Sleep/Wake Disorders


Historically, sleep disorders have long been commonly recognized within the context of other psychopathological conditions, but they have been frequently minimized or otherwise ignored as distinct entities or stand-alone psychopathological situations.  Research supporting the current DSM-IV-TR classification system is extremely limited, despite the common sense approach (in my opinion) of grouping sleep disorders primarily on the basis of underlying constellation of symptoms.

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Primary insomnia is the hallmark diagnosis in this category.  It is “characterized by chronic difficulty initiating and/or maintaining sleep or persistent poor-quality sleep.”  (Blaney & Millon, 2009, p. 508)  Individually commonly suffer from mild anxiety, mood disturbances, concentration/memory dysfunction, somatic concerns, and general malaise… but these conditions are generally viewed as symptoms rather than causes.  Insomnia prevalence increases with age, in contrast with sleep onset difficulties are more common in young adults.  It has also been suggested that, generally speak, women are more susceptible than men.  Societal prevalence is between 1% and 2%.  (Blaney & Millon, 2009, p. 508)

I was intrigued by the statement that “the majority of insomnia sufferers tend to overestimate the time it takes them to fall asleep and to underestimate the time they actually sleep to some degree.”  (Blaney & Millon, 2009, p. 510)  This might give some basis to a cognitive-behavioral approach if we can reset those expectations.  A stated by the text, the main problem is that most clinicians don’t have access to the raw data to confirm or refute this subjective complaint.  My question… is it out of the realm of possibility for us to send a client home with a measurement device so we can accumulate that data?

Narcolepsy is characterized by recurrent, irresistible day time sleep episodes.  The “classic tetrad” indicative of narcolepsy includes excessive daytime sleepiness and unintended sleep episodes during situations where most persons could stay awake, abrupt and reversible decrease or loss of muscle tome (without loss of consciousness, also known as cataplexy), and/or awakening from nocturnal or diurnal sleep with an inability to move (sleep paralysis), and finally vivid images and dreams that are evoked just as sleep develops (hypnagogic hallucinations).  (Blaney & Millon, 2009, p. 510)  Narcolepsy generally first appears during adolescence or young adulthood, and is believed to be genetically predisposed.   Life events may precipitate the onsite of this disorder… although it is not clear to me whether they are causes or effects?

Breathing related sleep disorders encompass what is widely known as sleep apnea.  This condition manifests as loud snorting, pauses in breathing, gasping for breath during sleep, headaches on wake, and automatic behaviors during wakefulness or excessive daytime sleepiness.  The headaches on waking part turned my head because I get that all the time… although I haven’t really noticed any other signs or symptoms.  Odd…

Circadian Rhythm Sleep Disorders (CRSDs) represent a mismatch between natural sleep/wake rhythms and the schedule imposed by occupational or social demands.  (Blaney & Millon, 2009, p. 512)  Individuals typically report insomnia at certain times of the day (generally when they want to be sleeping) and excessive sleepiness at other times (generally when they should be awake).

Parasomnias encompass nightmares, night terrors, and sleepwalking.  Nightmare disorder is characterized by repeated awakenings by disturbing dreams.  Sleepwalking and Night Terrors both occur early in the sleep period and appear to represent incomplete arousals from the deepest states of sleep (states 3-4), known as slow wave sleep (SWS).  All of the above are more prevalent in children when compared with adults, and more common in males than in females. (I honestly would have expected it to be more common in females?)

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Reference

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

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