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Sleep Related Disorders
Assessment & Diagnosis
SW 593
 Diagnoses are related to disturbances in the
sleep process that cause clinically
significant distress and/or psychosocial
 Two major categories:
– Dyssomnias: person sleeps too much, too little,
or at the wrong time
– Parasomnias: abnormal things occur during
sleep or immediately before/after sleep.
 Sleep disturbances are expected in a
number of instances:
– Mood and anxiety disorders
– Cognitive, schizophrenic, somatization
 Sleep disorder is only made when that
symptom is excessive or has become the
primary focus of intervention.
 Sleeping too little
 Takes the form of problems falling or staying
 It may be characterized by non-restorative
 Insomnia must last at least one month and
be causing distress or psychosocial
 Etiology:
– Primary Insomnia
– Insomnia Related to Another Mental Disorder
– Sleep Disorder due to a General Medical
Condition, Insomnia Type
– Substance-Induced Sleep Disorder, Insomnia
 Sleeping too much.
 Characterized either by prolonged sleep
episodes or by daytime sleep episodes that
occur daily or almost daily.
 Problem must have lasted at least one
month or be recurrent.
– Lasting 3 days several time a year for at least 2
 Characterized by irresistible episodes of
refreshing sleep that occur daily over at leas
a 3-month period.
 Client experiences episodes of cataplexy
(brief episode of loss of muscle power) or
recurrent intrusions of REM sleep in the
transitions between being awake and
sleeping (experienced as hallucinations or
sleep paralysis).
Breathing-Related Sleep Disorder
 Involves sleep disruption that leads to
excessive sleepiness or insomnia.
 Disruption is caused by a sleep-related
breathing condition but not by some other
general medical condition, mental disorder,
or substance use.
 Practitioner should list the underlying
breathing-related medical condition on Axis
Circadian Rhythm Sleep Disorder
 A persistent or recurrent pattern of sleep
disruption due to disruptions in the normal
sleep-wake schedule.
 Origin(s) of this problem is made clearer by
the specifiers used:
– Shift work type
– Jet lag type
– Delayed Sleep Phase type
 Some disruptive event occurs during
specific sleep periods and/or transitions.
 These conditions refer to instances in which
behaviors or physiological processes are
activated inappropriately while the individual
is asleep.
Nightmare Disorder
 Usually begins in children between the age of 3
and 6.
 Causes significant disruption for both the children
and their parents.
 It can persist into adulthood.
 The individual experiences repeated awakenings
with detailed recall of frightening dreams.
 Upon awakening, becomes oriented.
 Episodes generally occur during second half of
sleep period.
Sleep Terror Disorder
 Occurs both among children and adults.
 Individual experiences repeated episodes of
abrupt awakening during the first third of a sleep
 Individual awakes with a scream and physiological
symptoms similar to those of a panic attack.
 Individual is generally unresponsive to attempts to
be comforted and when finally awake, no memory
of the dream.
Sleepwalking Disorder
 Begins in childhood and ends during
 Initial onset of sleepwalking in adulthood is
 Involves the client getting up and walking
around, usually during the first third of the
sleep cycle.
 Very difficult to awake and no memory of the
 Has become a technologically advanced
medical procedure in recent years.
 Sleep studies are conducted by having the
person check in to a facility in the evening
and leaves when the person awakes the
following morning.
 Monitored throughout the night for:
– Breathing patterns and efforts
– Heart rate
– Oxygen saturation
– Brain activity
– Muscle activity
 Typically non-medical clinicians do not
administer self-report sleep instruments.