Sleep Disorders

Answers based on DSM-IV-TR and Tasman and First unless otherwise

stated.As of 1Aug07

ICD-9-CM

Since DSM-IV-TR was published, ICD-9-CM had vastly increased the number of sleep disorder diagnoses. While DSM-IV-TR printings in 2006 and 2007 reflected a few of these additions, the board examiners are very unlikely to expect candidates to know most of the new ICD-9-CM additions, so we will not address them in our answers.

Primary Insomnia

Q. The essential feature of primary insomnia is?

Primary Insomnia

Ans. A complaint of difficulty initiating or maintaining sleep or of nonrestorative sleep that last for at least one month and causes significant distress or impairment in important areas of functioning – and is not part of any other medical [including psychiatric] disorder.

Primary insomnia -- Prevalence

Q. Prevalence of primary insomnia?

Primary insomnia -- prevalence

Ans. 1 – 10 % of the population/year.

Primary insomnia – age and gender

Q. What ages and which gender have the highest prevalence of primary insomnia?

Primary insomnia – age and gender

Ans. More in women and increases with age.

Primary insomnia -- course

Q. What is the typical course in primary insomnia?

Primary insomnia -- course

• Ans. While there is considerable variation, usually a precipitating psychological or physical stress leads to a sudden insomnia that often is still present after the stress is removed.

Primary hypersomnia -- essentials

Q. State the essentials to the dx of primary insomnia.

Primary hypersomnia -- essentials

Ans. Almost daily excessive sleepiness for at least a month that is not part of any other disorder and cause significant distress or dysfunction.

“Recurrent” specifier

Q. “Recurrent” specifier = ?

Recurrent specifier

Ans. When there are periods of primary insomnia that last 3 days several times a year for at least two years.

Primary insomnia -- course

Q. Course?

Primary insomnia - course

Ans. Gradual onset in age group 15 – 30.

Narcolepsy -- essentials

Q. Essential features?

Narcolepsy – essential features

Ans. Repeated irresistible attacks of refreshing sleep or/and cataplexy, and recurrent intrusions of elements of REM sleep daily for at least 3 months.

Cataplexy

Q. What is cataplexy?

Cataplexy

Ans. Episodes of sudden, bilateral reversible loss of muscle tone that last for a few seconds to minutes and usually precipitated by intense emotion.

Narcolepsy -- prevalence

Q. Prevalence?

Narcolepsy -- prevalence

Ans. 0.02-0.16% of pop. Genders equal.

Breathing-related sleep disorder

Q. Essentials of this disorder?

Breathing-related sleep disorder

Ans. Sleep disruption leading to insomnia or hypersomnia that is judged to be due to ventilation abnormalities during sleep and not better accounted for by another disorder.

Breathing-related sleep disorder

Q. Prevalence?

Breathing-related sleep disorder

Ans. Prevalence is 1-10% of adult population.

Circadian Rhythm Sleep Disorder

Q. Essential features?

Circadian rhythm sleep disorder

Q. A mismatch between the individual’s endogenous circadian sleep-wake system and exogenous demands regarding the timing and duration of sleep.

Circadian rhythm sleep disorder

Q. Subtypes?

Circadian rhythm sleep disorder

Ans. Subtypes:

Delayed sleep phase type

Jet lag type

Shift work type

Unspecified type

Parasomnias

Q. List the three parasomnias other than parasomnia NOS.

Parasomnias

Ans.

1] Nightmare disorder

2] Sleep terror disorder

3] Sleepwalking disorder

Nightmare disorder

Q. Essential features of nightmare disorder?

Nightmare disorder

Ans. Repeated occurrence of frightening dreams that lead to awakening from sleep.

Nightmare disorder -- prevalence

Ans. Unknown, but between 10 and 50% of children, age 3-5 years, have nightmares that disturb their parents.

Sleep terror disorder

Q. Essential features of sleep terror disorder?

Sleep terror disorder

Ans. Essentials are repeated sleep terrors, consisting of abrupt awaking from sleep with a panicky cry, intense fear and difficult in being awakened and comforted.

[note difference between this disorder and nightmare disorder as to awaken in nightmare disorder, hard to awaken in sleep terror disorder as examiner or exam questions have focused on the difference.]

Sleep terror disorder -- prevalence

Q. Prevalence?

Sleep terror disorder

Ans. Estimates are 1-6% of children, 1% of adults.

Runs in families.

Sleepwalking disorder

Q. Essentials?

Sleepwalking disorder

Ans. Repeated episodes of complex motor behavior initiated during sleep, including rising from bed and walking.

Sleepwalking disorder

Q. Prevalence?

Sleepwalking disorder

Ans. 10 to 30% of children have at least one episode and 2-3% have repeated episodes. Peak prevalence is about the age of 12. Rare in adults.