Psychology
Sleep Disorders
Sleep disorders refer to a range of conditions that disrupt a person's normal sleep patterns. These can include insomnia, sleep apnea, narcolepsy, and restless legs syndrome, among others. These disorders can lead to significant impairment in daily functioning, impacting mood, cognitive abilities, and overall health. Treatment typically involves a combination of behavioral changes, therapy, and in some cases, medication.
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eBook - PDFAbnormal Psychology in Context
The Australian and New Zealand Handbook
- Nadine Pelling, Lorelle Burton(Authors)
- 2017(Publication Date)
- Cambridge University Press(Publisher)
Diagnostic formulations incorporate validated polysomnographic and neurobiologic biomarkers, which distinguish the diagnosis of sleep from most other psychiatric disorders. Unfortunately, it is not possible to review all 10 DSM-5 sleep-wake disorders in one summary chapter. As a result, this chapter will focus on those most often addressed via psychological interventions. Readers interested in a review of the full range of sleeping disorders are referred to the companion academic supplementary materials available for the current textbook. Common to all the DSM-5 sleep-wake disorders is dissatisfaction with the quality, timing, and amount of sleep, together with evidence of impact or distress in everyday functioning. Diagnosis also depends on the sleep problem being primary in origin and not secondary to a known medical condition, disease, or health impairment. However, identifying the primary disorder can be complicated by the bidirectional and often mutually exacerbating relationship that exists between disordered sleep (e.g., insomnia, excessive sleepiness, early morning wakefulness) and many psychiatric and medical conditions. Sleep problems typically do not occur in isolation, but there is good evidence that treating Sleep Disorders can lead to gains, even when secondary to other medical problems. Two distinguishing features of the Sleep Disorders field are: 1. the diversity of disorders; and 2. the degree to which psychological treatments play a role in therapy. 203 Chapter 18 Sleep-wake disorders Some Sleep Disorders are more properly addressed via medical and pharmaceutical interventions, such as narcolepsy with stimulant medication and obstructive sleep apnoea hypopnea disorder with continuous positive airway pressure (CPAP) apparatus, although cognitive behaviour therapy (CBT) has been shown to increase CPAP adherence (Agudelo et al., 2014 ; Richards et al., 2007 ).
eBook - PDF- Simon Green(Author)
- 2017(Publication Date)
- Red Globe Press(Publisher)
74 Chapter X Disorders of sleep Chapter 4 Introduction Do you find yourself yawning during the day, or dozing off while watching TV? Do you feel irritable and sleepy during the day? Do people say you look tired? Are your reactions slow? Do you feel like taking a nap during the day? Do you drink a lot of caffeine to stay alert? Do you hit the snooze button on your alarm to buy yourself just a few more moments in bed? Do you find it difficult to get to sleep? If the answer to any of these questions was yes, this suggests you are lacking in sleep. Everyone suffers from loss of sleep from time to time, but while short-term loss of sleep can be corrected by getting more sleep to overcome the deficit, problems with sleep that occur on a regular basis can indicate the presence of a sleep disorder that requires medical or psychological treatment. Given the pressures of modern life, such as work and family responsibilities and increased opportunities for social-izing and networking, Sleep Disorders have become more frequent, and research into their causes and treatments has expanded accordingly. In this chapter, we will cover: ■ Classifying Sleep Disorders ■ Insomnia ■ Primary insomnia ■ Secondary insomnia ■ Factors influencing insomnia ■ Hypersomnia ■ Narcolepsy ■ Sleepwalking 75 Disorders of sleep Classifying Sleep Disorders The twentieth century saw a dramatic increase in our understanding of both sleep and Sleep Disorders. Broadly, Sleep Disorders are a group of syndromes characterized by disturbances in the amount of sleep, the quality of sleep and the timing of sleep, or in behaviours or the physio-logical states associated with sleep. In 2005, the American Academy of Sleep Medicine (2005) produced the International Classification of Sleep Disorders (ICSD-2), recognized as the main diagnostic tool by both researchers and clinicians. The ICSD-2 identifies over 70 different Sleep Disorders, broadly grouped into two subcategories – dyssomnias and parasomnias.
Available until 4 Dec |Learn more- S. R. Pandi-Perumal, Rocco R Ruoti, Milton Kramer, S. R. Pandi-Perumal, Rocco R Ruoti, Milton Kramer(Authors)
- 2007(Publication Date)
- CRC Press(Publisher)
125 10 Sleep and personality disorders Samuel J Huber, C Robert Cloninger INTRODUCTION – CHALLENGES AND LIMITATIONS Contemporary research in sleep faces several significant methodologic and definitional chal-lenges. 1 Although research criteria in insomnia and other Sleep Disorders have been developed, they have yet to be widely accepted. Also, longitudinal studies have not validated these criteria as identi-fying a discrete subset of pathology with clinical, prognostic, and etiologic correlates. 2 Although difficulty with sleeping is a common concern throughout medicine, it remains difficult to distinguish between sleep as a symptom of another illness (e.g., depression) and sleep as a distinct category of function and dysfunction. As will be discussed below, a third possibility arises in the course of sleep research in psychosomatics, namely that sleep disturbance may be a predictive factor or vulnerability trait predicting future mental illness or its severity. In the absence of validated criteria, attempts have been made to establish working definitions for Sleep Disorders, particularly insomnia. 2, 3 Perhaps some of the variability of results can be accounted for by this heterogeneity of definition or the heterogeneity of the group identified for study. It is also important in this research to identify and acknowledge the impact of substance abuse and comorbid depres-sive illness on sleep and sleep architecture. 1,3 Recent literature will be discussed below, with attention being paid to both sides of the sleep–personality relationship. A body of research exists that attends to the personality configurations of patients with Sleep Disorders, largely insomnia. A separate literature examines the sleep features of patients with personality disorders.
- Andrew Green, Cary Brown(Authors)
- 0(Publication Date)
- Jessica Kingsley Publishers(Publisher)
7 Sleep Disorders Andrew Green and Dietmar Hank 7.1 IntroductionPeople are seldom likely to be referred to occupational therapists for Sleep Disorders alone, although many patients with other conditions also have sleep difficulties, and in order to help manage such difficulties, and to know when to refer, it is important to have an understanding of Sleep Disorders. Essentially, Sleep Disorders can be categorized as insufficient sleep (insomnia), too much sleep (hypersomnia or excessive daytime sleepiness), unusual behaviours in sleep (parasomnia), sleeping at the wrong time (circadian-rhythm disorders) and movement disorders in sleep. Most Sleep Disorders are managed by either medication or cognitive and behavioural strategies, or a combination of these approaches. For example, in the case of insomnia the more effective long-term management is cognitive behavioural therapy for insomnia, whereas in the case of narcolepsy, medication is often effective and there is less emphasis on behavioural management. This chapter explores the major Sleep Disorders and outlines the principles of their management, but it is not intended as a guide to treatment of Sleep Disorders. The next chapter focuses on the non-pharmacological management of some insomnia and excessive daytime sleepiness. (For a concise but full guide to Sleep Disorders see Wilson and Nutt 2013, or for more detailed information see, for example, Avidan and Zee 2011.)7.2 InsomniaThe most common sleep problem is insomnia, which affects about 10–15% of the population (Wilson and Nutt 2013). It is defined as complaints of disturbed sleep in the presence of adequate opportunity and circumstance for sleep. The disturbance may consist of one or more of three features: (1) difficulty in initiating sleep; (2) difficulty in maintaining sleep; or (3) waking up too early. A fourth characteristic, non-restorative or poor-quality sleep, has frequently been included in the definition, although there is controversy as to whether individuals with this complaint share similar pathophysiological mechanisms with the others (NIH 2005, p.5).
eBook - PDF- Alexander Golbin, Howard Kravitz, Louis G. Keith, Alexander Golbin, Howard Kravitz, Louis G. Keith(Authors)
- 2004(Publication Date)
- Taylor & Francis(Publisher)
Section 2: The effect of Sleep Disorders on health and mental function 5 Insomnia: perspectives from sleep medicine and psychiatry Jamie K. Lilie and Henry W. Lahmeyer INTRODUCTION Insomnia can have a serious impact upon one’s ability to perform at work and maintain healthy social relationships, and it can be the source of, or contribute to, a variety of psychological disturbances, including major mood and anxiety disorders. Several studies have also indicated that the length and quality of sleep are related to general health and longevity. Given the potential impact insomnia can have on physical and mental health and well-being, it is not surprising that there has been a proliferation of research in the areas of assessment and treatment for this sleep disorder 1–5 . EPIDEMIOLOGY Despite advances in pharmacological and behavioral treatments, insomnia remains a common problem for both children and adults. Some surveys estimate that in the USA about 75 million people feel their sleep is inadequate 3 . Several large-scale surveys of sleep problems, both in the USA and in Britain, have found that about 30–35% of adults report at least occasional difficulties with falling asleep or staying asleep 3–5 . Furthermore, large-scale studies have consistently found that females report more complaints than males and that the incidence of sleep complaints increases with age 6–8 . DEFINITION OF INSOMNIA Insomnia is defined as an inability to obtain adequate sleep. This statement is sufficiently broad to permit classification of essential commonalities, which are persistence of the complaint (i.e. more than a transient poor night of sleep), and the subjective element as noted by the word adequate. The latter also highlights the fact that individuals vary in their need for sleep.
- Donald Moss, Angele McGrady, Terence C Davies, Ian Wickramasekera, Donald P. Moss, Angele V. McGrady, Terence C. Davies, Ian Wickramasekera(Authors)
- 2002(Publication Date)
- SAGE Publications, Inc(Publisher)
Considering these figures, it is amazing how few people actually consult their physicians about problems during sleep, leaving many of these problems undiagnosed and untreated. NEUROPHYSIOLOGY OF SLEEP Sleep research has come a long way since 1935, when specific stages of sleep character-ized by distinct electroencephalographic (EEG) patterns were first described (Loomis, Harvey, & Hobart, 1935). There are two distinct kinds of sleep: REM (rapid eye movement) and non-REM sleep. These phases of sleep are as different from each other as they are from waking, and can be measured by polysomnography. Non-REM sleep has four stages, which together constitute close to 80 percent of a night’s sleep. 393 394 APPLICATIONS TO COMMON DISORDERS • 395 Sleep and Sleep Disorders Box 28.1 International Classification of Sleep Disorders, Classification Outline 1. Dyssomnias A. Intrinsic Sleep Disorders B. Extrinsic Sleep Disorders C. Circadian rhythm Sleep Disorders 2. Parasomnias A. Arousal disorders B. Sleep-wake transition disorders C. Parasomnias usually associated with REM sleep D. Other parasomnias 3. Sleep Disorders associated with mental, neurological, or other medical disorders 4. Proposed Sleep Disorders American Sleep Disorders Association (1997). Dyssomnias Dyssomnias are the primary sleep dis-orders associated with disturbed sleep at night or impaired wakefulness. They are divided into three major groups: (1) intrinsic Sleep Disorders, (2) extrinsic Sleep Disorders, and (3) circadian rhythm Sleep Disorders. Intrinsic Sleep Disorders Intrinsic Sleep Disorders originate or develop within the body and include psychophysio-logical insomnia, periodic limb movement dis-order and restless legs syndrome, narcolepsy, and obstructive sleep apnea. Psychophysiological Insomnia. Of the intrinsic Sleep Disorders, psychophysiological insomnia is the most common sleep-related complaint encountered in the general popu-lation.
eBook - PDF- Alon Y. Avidan, Cathy Alessi, Alon Y. Avidan, Cathy Alessi(Authors)
- 2008(Publication Date)
- CRC Press(Publisher)
3 Sleep and Psychiatric Illness Wilfred R. Pigeon and Michael L. Perlis Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A. INTRODUCTION Both psychiatric disorders and Sleep Disorders are significant public health issues in the geriatric population. While the prevalence of Sleep Disorders such as insom-nia, sleep apnea, and restless legs syndrome has a pronounced increase across the lifespan (1–3), the prevalence of psychiatric conditions such as mood and anxiety disorders remains somewhat constant from middle to old age (4). Sleep disturbance is a symptom criterion across a number of psychiatric illnesses, including many of the mood and anxiety disorders as delineated in the Diagnostic and Statistical Manual of Mental Disorders, 4th revision (DSM) (5). Most commonly, the sleep dis-turbance is in the form of an insomnia complaint and to a lesser extent it relates to hypersomnia and other common disorders of sleep such as sleep apnea. Alterations in sleep architecture are evidenced across a variety of mood and anxiety disorders when sleep is subjected to polysomnographic evaluation. It is also the case that a host of psychotropic medications either alter sleep architecture and/or contribute to subjective sleep complaints. This chapter will review literature from older populations, although in some areas, the limited number of studies requires the extrapolation of findings from nonelder populations. It is also the case that sleep problems are not measured or defined in a consistent manner across studies. This is especially true for data drawn from epidemiologic and community samples, but is also found in studies in which depression status (and not sleep) was the primary outcome(s). Typically, such inves-tigations report on single-item measures of sleep complaints either developed for the study or embedded within other instruments.
eBook - PDFSleep Apnea
Current Diagnosis and Treatment
- W. J. Randerath, B. M. Sanner, V. K. Somers, J. J. F. Herth(Authors)
- 2006(Publication Date)
- S. Karger(Publisher)
There are numerous Sleep Disorders. However, many behavioral changes occurring during sleep do not necessar-ily represent a health hazard. Moreover, the boundary between normality and disease is often difficult to estab-lish. Snoring, for instance, obviously represents an increase in upper airway resistance. Primary snoring, however, may only be a social nuisance. On the other hand, snoring may further be associated with sleep fragmentation and sleep apnea, thus leading to excessive daytime sleepiness and cardiovascular morbidity. There are also many changes occurring with ageing without significant health impact. For instance, inspiratory flow limitation, a common feature in sleep-disordered breathing (SDB), seems to be very fre-quent during sleep in male adults over 40, without neces-sarily any symptom or health consequence. In the present overview, we refer to the 2nd International Classification of Sleep Disorders (ICSD II) [1], published in 2005. Sleep Disorders have been described in accordance with ICSD II, i.e. insomnia, SDB, hypersomnias, parasom-nias, circadian disorders and movement disorders. The ICSD II can be summarized in eight categories, as shown in table 1. Insomnia Definitions Insomnia is defined as a repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs Randerath WJ, Sanner BM, Somers VK (eds): Sleep Apnea. Prog Respir Res. Basel, Karger, 2006, vol 35, pp 1 – 1 2 Sleep Disorders and Their Classification – An Overview Patrick Lévy a Véronique Viot-Blanc b Jean-Louis Pépin a a Sleep Laboratory and HP2 Inserm ERI 0017, Grenoble University, Grenoble, b Sleep Unit, Lariboisière Hospital, Paris, France despite adequate time and opportunity for sleep and results in some form of daytime impairment [1]. An adult insomniac patient usually complains of difficulty initiating or main-taining sleep. Concerns about insufficient amount of noc-turnal sleep and extended periods of nocturnal wakefulness are usually present.
- Michel Hersen, Jay C. Thomas(Authors)
- 2007(Publication Date)
- SAGE Publications, Inc(Publisher)
Sleep problems are extremely common in children with developmen-tal disabilities (Quine, 2001) and can be identified in nearly every psychiatric condition, including anxiety (Glod, Teicher, Hartman, & Harakal, 1997; Rapoport et al., 1981; Sadeh, 1996), depression (Gregory, Rijsdijk, Dahl, McGuffin, & Eley, 2006; Ivanenko, Crabtree, & Gozal, 2005), attention-deficit/hyperactivity disorder (ADHD) (Owens, 2005), and school refusal (Tomoda & Miike, 1996). The association is considered to be bidirec-tional; however, sleep disturbances at a young age have been found to predict subsequent emotional and behavioral problems during midadolescence (Gregory & O’Connor, 2002). Given the relationship between sleep and children’s emotional and behavioral regulation during the day, it is incumbent upon behavioral health clinicians to screen for pediatric sleep problems during the initial diagnostic evaluation. Children and their parents are often unaware of the connection between sleep, emotional regula-tion, and behavior problems and are unlikely to report sleep disturbances unless asked. At the very minimum, three screening questions should be incorporated into any initial diagnostic interview with the parent and/or the youth: 1. Do you have any concerns about your (or your child’s) sleep? 2. How much sleep do you (or your child) usually get? 3. Has anyone told you that you snore? Does your child snore? When concerns or potential sleep problems arise, a more detailed sleep history (sleep-specific clinical interview) is warranted. With slightly more time investment, behavioral health clinicians can get a more systematic sleep history by using the “BEARS” (Owens & Dalzell, 2001). This pediatric sleep-screening tool is divided into five major sleep domains—Bedtime issues, Excessive daytime sleepiness, Awakening during the night, Regularity and duration of sleep, and Snoring—that affect children between 2 and 18 years of age.
eBook - PDF- S. R. Pandi-Perumal, Milton Kramer(Authors)
- 2010(Publication Date)
- Cambridge University Press(Publisher)
Sleep Disorders are described as vary- ing together with the waxing and waning phases of chronic schizophrenia, whereas insomnia may alternate with excessive sleepiness. For example, the acute exacer- bation of psychotic symptoms is usually accompanied by a severe disturbance of sleep continuity while chronic stable patients may appear as having long periods of uninterrupted sleep. Below are some of the essential features of ICSD indications [6]. Diagnostic criteria The ICSD diagnostic criteria for “Psychoses associ- ated with sleep disturbance” are: a. The patient has a complaint of insomnia or excessive sleepiness. b. The patient has a clinical diagnosis of schizophrenia, schizophreniform disorder, or other functional psychosis. c. Polysomnographic monitoring demonstrates an increased sleep latency, reduced sleep efficiency, an increased number and duration of awakenings, and often a reversed first-night effect. d. The sleep disturbance is not associated with other medical or mental disorders (e.g., dementia). e. The complaint does not meet diagnostic criteria for other Sleep Disorders. Sleep and Mental Illness, eds. S. R. Pandi-Perumal and M. Kramer. Published by Cambridge University Press. # Cambridge University Press 2010. 265 The ICSD minimal criteria are (a) plus (b); it is thus noteworthy that the diagnosis of a sleep disorder in a person with schizophrenia can be solely based on subjective complaints and that polysomnography, i.e., the simultaneous recording of many physiological parameters during sleep, is not required.
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