SLEEP/WAKE DISORDERS

Nicole Depasquale
CNPY 518
 SLEEP WAKE DISORDERS:
• Insomnia Disorder
• Other Specified Insomnia Disorder
• Unspecified Insomnia Disorder
• Hypersomnolence Disorder
• Other Specified Hypersomnolence
Disorder
• Unspecified Hypersomnolence Disorder
• Narcolepsy
• Breathing-Related Sleep Disorders
• Obstructive Sleep Apnea Hypopnea
• Central Sleep Apnea
• Sleep-Related Hypoventilation
• Circadian Rhythm Sleep-Wake
Disorders
• Other Specified Sleep-wake Disorder
• Unspecified Sleep-wake Disorder
• Parasomnias
• Non–Rapid Eye Movement Sleep Arou
Disorders
• Nightmare Disorder
• Rapid Eye Movement Sleep Behavior
Disorder
• Restless Legs Syndrome
• Substance/Medication-induced
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
• No Longer A Distinction Between Primary
& Secondary Insomnia
• Hypersomnolance Disorder
• Used to be “Hypersomnia”
• Distinction Of Duration
• Acute (Less Than 1 Month)
• Subacute (1 To 3 Months)
• Chronic (Longer Than 3 Months)
• Narcolepsy
• Hypocretin Deficiency Added To
Diagnostic Criteria
• 5 Sub-types Added
• Narcolepsy Without Cataplexy But
Hypocretin Deficiency
• Narcolepsy With Cataplexy But Wit
Hypocretin Deficiency
• Autosomal Dominant Cerebellar At
Deafness, And Narcolepsy
• Autosomal Dominant Narcolepsy,
Obesity, And Type 2 Diabetes Mellit
• Narcolepsy Secondary To Another
Medical Disorder
 CHANGES CONT.

• Circadian Rhythm Sleep-Wake • Parasomnias

Disorders
• Removed Jet-lag
• New Subtypes Include:
• Advanced Sleep-phase Type
• Irregular Sleep-wake Type
• Non–24-hour Sleep-wake Type
• Divides NREM Sleep Arousal Disorders
• Sleepwalking Type & Sleep Terror T
• Sub-divides Sleepwalking into:
• Sleepwalking
• Sleep-related Eating
• 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

• Sleep Restriction Therapy:
• Dictates When You Can Sleep
• Napping/Hours For Sleep
• Stimulus Control Instructions:
• Changes The Sleep/Wake Environment
• Bedroom Only For Sleeping
• Leave When Unable To Sleep
Therapy For Sleep Apnea
• Requires Dental Intervention
• Scans, Evaluation, And Electrical Impu
Stimulation To Determine Physical C
• Behavioral Modifications & Specialized
Exercises To Change Muscular Patter

• 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
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