General Introduction 

Sleep disturbances are common in the general population and among patients with mental disorders. Insomnia is the most prevalent disoreder. Up to 30% of the population suffers from insomnia and seeks help for it. Other conditions include excessive daytime sleepiness, difficulty sleeping during desired sleep time, and unusual nocturnal events, such as nightmares and sleepwalking.

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Sleep Stages:

Sleep is Measured with a polysomnograph, which simultaneously measures brain activity -electroencephalogram (EEG), eay movement -electro-oculogram (EOG), and muscle tone - electromyogram(EMG).Other physiological tests can be applied during sleep and measured along with the above. EEG findings are used to describe sleep stages.

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Dyssomnias

1. Primary insomnia:
The trem "primary" indicates that the insomnia occurs independently of any known physical or mental condition. It is characterized by difficulty in falling asleep and repeated awakenings, which continue for at least a month.

2. Primary hypersomnia:
Diagnosed when no other cause for excessive comenolence occurring for at least 1 month can be found. Treatment consists of stimulant drugs (such as amphetamines) given in the morning or evening.

3. Narcolepsy:
Characterized by symptom tetrad- (1) excessive daytime somnolence, (2) cataplexy, (3) sleep paralysis, and (4) hypnagogic hallucinations.

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Cataplexy

1. Reported by 70-80% of narcoleptics.

2. Brief (seconds to minutes) episodes of muscle weakness of paralysis.

3. No loss of consciousness, if episode is brief.

4. When attack is over, the patient is completely normal.

 

Sleep paralysis:

1. Reported by 25-50% of general population.

2. Temporary partial or complete paralysis in sleep -wake transitions.

3. Most commonly occurs upon awakening.

4. Conscious but unable to move.

5. Generally lasts less than 1 minute.​

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Dyssomnia not otherwise specified (NOS)

Nocturnal myoclonus

1. Stereotypical leg movement - periodic every 30 seconds.

2. No seizure activity.

3. Most prevalent in patients over age 55.

4. Frequent awakenings.

5. Unrefreshing sleep.

6. Daytime sleepiness is a major symptom.

7. Patient is unware of the myoclonus events.

8. Various drugs have been reported to help. these include clonazepam (Klonopin), opioids, and l-dopa (Larodapa).

 

Restless legs syndrome

1. Uncomfortable sensations in legs at rest.

2. Not limited to sleep, but can interfere with falling asleep.

3. Relieved by movement.

4. Patient may have associated sleep-related myoclonus.

5. Benzodiazepines, eg. clonazepam, are the treatment of choice. In severe cases , L-dopa or opioids may be used

 

Menstrual-associated syndrome
Some women experience intermittent marked hypersomnia, altered behavioural patterns and voracious eating at or shortly beforethe onset of menses.

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Insufficient sleep
Characterized by complaints of daytime sleepiness, irritability, inability to concentrate judgment by a person who persistently fails to sleep enough to support alert wakefulness 

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Parasomnias:

Nightmare disorder

1. Nightmares almost always occur during REM sleep.

2. Can occur at any time of night

3. Good recall (quit detailed)

4. Long, frightening dream in which one awakeness frightened

5. Less anxiety, vocalization, motility ,and autonomic discharge than in sleep terrors

6. No specific treatment; benzodiazepines may be of help

 

Sleep terror disorder

1. Especially common in children

2. Sudden awakening with intense anxiety

3. Autonomic overstimulation 

4. Movement

5. Crying out

6. Patient does not remember the event.