Sleep and Psychosomatic Medicine

S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer, S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer

• Publisher: CRC Press
• Year: 2017
• Print ISBN:
  9781498737289
• eBook ISBN:
  9781315352497
• Topic: Medicine
• Subtopic: Internal Medicine & Diagnosis

Sleep and Psychosomatic Medicine presents an overview of sleep medicine and the management of common sleep disorders seen in a wide variety of practice settings.

Chapters have been written by experts in the field in order to provide physicians of a wide range of interests and abilities with a highly readable exposition of the principal results, including numerous well articulated examples and a rich discussion of applications.

The second edition has been revised to further broaden the scope with the inclusion of several new chapters such as Sleep and Dermatology, Fatigue in Chronic Medical Conditions, Occupational Sleep Medicine, Restless Legs Syndrome and Neuropsychiatric Disorders and Sleep Dysfunction after Traumatic Brain Injury, to name a few.

This second edition of Sleep and Psychosomatic Medicine is an interdisciplinary, scholarly, authoritative, evidence-based review of the field designed to meet the needs of a wide range of health care professionals, including psychiatrists, psychologists, nurses, medical students, and social workers in health care settings.

1
Classification of sleep disorders

MICHAEL J. THORPY

• DSM-V
• ICSD-3
• Insomnia disorders
• Sleep-related breathing disorders
• Central disorders of hypersomnolence
• Circadian rhythm sleep–wake disorders
• Parasomnias
• Conclusion

Sleep disorders have had a formal classification since 1979, when the Association of Sleep Disorder Centers published the Classification of Sleep and Arousal Disorders in the journal Sleep.¹ In 2013, the revised version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) included a section entitled “Sleep Wake Disorders,” an update of the DSM-IV section (Table 1.1).² This produced a classification for mental health and general medical clinicians who are not experts in sleep medicine. The classification differs from that of the International Classification of Sleep Disorders (ICSD-3) that was produced by the American Academy of Sleep Medicine and updated in 2014 (Table 1.2).³ The presence of two current competing classifications is not ideal, as it can cause confusion with health insurance companies and for epidemiological research. The International Classification of Diseases modified version—the ICD-10-CM (Table 1.3)—will be adopted in the United States in 2016 and contains a classification that more closely conforms to the ICSD-3.⁴

DSM-V

Insomnia disorder, the first entry in the DSM-V (Table 1.1), is a diagnostic entry that requires the presence of at least one sleep complaint such as difficulty initiating sleep that must be present at least 3 nights per week for at least 3 months. The diagnosis is coded along with other mental, medical, and sleep disorders. The diagnosis can be specified as being episodic if it occurs for at least 1 month; however, acute and short-term insomnia, which have symptoms of less than 3 months, should be coded as “other specified insomnia disorder.”

Hypersomnolence disorder requires a 3-month history of excessive sleepiness in the presence of significant distress or other impairment. Objective documentation by electrophysiological tests, such as the multiple sleep latency test (MSLT), is not required. This diagnosis is coded along with any other concurrent mental, medical, and sleep disorder. Narcolepsy is defined as recurrent episodes of sleep that occur for at least 3 months along with one of three additional features, such as cataplexy, hypocretin deficiency, or polysomnographic features, either a sleep-onset rapid eye movement period (SOREMP) on a nighttime polysomnogram (PSG) or an MSLT that shows a mean sleep latency of 8 minutes or less and two or more SOREMPs. So narcolepsy can be diagnosed in DSM-V if just sleepiness occurs for 3 months and there is a SOREMP on the nocturnal PSG. This has the potential for leading to errors in diagnosis, as other disorders, including obstructive sleep apnea syndrome (OSA), can produce similar features. Five subtypes of narcolepsy are specified according to: without cataplexy but with hypocretin deficiency; with cataplexy but without hypocretin deficiency; autosomal dominant cerebellar ataxia, deafness and narcolepsy; autosomal dominant narcolepsy, obesity and type 2 diabetes; or secondary to another medical condition.

Table 1.1 DSM-V

Sleep–wake disorders

• Insomnia disorder

• Hypersomnolence disorder

• Narcolepsy

• Subtypes:

– Without cataplexy but with hypocretin deficiency

– With cataplexy but without hypocretin deficiency

– Autosomal dominant cerebellar ataxia, deafness and narcolepsy (ADCADN)

– Autosomal dominant narcolepsy, obesity and type 2 diabetes (ADNOD)

– Secondary to another medical condition

• Obstructive sleep apnea syndrome

• Central sleep apnea

• Sleep-related hypoventilation

• Subtypes:

– Idiopathic hyperventilation

– Congenital central alveolar hypoventilation

– Comorbid sleep-related hypoventilation

• Circadian rhythm sleep disorders

• Delayed sleep phase type

• Advance sleep phase type

• Irregular sleep–wake type

• Non-24-hour sleep–wake type

• Shift work disorder

• Unspecified type

• Parasomnias

• Non-rapid eye movement sleep arousal disorder

– Subtypes: Sleepwalking type Sleep terror type

– Nightmare disorder

– Rapid eye movement sleep behavior disorder

• Restless legs syndrome

• Substance/medication-induced sleep disorder

• Other specified insomnia disorder

• Other specified hypersomnolence disorder

• Unspecified sleep–wake disorder

• Unspecified insomnia disorder

• Unspecified hypersomnolence disorder

• Unspecified sleep–wake disorder

Source: Adapted from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). Washington, DC: American Psychiatric Association, 2013.

OSA consists of an apnea hypopnea index (AHI) of at least 5 per hour, along with typical nocturnal respiratory symptoms, or daytime excessive sleepiness or fatigue. Alternatively, the diagnosis requires an AHI of at least 15, regardless of accompanying symptoms. Mild OSA is regarded as having an AHI of less than 15, moderate 15–30, and severe greater than 30. Central sleep apnea (CSA) requires the presence of five or more central apneas per hour of sleep. Sleep-related hypoventilation has PSG evidence of decreased ventilation with either elevated CO2 levels or persistent oxygen desaturation unassociated with apneic/hypopneic events. Subtypes of sleep-related hypoventilation include idiopathic hypoventilation, congenital central alveolar hypoventilation, and comorbid sleep-related hypoventilation.

Circadian rhythm sleep–wake disorders (CRSWDs) with five subtypes is caused by a persistent recurrent pattern of sleep disruption due to an alteration or misalignment of the endogenous circadian rhythm and the individual’s required sleep–wake schedule, along with symptoms of either insomnia or excessive sleepiness or both. Subtypes are delayed sleep phase type, advanced sleep phase type, irregular sleep–wake type, non-24-hour sleep–wake type, and shift work type, none of which have specifi...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Table of Contents
• Preface to the first edition
• Preface to the second edition
• Contributors
• 1 Classification of sleep disorders
• 2 Sleep and gastrointestinal functioning
• 3 Sleep and attachment disorders in children
• 4 Fatigue in chronic medical conditions: A psychosomatic perspective
• 5 Occupational sleep medicine: Role of social stressors
• 6 Restless legs syndrome and neuropsychiatric disorders
• 7 Narcolepsy and psychosomatic illnesses
• 8 Sleep and headache disorders
• 9 Fibromyalgia and the neurobiology of sleep
• 1 Sleep in chronic fatigue syndrome
• 1 Sleep and coronary heart disease
• 1 Sleep and personality disorders
• 1 Sleep and Dermatology
• 1 Neuroimaging of sleep and depression
• 1 Sleep Alterations in Schizophrenia
• 1 Sleep dysfunction after traumatic brain injury
• 1 Dreaming in psychiatric patients
• 1 Medication effects on sleep
• 1 Behavioral intervention for sleep disorders
• 2 Sleep deprivation therapy: A rapid-acting antidepressant
• 2 Non-pharmacological interventions for insomnia in cancer patients
• Index