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Sleep Disorders in Psychiatry
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Insomnia Disorder
Diagnostic Criteria: Dissatisfaction with sleep quantity/quality, difficulty initiating/maintaining sleep, early-morning awakening. Management: Cognitive Behavioral Therapy for Insomnia (CBT-I), sleep hygiene education, and, if necessary, short-term pharmacotherapy.
Restless Legs Syndrome (RLS)
Diagnostic Criteria: Urge to move the legs often accompanied by unpleasant leg sensations, relief with movement, symptoms occur or worsen at rest, and symptoms are worse in evening/night. Management: Iron supplementation if necessary, dopamine agonists, and avoiding caffeine, alcohol, and nicotine.
REM Sleep Behavior Disorder (RBD)
Diagnostic Criteria: Episodes of arousal during REM sleep that result in vocalizations or complex motor behaviors, REM sleep without atonia on polysomnographic recording. Management: Clonazepam and melatonin, and ensuring a safe sleeping environment.
Narcolepsy Type 2
Diagnostic Criteria: Chronic daily need to sleep without cataplexy but with abnormal REM sleep patterns. Management: Scheduled daytime naps, modafinil, and avoiding aggravating factors.
Hypersomnia Disorder
Diagnostic Criteria: Excessive sleepiness despite a main sleep period lasting at least 7 hours, with significant distress or impairment. Management: Stimulants, scheduled naps, and improving sleep hygiene.
Parasomnias
Diagnostic Criteria: Abnormal behaviors or physiological events occurring in association with sleep, specific sleep stages, or sleep-wake transitions. Management: Ensuring safety during episodes, counseling, and in some cases medication.
Sleep-Related Hypoventilation
Diagnostic Criteria: Decreased breathing during sleep leading to elevated levels of carbon dioxide. Management: Addressing underlying conditions, CPAP or BiPAP, and ventilatory support during sleep.
Advanced Sleep Phase Syndrome (ASPS)
Diagnostic Criteria: Persistent early evening sleep onset and early morning awakening. Management: Light therapy in the evening, and possibly melatonin in the morning to delay the sleep phase.
Sleep-Related Hypoxemia Disorder
Diagnostic Criteria: Blood oxygen levels drop during sleep. Management: Administering supplemental oxygen during sleep, addressing underlying conditions, and ventilatory support.
Sleep Terrors
Diagnostic Criteria: Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream. Management: Reassurance, stress reduction, and in severe cases benzodiazepines or antidepressants.
Delayed Sleep Phase Syndrome (DSPS)
Diagnostic Criteria: Habitual sleep-wake times that are significantly later than conventional or desired times. Management: Chronotherapy, bright light therapy in the morning, and in some cases, melatonin in the evening.
Non-24-Hour Sleep-Wake Disorder
Diagnostic Criteria: Sleep-wake pattern that follows a non-24-hour cycle, often in blind individuals. Management: Timing of melatonin, and for sighted individuals, light therapy.
Nightmare Disorder
Diagnostic Criteria: Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams. Management: CBT, imagery rehearsal therapy, and sometimes medication.
Circadian Rhythm Sleep-Wake Disorders
Diagnostic Criteria: Persistent or recurrent pattern of sleep disruption primarily due to alterations of the circadian system. Management: Light therapy, melatonin, and maintaining consistent sleep schedules.
Sleep Apnea Hypopnea Syndrome (SAHS)
Diagnostic Criteria: Five or more episodes of apnea or hypopnea per hour of sleep and symptoms of disrupted sleep. Management: CPAP, weight loss, avoiding alcohol and sedatives, and positional therapy.
Bruxism
Diagnostic Criteria: Grinding or clenching of teeth during sleep, often associated with jaw pain or tooth damage. Management: Dental guard, stress reduction techniques, and muscle relaxants.
Sleep-Related Eating Disorder (SRED)
Diagnostic Criteria: Recurrent episodes of involuntary eating/drinking during sleep with little or no awareness. Management: Addressing any underlying sleep disorder, pharmacological treatment with medications such as topiramate, and behavioral strategies.
Obstructive Sleep Apnea (OSA)
Diagnostic Criteria: Five or more obstructive apneas or hypopneas per hour of sleep and symptoms of sleep disruption. Management: Continuous Positive Airway Pressure (CPAP), weight loss, and in some cases, surgery.
Narcolepsy Type 1
Diagnostic Criteria: Irresistible need to sleep occurring daily for at least 3 months, cataplexy, and deficiency of hypocretin. Management: Scheduled naps, modafinil, and sodium oxybate.
Central Sleep Apnea
Diagnostic Criteria: Five or more central apneas per hour of sleep, with or without symptoms. Management: Treating underlying heart or neurological conditions, CPAP, and adaptive servo-ventilation (ASV).
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