this should be contrasted with nightmare disorder in which the patient has dysphoric and threatening dreams that are recalled in the morning you can see that dream recall is a key difference between these disorders finally restless leg syndrome involves a recurrent urge to move one's legs most often occurring at night and before sleep this urge worsens with an activity and is relieved with movement let's conclude with the Sleep breathing disorders which are diagnosed based on sleep study obstructive sleep apnea

3:54 involves a sleep study showing at least five obstructive apneic events per hour similarly Central sleep apnea involves at least five central apneic events per hour in obstructive apneic events the patient is attempting to breathe but is unable to due to respiratory obstruction so it is a respiratory tract problem in central apneic events the patient does not attempt to breathe so it is a problem with the stimulation of respiratory drive in the brain finally sleep related hypoventilation involves decreased frequency of respirations while sleeping leading to an increase in serum CO2 levels all of these problems are associated with daytime fatigue or a nighttime breathing issue such as loud snoring coughing or choking during sleep that's the end of this talk I hope this is a useful guide to these disorders

4:41 thank you