SLEEP DISORDER S

CLASSIFICATION
• Dyssomnias 1. Insomnia 2. Hypersomnia 3. Disorders of sleep-wake schedule.
Parasomnias 1. Stage 4 sleep disorders 2. Other sleep disorders.
Dyssomnias
• Dyssomnias are sleep disorders that are characterised by disturbances in the amount,
quality or timing of sleep.
Insomnia(Disorder of Initiation and/or Maintenance
of Sleep)
• 1. Diffi culty in initiating sleep (going-off to sleep).
• 2. Diffi culty in maintaining sleep (remaining asleep)
• 3. Non-restorative sleep (poor quality sleep).
Aetiology
1. Medical illnesses(PMS ( Periodic movements in sleep),Heart diseases)
2. Alcohol and drug use(Amphetamine)
3. Psychiatric disorders(Mania,Anxiety disorder )
4. Idiopathic insomnia
PMS ( periodic movements in sleep)
• 1. Periodic Limb Movement Disorder (PLMD),
• 2. ‘ Restless Legs’ Syndrome

Periodic Limb Movement Disorder (PLMD) is characterised by sudden, repeated contraction of

one or more of muscle groups (usually of the legs) during sleep. Often occurring
bilaterally, it is followed by partial (most commonly) or complete arousal.
Restless Legs’ Syndrome (Ekbom syndrome) RLS is a condition in which the person expe
riences, during waking, an extremely uncom fortable feeling in the leg muscles.
Sometimes, it may resemble painful creeping sensations deep inside the calf muscles.
• Treatment
• 1. A thorough medical and psychiatric assess ment.
• 2. Polysomnography
• 3. Treatment of the underlying physical and/or psychiatric disorder,
• 4. Withdrawal of current medications, if any.
• 5. Relaxation techniques before sleep time and education regarding sleep hygiene
• 6. Psychotherapy,
• 7. Benzodiazepines may be used
Hypersomnia(Disorder of excessive somnolence)
• Excessive day time sleepiness
• ‘ Sleep attacks’ during day time (falling asleep unintentionally).
• ‘ Sleep drunkenness’ (person needs much more time to awaken; and during this period is confused or disoriented).
Hypersomnia is seen in about 1-2% of general population at any given time
Aetiology
• Narcolepsy
• Sleep apnoea
• Sleep deprivation
• Trypanosomiasis
• Alcohol and drug use
Narcolepsy
• characterised by excessive daytime sleepiness, often disturbed night-time sleep and disturbances in the REM-sleep
• REM-sleep usually occurs within 10 minutes of the onset of sleep.(Normal REM latency is 90-100 minutes.)
• The common age of onset is 15-25 years, with usually a stable course throughout life. The prevalence rate of narcolepsy is about 4
per 10,000.
classical tetrad of symptoms
1. Sleep attacks
2. Cataplexy-characterised by a loss of muscle tone in the various parts of body
3. Hypnagogic hallucinations
4. Sleep paralysis
The treatment consists of forced naps at regular times in the day, stimulant medication (such as amphetamines) or modafi nil in some
patients, and/ or antidepressants (particularly when cata plexy is a prominent symptom)
Sleep Apnoea
• characterised by presence of repeated episodes of apnoea during sleep
• commoner in elderly and obese ( Pick wickian syndrome). Typically, there are 5 or more
apnoeic episodes per hour of sleep and the total number of apnoeic episodes exceeds 30
during one night’s sleep. In severe cases, the number of episodes may be in hundreds
• bed part ner may report of loud snoring, rest less sleep or of periodic absences of breathing.
• The treatment consists of avoidance of alcohol and depressant medications, use of stimulants
such as caffeine, regular exercises, losing excess weight, teaching correct sleeping posture, and
corrective procedures for obs tructive sleep apnoea (e.g. mechanical tongue retaining device).
Very severe obstructive sleep apnoea may necessitate tracheostomy (functional only at night),
CPAP (continuous positive airway pressure) through nasal mesh, or even pharyngoplasty.
Disorders of Sleep-wake Schedule
• characterised by a disturbance in the timing of sleep. The person with this disorder is not able
to sleep when he wishes to, although at other times he is able to sleep adequately.
Aetiology
1. Jet lag’ or rapid change of time zone
2. Work-shift’ from day to night or vice-versa.
3. Unusual sleep phases
Treatment No specific treatment is usually needed. Benzodiazepines may be needed for short-term
correc tion of insomnia. Changes in ‘work-shifts’ may be needed for persons with unusual sleep
phases. Exposure to sunlight during outdoor activity (instead of staying indoors) and adopting
the local (new) hours for sleeping (and working) can help in combating jet lag.
Parasomnias
• Parasomnias are dysfunctions or episodic noc turnal events occurring with sleep, sleep
stages or partial arousals.Most parasomnias are common in childhood though they may
persist into adulthood
Stage 4 Sleep Disorders
• Sleep-walking ( somnambulism)-The patient carries out automatic motor activities that
range from simple to complex. He may leave the bed, walk about or leave the house.
• Sleep-terrors or night terrors ( pavor nocturnus)-patient suddenly gets up screaming
with auto nomic arousal (tachycardia, sweating and hyperventilation). He may be diffi cult
to arouse and rarely recalls the episode on awa kening
• Sleep-related enuresis (bedwetting):
• Bruxism (teeth-grinding)-patient has an involuntary and forceful grinding of teeth during
sleep
• Sleep-talking ( somniloquy)-patient talks during stages 3 and 4 of sleep but does not
remember anything about it in the morning on awakening.
• Treatment Since benzodiazepines suppress stage 4 of NREMsleep, a single dose at
bedtime usually provides relief from stage 4 parasomnias.
Other Sleep Disorders
Nightmares ( dream anxiety disorder)-characterised by fearful dreams occurring most commonly in
the last one-third of night sleep. The person wakes up very frightened and remembers the
dream vividly.occur during the REM-sle ep.
night terrors -which occur early in the night, are a stage 4 NREM disorder, and are characterised by
complete amnesia.
Other sleep disorders include nocturnal angina, nocturnal asthma, nocturnal seizures, paroxy s mal
nocturnal haemoglobinuria, nocturnal head banging, and familial sleep paralysis.
Treatment There is no specific treatment. Treatment of the underlying condition is the most impor
tant step. The treatment of nightmares is by suppression of REMsleep, e.g. by bedtime dose of a
benzo diazepine. However, on stopping the drug, a rebound increase in symptoms may occur.
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