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Sleep Disorders CHAPTER 2 Sleep Disorders CHAPTER OUTLINE excessive daytime maintenance of wakefulness sleepiness (EDS) test (MWT) History of Sleep Disorders Apnea Hypopnea Index (AHI) narcolepsy Classifi cation of Sleep Disorders Respiratory Disturbance cataplexy Insomnias Index (RDI) sleep paralysis Sleep-Related Breathing Disorders respiratory effort–related hypnagogic hallucinations Central Disorders of Hypersomnolence arousal (RERA) narcolepsy tetrad Circadian Rhythm Sleep–Wake Disorders upper airway resistance automatic behavior Parasomnias syndrome (UARS) microsleep Sleep-Related Movement Disorders sudden infant death narcolepsy type i Other Sleep Disorders syndrome (SIDS) hypnagogic Chapter Summary central sleep apnea (CSA) hypnopompic central apnea sleep onset REM periods hypercapnia (SOREMPs) LEARNING OBJECTIVES Cheyne-Stokes breathing narcolepsy type ii 1. Discuss a brief history of sleep disorders high-altitude periodic idiopathic hypersomnia 2. Learn the classifi cation of sleep disorders as outlined by the breathing recurrent hypersomnia AASM primary sleep apnea of periodic hypersomnolence 3. Describe the features and symptoms of each disorder infancy kleine-levin syndrome 4. Discuss the social and personal impact of specifi c disorders treatment-emergent central hypersomnia sleep apnea insuffi cient sleep syndrome complex sleep apnea circadian rhythm sleep– KEY TERMS obesity hypoventilation wake disorders pickwickian syndrome behavioral insomnia of syndrome delayed sleep–wake phase Association of Sleep childhood congenital central alveolar disorder Disorders Centers (ASDC) adjustment insomnia hypoventilation syndrome advanced sleep–wake phase International Classi cation of group therapy late-onset central disorder Sleep Disorders (ICSD) light therapy hypoventilation with irregular sleep–wake rhythm insomnia sleep restriction hypothalamic dysfunction disorder psychophysiological self-control techniques alveolar hypoventilation free-running circadian insomnia biofeedback idiopathic central alveolar rhythm idiopathic insomnia sleep-related breathing hypoventilation non-24-hour sleep–wake sleep state misperception disorders primary snoring rhythm disorder paradoxical insomnia obstructive sleep apnea snoring shift work disorder sleep diary (OSA) sleep-related groaning jet lag disorder sleep log obstructive apnea catathrenia parasomnia sleep hygiene hypopnea central disorders of confusional arousal limit-setting disorder oxygen desaturation hypersomnolence sleepwalking EEG arousal multiple sleep latency test sleep terror (MSLT) night terror 12 9781284030273_CH02_Pass3.indd 12 03/04/14 2:19 PM Classifi cation of Sleep Disorders 13 sleep-related eating periodic limb movements in professional sleep societies had developed, including disorder sleep (PLMS) REM-related parasomnias pLM index the ASDC, Clinical Sleep Society (CSS), Association of REM sleep behavior sleep-related leg cramps Professional Sleep Societies (APSS), American Board of disorder (RBD) bruxism Sleep Medicine (ABSM), and National Sleep Foundation isomorphism sleep-related bruxism (NSF). e American Academy of Sleep Medicine was sleep paralysis body rocking known as the Clinical Sleep Society from 1984 to 1986 recurrent isolated sleep head banging paralysis sleep-related rhythmic and the American Sleep Disorders Association from nightmare movement disorder 1987 to 1998; in 1999 it became the American Academy posttraumatic stress benign sleep myoclonus of of Sleep Medicine. disorder (PTSD) infancy In 1990, the AASM developed the fi rst edition of the exploding head myoclonus International Classifi cation of Sleep Disorders (ICSD), syndrome propriospinal myoclonus at sleep-related hallucinations sleep onset (PSM) which categorized and described all known sleep dis- nocturnal enuresis excessive fragmentary orders. A second edition of the ICSD was published in bedwetting myoclonus 2005, and the third edition was published in 2014. e sleep enuresis hypnagogic foot tremor (HFT) information in this chapter is refl ective of the updated sleep talking alternating leg muscle defi nitions and classifi cations of sleep disorders found in sleep-related movement activation (ALMA) disorders sleep starts the ICSD-3. restless legs syndrome (RLS) hypnic jerks periodic limb movement environmental sleep Classifi cation of Sleep Disorders disorder (PLMD) disorder e following pages categorize sleep disorders as 1 History of Sleep Disorders outlined in the third edition of the ICSD : 1. Insomnia Since the beginning of time, humans have been fas- a. Chronic insomnia disorder cinated with sleep. Many early writings discuss sleep b. Short-term insomnia disorder and sleep disorders in a variety of ways. In 1836, c. Other insomnia disorder Charles Dickens published a series of papers called the d. Isolated symptoms and normal variants “Posthumous Papers of the Pickwick Club.” In these writ- ings, he describes a boy named Joe who was overweight 2. Sleep-related breathing disorders and very tired, and who snored heavily. A drawing of the a. Obstructive sleep apnea disorders boy shows an obese young man with a short, fat neck. i. Obstructive sleep apnea, adult From this, the term Pickwickian syndrome was coined; ii. Obstructive sleep apnea, pediatric although it is not used today, it is similar to a sleep disor- b. Central sleep apnea syndrome der called obesity hypoventilation syndrome (OHS). i. Central sleep apnea with Cheyne-Stokes Pioneering sleep researchers in the 1950s and 1960s, breathing such as Nathaniel Kleitman, William Dement, and oth- ii. Central sleep apnea due to a medical dis- ers, identifi ed diff erent stages of sleep and were able to order without Cheyne-Stokes breathing recognize specifi c patterns of these stages throughout iii. Central sleep apnea due to high altitude the night. is, along with the development of new tech- periodic breathing nologies designed to read and record physiological activ- iv. Central sleep apnea due to medication or ities, gave way to the development of the fi eld of sleep substance disorders. In 1961, the Sleep Research Society began v. Primary central sleep apnea informally with such sleep pioneers as Doctors William vi. Primary central sleep apnea of infancy Dement, Allan Rechtschaff en, Nathaniel Kleitman, vii. Primary central sleep apnea of prematurity Michel Jouvet, and Eugene Aserinsky. In 1968, Doctors viii. Treatment-emergent central sleep apnea Rechtschaff en and Anthony Kales produced A Manual of Standardized Technology Techniques and Scoring Systems c. Sleep-related hypoventilation disorders for Sleep Stages of Human Subjects , which defi ned scor- i. Obesity hypoventilation syndrome ing techniques for sleep studies for the next 40 years. ii. Congenital central alveolar hypoventila- In 1970, Dement started the fi rst sleep disorders tion syndrome lab, which provided all-night evaluations of patients iii. Late-onset central hypoventilation with with sleep complaints; within fi ve years there were four hypothalamic dysfunction more sleep centers in business. In 1975, the Association iv. Idiopathic central alveolar hypoventilation of Sleep Disorders Centers (ASDC) was developed, v. Sleep-related hypoventilation due to which is now known as the American Academy of Sleep medication or substance Medicine (AASM). Its sleep center accreditation went into vi. Sleep-related hypoventilation due to eff ect two years later, in 1977. By the early 1990s, several medical disorder 9781284030273_CH02_Pass3.indd 13 03/04/14 2:19 PM 14 CHAPTER 2 Sleep Disorders d. Sleep-related hypoxemia disorder h. Sleep-related movement disorder due to e. Isolated symptoms and normal variants medical disorder i. Snoring i. Sleep-related movement disorder due to ii. Catathrenia medication or substance j. Sleep-related movement disorder, unspecifi ed 3. Central disorders of hypersomnolence a. Narcolepsy type I b. Narcolepsy type II Insomnias c. Idiopathic hypersomnia Insomnia can be defi ned as a complaint of a lack of sleep or d. Kleine-Levin syndrome of nonrestorative sleep. e ICSD-3 defi nes insomnia as “a e. Hypersomnia due to a medical disorder repeated diffi culty with sleep initiation, duration, consoli- f. Hypersomnia due to a medication or dation, or quality that occurs despite adequate opportunity substance and circumstances for sleep, and results in some form of g. Hypersomnia associated with a psychiatric daytime impairment." e ICSD-2 identifi ed several dif- disorder ferent types of insomnia. e ICSD-3 consolidates these h. Insuffi cient sleep syndrome types and groups them into the categories of chronic and 4. Circadian rhythm sleep–wake disorders short-term insomnia. Within the chronic insomnia group- a. Delayed sleep–wake phase disorder ing, several characteristic types of insomnia are defi ned. b. Advanced sleep–wake phase disorder c. Irregular sleep–wake rhythm Psychophysiological Insomnia d. Non-24-hour sleep–wake rhythm disorder Psychophysiological insomnia is very prevalent. e e. Shift work disorder insomnia must last at least one month to classify as f. Jet lag disorder psychophysiological insomnia, and is not caused by an g. Circadian rhythm sleep–wake disorder not outside stressor. Rather, psychophysiological insomnia is otherwise specifi ed (NOS) caused by a learned response that teaches the subject to 5. Parasomnias not fall asleep when planned. e subject typically has a. NREM-related parasomnias no diffi culty falling asleep when sleep is not planned, but i. Disorders of arousal from NREM sleep at the normal bedtime and during planned naps, sleep ii. Confusional arousals
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