Sleep Disorders Quick Reference

  • Insomnia

    • Definition: persistent difficulty in falling or staying asleep; waking during the night; criteria: at least 33 nights/week for at least 11 month.

    • Consequences: increased anxiety about sleep → higher arousal → further sleep disruption; chronic insomnia linked to feeling overtired and possible depression.

    • Contributing factors: age, drug use, exercise, mental status, bedtime routines.

    • Treatments (brief):

    • Lifestyle: limit stimulants (e.g., caffeine), increase daytime exercise.

    • Medications: OTC or prescribed sleep meds can cause dependence and alter sleep architecture; use with caution.

    • Psychotherapy: cognitive-behavioral therapy (CBT) targeting cognitive processes and behaviors; stress management; has been shown to be effective.

  • Sleep Hygiene and Everyday Sleep Tips

    • Maintain a consistent sleep schedule every day (weekends included).

    • Avoid stimulation within 60ext−67extoF60 ext{-}67^ ext{o}F bedroom temperature range before bed; avoid bright device light.

    • Exercise daily.

    • Avoid naps.

    • Do not eat large meals or consume alcohol/cigarettes/caffeine before bed; alcohol can disrupt REM and cause awakenings.

    • If unable to fall asleep, leave the bed and engage in a quiet activity until sleepy again.

    • Train the bed to be used for sleep (not studying, eating, or watching TV).

  • Parasomnias (disorders with disruptive motor activity or experiences during sleep eg sleepwalking. REM, NREM.)

    • General: can occur in REM or NREM sleep.

    • Sleepwalking (somnambulism)

    • Complex behaviors during sleep, eyes open but unresponsive; usually during slow-wave (NREM) sleep; may occur at any time in some individuals.

    • Historical pharmacotherapy (benzodiazepines, antidepressants) has limited and questionable efficacy.

    • Some improvement when sleep-related breathing problems are treated.

    • REM Sleep Behavior Disorder (RBD)

    • REM atonia is absent; individuals act out dreams with movements (kicking, punching, etc.).

    • Risk of injury to self or partner; no memory of events.

    • Associated with neurodegenerative diseases (e.g., Parkinson’s); may aid in diagnosis/treatment planning.

    • Treatments: clonazepam; melatonin; safety measures to modify sleeping environment.

    • Restless Leg Syndrome (RLS)

    • Uncomfortable leg sensations during inactivity or while trying to sleep; relief with leg movement.

    • Common; associated with conditions like chronic kidney disease and diabetes.

    • Treatments include benzodiazepines, opiates, and anticonvulsants.

  • Night Terrors

    • Panic episodes with screams, attempts to escape; person often has no memory of the event.

    • Typically occur during NREM sleep; usually resolve quickly; treatment not always necessary unless underlying conditions exist.

  • Sleep-Related Breathing Disorders

    • Sleep Apnea: episodes of stopped breathing during sleep; can last 10ext−2010 ext{-}20 seconds or longer; leads to fatigue.

    • Snoring and gasping during sleep are common signs; overweight individuals are at higher risk; may worsen cardiovascular disease.

    • Types:

    • Obstructive Sleep Apnea (OSA): airway blockage during sleep.

    • Central Sleep Apnea: brain signaling to breathe is disrupted.

    • Treatments:

    • Continuous Positive Airway Pressure (CPAP): mask worn during sleep; keeps airway open; effective for mild to severe cases.

    • Compliance with CPAP can be challenging; Expiratory Positive Air Pressure (EPAP) devices show promise as alternatives.

  • SIDS (Sudden Infant Death Syndrome)

    • Infants <1212 months at highest risk; higher risk in boys.

    • Risk factors: prematurity, home smoking, hyperthermia.

    • Recommendations to reduce risk:

    • Place infants on their backs to sleep.

    • Keep crib free of blankets, pillows, bumper pads; avoid caps to prevent overheating.

    • Avoid smoking in the home.

    • Safe to Sleep campaign promotes these guidelines.

  • Narcolepsy

    • Characterized by uncontrollable daytime sleepiness; episodes can occur at inappropriate times.

    • Often accompanied by cataplexy (sudden loss of muscle tone) and sometimes sleep paralysis or vivid hallucinations.

    • Attacks can resemble REM sleep features (e.g., dream-like experiences during attacks); triggered by arousal or stress.

    • Typical episode duration: from a minute or two up to about frac12frac{1}{2} hour.

    • Treatment: psychomotor stimulant drugs (e.g., amphetamines) to promote wakefulness; traditional stimulants do not directly target hypocretin system.

    • Neurobiology: associated with reduced hypocretin (orexin) signaling in parts of the brain; future meds may target the hypocretin system.

    • Variability: symptom presentation and treatment response vary widely among individuals.

    • Case example: a 50-year-old woman with daytime sleepiness and unilateral cataplexy improved when a stimulant was combined with an antidepressant after initial stimulant-alone treatment failed.

  • Homicidal Sleepwalking (Legal Considerations)

    • Historical case: Scott Falater (1997) murdered his wife during a sleepwalking episode; later found guilty of first-degree murder.

    • Demonstrates that dissociated sleep states can have real-world legal and safety implications.

    • Some research supports the possibility of homicidal sleepwalking in certain sleep disorders, prompting ongoing debate about criminal responsibility in such cases.