Sleep Disorders

 

Learn more about the symptoms of Sleep-Wake Disorders, Breathing-Related Sleep Disorders, and Parasomnias.  

Insomnia is often treated with lifestyle modifications (sleep hygiene) and/or hypnotics.  


Sleep-Wake Disorders

Insomnia Disorder

  • Dissatisfaction with sleep quantity or quality, in association with one or more of the following symptoms:
    • Difficulty falling asleep.
    • Difficulty staying asleep (frequent awakenings or problems returning to sleep after awakenings).
  • The sleep disturbance causes significant impairment in social, work, school, or other important areas of functioning.
  • The sleep difficulty occurs at least three nights per week, for at least three months.
  • The sleep difficulty occurs despite sufficient opportunity for sleep.
  • The insomnia is not better explained by another sleep-wake disorder and is not due to a substance (medication or illicit drug) or other medical condition.

Hypersomnolence Disorder

  • Self-reported excessive sleepiness, despite getting at least seven hours of sleep daily, with at least one of the following symptoms:
    • Recurrent periods of sleep within the same day.
    • A prolonged main sleep episode of more than nine hours per day that is non-restorative.
    • Difficulty being fully awake after abrupt awakening.
  • These symptoms occur at least three times per week, for at least three months.
  • The hypersomnolence causes significant impairment in cognitive, social, work, school, or other important areas of functioning.
  • The hypersomnolence is not better explained by another sleep-wake disorder and is not due to a substance (medication or illicit drug) or other medical condition.

Narcolepsy

  • Recurrent episodes of an irrepressible need to sleep, falling asleep or napping occurring within the same day.  These symptoms occur at least three times per week, for at least three months.
  • The presence of at least one of the following:
    • Episodes of cataplexy, defined as either (a) or (b), occurring at least three times per month:
      • (a) In individuals with long-standing disease, brief episodes of sudden loss of muscle tone with maintained consciousness that are caused by laughter or joking.
      • (b) In children or in individuals within six months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or global loss of muscle tone.
    • Hypocretin deficiency (measured using cerebrospinal fluid hypocretin-1 immunoreactivity values).
    • Nocturnal sleep polysomnography showing rapid eye movement (REM) latency ≤ 15 minutes, or a multiple sleep latency test showing a mean sleep latency ≤  8 minutes and two or more sleep-onset REM periods.

Breathing-Related Sleep Disorders

Obstructive Sleep Apnea Hypopnea

Either (1) or (2):

1. Evidence by polysomnography of at least five obstructive apneas (temporary cessation of breathing) or hypopneas (abnormally slow or shallow breathing) per hour of sleep and either of the following sleep symptoms:

  • Nocturnal breathing disturbances, such as snoring, snorting, gasping, or breathing pauses.
  • Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder or medical condition.

2. Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of other symptoms.

Central Sleep Apnea

  • Evidence by polysomnography of five or more central apneas per hour of sleep.
  • The disorder is not better explained by another sleep disorder.

Sleep-Related Hypoventilation

  • Polysomnography shows episodes of decreased respiration associated with elevated carbon dioxide (CO2) levels.
  • The disorder is not better explained by another sleep disorder.

Circadian Rhythm Sleep-Wake Disorders

  • A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual's physical environment or daily schedule.
  • The sleep disturbance causes excessive sleepiness or insomnia.
  • The sleep disturbance causes significant impairment in social, work, school, or other important areas of functioning.

Parasomnias

Non-Rapid Eye Movement Sleep Arousal Disorders

  • Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of a major sleep episode, accompanied by either one of the following:
    • Sleepwalking: Episodes of rising from bed during sleep and walking around.  While sleep walking, the individual has a blank face, is unresponsive to the efforts of others to communicate with him/her, and can be awakened only with great difficulty.
    • Sleep terrors: Episodes of abrupt terror awakenings from sleep, usually beginning with a panicky scream. There is intense fear and bodily signs, such as sweating, increased heart rate, rapid breathing, and pupil dilation.
  • Little or no dream recollection.
  • The individual cannot remember these episodes.
  • The episodes cause significant impairment in social, work, school, or other important areas of functioning.
  • Coexisting mental or medical conditions do not adequately explain the episodes of sleepwalking or sleep terrors.

Nightmare Disorder

  • Repeated occurrences of extended, disturbing and well-remembered dreams, that usually involve efforts to avoid dangerous situations or threats to survival, security, or physical integrity.
  • On awakenings from the disturbing dreams, the individual rapidly becomes alert and oriented.
  • The sleep disturbance causes significant impairment in social, work, school, or other important areas of functioning.
  • The nightmare symptoms are not due to the effects of a medication or illicit drug.
  • Coexisting mental or medical conditions do not adequately explain the disturbing dreams.

Rapid Eye Movement Sleep Behavior Disorder

  • Repeated episodes of arousal during sleep associated with speaking and/or complex motor behaviors (movements).
  • These behaviors arise during rapid eye movement (REM) sleep.
  • Upon awakening from these episodes, the individual is completely alert and not confused or disoriented.
  • Either of the following:
    • REM sleep without atonia (lack of muscle tone) on polysomnographic recording.
    • A history suggestive of REM sleep behavior disorder and an established synucleinopathy diagnosis (such as Parkinson’s disease or multiple system atrophy).
  •  The behaviors cause significant impairment in social, work, school, or other important areas of functioning.
  • The disturbance is not caused by another substance (medication or illicit drug) or medical condition.
  • Coexisting mental or medical conditions do not adequately explain the episodes.

Restless Legs Syndrome

  • An urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs, characterized by:
    • The urge to move the legs begins or worsens during periods of inactivity or rest.
    • The urge to move the legs is partially or totally relieved by moving the legs.
    • The urge to move the legs is worse in the evening or at night, or occurs only in the evening or at night.
  • The above symptoms occur three times per week, for at least three months.
  • The above symptoms cause significant distress or impairment in social, work, school, or other important areas of functioning.
  • The above symptoms are not caused by another mental or medical condition or other substance (medication or drug).
 

The above criteria are adapted from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).