Chapter 14 - Sleep-Wake Disorders

Neonatal Sleep

• Birth to 5 weeks

• Short periods alternating with wakefulness; differentiated

• Indeterminate and not established

Infant Sleep

• 6 weeks to 3 months

• Longer nocturnal periods

• 10 to 19 hours and not established

Early Childhood Sleep

• 1 year to 4 years

• Decrease in daytime naps

• Minimum of 10 hours; well established

School-aged sleep

• 5 years to 11 years

• Excellent with sustained nocturnal sleep; daytime naps are unusual

• Maximum of 10 to 11 hours; well established

Adolescence Sleep

• 12 years to 18 years

• Sleep affected by multifactorial origins

• 9 to 10 hours

Insomnia

• has a typical onset in early adulthood but can occur at any age

• insomnia disorder is directly related to reported satisfaction with the amount and quality of sleep

• must manifest difficulty initiating sleep, maintaining sleep, or early-morning awakening without the ability to return to sleep

Hypersomnolence Disorder

• involves disproportionate amounts of sleep and typically manifests from late adolescence to early adulthood

• with indicators starting between ages of 15 and 25, with a steady symptom development over weeks to month

• not typically diagnosed until at least 10 years after the appearance of the first symptoms

Narcolepsy

• a sleep-wake disorder that may be underdiagnosed during childhood and adolescence

• a disproportionate amount of daytime sleepiness

• is a lifelong, nonprogressive disorder that has bimodal peak onset between the ages of 15 to 25 or 30 to 35

Breathing-Related Sleep Disorders

• Central sleep apnea, obstructive sleep apnea hypopnea, and sleep-related hypoventilation are the three breathing-related disorders identified

Circadian Rhythm Sleep-Wake Disorders

• wake disorder is a result of a persistent disruption in the endogenous sleep cycle because of issues with the physical environment or social or work-related schedule demands

• indicates that a clinician diagnosing circadian rhythm disorder should specify one of six types

Parasomnias

• interplay between waking and nonrapid eye movement (NREM) sleep states and are characterized by a range of undesirable presenting issues

• are some of the more commonly experienced sleep-wake disorders among children and adolescents and can be considered nonthreatening conditions that have little impact on the quality and quantity of sleep

Nightmare Disorder

nightmare disorder involves disquieting or frightening experiences during sleep that arouse the individual and are recalled upon awakening

Rapid Eye Movement Sleep Behavior Disorder

rapid eye movement sleep behavior disorder (REMSBD), involves more complex behavioral patterns (e.g., vocalizations or motor movements) that occur later in the sleep period

Restless Legs Syndrome

• is a sensorimotor, neurological disorder that typically has an onset between ages 20 and 40

• When children experience the symptoms of RLS, the condition is often comorbid with other neurological issues

Medical and Neuropsychological Assessments

• Neuropsychological Assessments

• Polysomnography

• Actigraphy

• Multiple Sleep Latency Test

Multiple Sleep Latency Test

is a common assessment behavioral medical professionals use to measure the relationships among sleepiness

Actigraphy

• is a low-cost objective procedure used to measure body movement through a watchlike device

• a popular assessment process because it can monitor sleep behavior in both home or lab settings

Polysomnography

• provides an objective analysis of wake time, sleep time, and sleep architecture

• has proved to be a more reliable measure of disorders of consciousness

Neuropsychological Assessments

• specialized field of psychology that examines the interplay of brain and behavior

• have specialized training in the assessment and treatment of issues related to normal and abnormal functioning of the central nervous system

Behavioral Health Care Assessment

• Sleep Diaries

• Self-Assessment Questionnaires and Parental Assessments

• Specific Assessment Instruments

Specific Assessment Instruments

• behavioral health clinicians can use a number of specific assessment instruments to identify the symptoms of a sleep-wake disorde

Self-Assessment Questionnaires and Parental Assessments

• have limited reliability but can provide some useful information in conjunction with other assessment procedures

Sleep Diaries

• often ask patients to maintain sleep journals in an effort to track sleep, sleep latency, behavioral disruptions during sleep, the impact of sleep on wake periods, and any other sleep-related phenomena that a patient can report

Behavioral Health Care Interventions

• Sleep Hygiene

• Extinction

• Bedtime Fading

• Diet and Exercise

Diet and Exercise

• Having a healthier lifestyle can improve more than just sleep quality. It can also enhance the adolescent’s mood, increase alertness, and improve academic performance.

Scheduled Awakening

• are the third behavioral method and may be introduced with childhood nightmares that are accompanied by nighttime awakenings.

Bedtime Fading

• initial development of a healthy sleep-wake behavior would be controlling the youth’s bedtime routines.

Extinction

procedures are used to weaken or eliminate objectionable conduct and are frequently employed with reinforcement procedures to intensify a preferred behavior

Sleep Hygiene

• training programs should include didactic instruction that focuses on the interplay between positive health practices and environmental factors

• teaching patients to engage in self-monitoring of sleep behaviors and helping them understand the impact of waking behaviors on sleep function

Medications and Supplements

• Melatonin, a hormone created in the brain, is a common over-the-counter supplement prescribed for individuals who have difficulty sleeping or who have irregular sleep cycles.

  • Melatonin has been useful in treating childhood seizures, insomnia, and poor sleep quality of children diagnosed with autism spectrum disorder and ADHD

• Clonidine is a regulated drug that reduces the body’s heart rate and diminishes pressure in the blood vessels.

Medical Devices

• Continuous positive airway pressure (CPAP) machines and bilevel postulate airway pressure (BPAP) machines are two devices that have been proved to be successful in treating childhood breathing disorders

Surgery

• medical operation choices apply only to the category of breathing-related sleep disorders

• The common surgical procedures for this category involve removing the tonsils, adenoids, or both