Classification and Description of Sleep Disorders
These disorders are not primarily disorders of sleep and wake states per se. Rather, they are disorders of partial arousal or disorders that interfere with sleep stage transitions.
1. Confusional arousals (sleep drunkenness or excessive sleep inertia)
This disorder is an extreme example of the slowness most people feel upon awakening. People with confusional arousals respond poorly to commands or questions, and they have major memory impairment of things that have just happened or happened a short time before. They may exhibit bizarre and strange behavior. Example: picking up a lamp and talking as if it is a phone. Typically occur when someone is aroused from a deep sleep in the first part of the night.
Sleepwalkers engage in behaviors not usually associated with sleep, such as sitting up in bed, walking about, or even frantic attempts to "escape." These actions are apparently initiated during slow wave sleep. Sleepwalking may end by itself when the sleepwalker returns to bed and goes back to sleep.
3. Night terrors
This disorder is characterized by a sudden arousal from slow wave sleep with a piercing scream or cry and signs of intense fear. The individual usually sits up in bed with eyes open, but is unresponsive to other people or stimuli. If awakened, the patient is confused and disoriented. People usually can't remember the event or have vague, dreamlike images of it. This is usually a disorder of childhood.
Sleep-wake transition disorders
1. Rhythmic movement disorder
This a group of repeated movements (usually in the head and neck) that typically occur immediately before sleep. This disorder is usually found in children age one or younger. The child may lie prone and repeatedly lift the head or entire upper body, and then forcibly bang the head back on the pillow. Or the child may sit against the wall or headboard and repeatedly bang the back of his head against it. Because of this, the disorder is sometimes called "head banging," but it can involve other movements, such as a body rolling or rocking on hands and knees.
2. Sleep starts
Sleep starts are sudden, brief contraction of muscles in the legs, arms, or head, that occur just as people are falling asleep. These hypnagogic jerks are felt by most people at some time, but when they are very strong or frequent they can lead to insomnia.
3. Sleep talking
This problem can be precipitated by emotional stress, fever, or sleep disorders such as night terrors or even sleep apnea. The talk is usually brief and devoid of emotional content, but it can be a long speech or infused with anger and hostility.
4. Nocturnal leg cramps
As the name suggests, these are leg cramps (usually in the calf) that occur spontaneously during sleep. They may last for only a few seconds or as long as 30 minutes. The cramps cause arousal and disturb sleep.
Parasomnias usually associated with REM sleep
The sleeper is awakened from REM sleep with frightening dreams.
2. Sleep paralysis
People with sleep paralysis are unable to perform voluntary movements either right before they go to sleep or upon waking in the morning. Sleep paralysis most often lasts for several minutes and then disappears.
3. Impaired sleep-related penile erections
In men, erections are a natural part of REM sleep. When REM- related erections are not present, it indicates a physical cause of impotence.
4. Sleep-related painful erections
Sometimes the erections associated with REM sleep can be so intense as to be painful. This may cause nighttime awakenings during REM sleep, and subsequent sleep loss.
5. REM sleep-related sinus arrest
This is a rare disorder in which the heart will periodically stop beating during REM sleep. Heart stoppages can last up to nine seconds before starting again. This is different from cardiac arrest caused by sleep apnea.
6. REM sleep behavior disorder
In this disorder, the usual REM-associated muscle paralysis is absent, so that people act out the dreams they are having. Punching, kicking, leaping, and running from the bed are common.
1. Sleep bruxism
Grinding or clenching teeth during sleep. The sound of grinding teeth can be unpleasant to others who hear it and can cause excessive tooth wear in the individual. It can also lead to jaw pain and headaches while awake.
2. Sleep enuresis (bedwetting)
Urination at night is found in every infant, but as children are toilet trained, they become more able to control their bladder at night. Usually, though, regular bedwetting disappears after the age of five. It is estimated that regular bedwetting occurs in 10 percent of 6-year-olds, 5 percent of 10-year-olds and 3 percent of 12-year-olds. When there are no other neurological, psychiatric, or urological problems that may cause bedwetting, it is called "primary enuresis." There is evidence that primary enuresis is hereditary.
3. Sleep-related abnormal swallowing syndrome
People with this disorder have inadequate swallowing of their saliva while sleeping. Saliva builds up in the mouth, then flows down the throat and is breathed into the lungs. The sleeper wakes up choking and coughing.
4. Sudden unexplained nocturnal death syndrome
This syndrome is typified by sudden death in healthy young adults while they sleep. Neither clinical history nor autopsy provides an explanation for death. The first signs are labored breathing, gasping, and choking, but the disorder is not sleep apnea. Fibrillation (spasm) of the heart muscle has sometimes been detected. Southeast Asian men between 25 and 44 years of age are most often the victims of this disorder.
5. Primary snoring
Primary snoring is loud upper airway breathing sounds without signs of sleep apnea or diminished breathing.
6. Infant sleep apnea
Central or obstructive apneas during sleep in infants. Premature infants are more at risk for this disorder than infants born at term. Infants born before 31 weeks of gestation have about a 50 to 80 percent chance of developing apnea, whereas 7 percent of infants born at term have apnea.
7. Congenital central hypoventilation syndrome
Due to a failure of the automatic control of breathing, not enough air is pulled into the lungs. It is usually worse during sleep than during wakefulness. It usually gets better over 6 to 12 months, although children may have to be hospitalized when they get colds or flus until they are four or five years old.
8. Sudden infant death syndrome
This is an unexplained sudden death during sleep for which there is no adequate explanation. The cause is still a mystery , although risk factors include laying an infant on its stomach, respiratory infections, being one of a multiple birth, or being born to a substance abusing mother.
9. Benign neonatal sleep myoclonus
This is a jerking of the limbs and trunk, or repetitive stretching. The disorder is rare but harmless. The cause is not known.
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