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Classification of sleep disorders
In this section, I review some of the common sleep disorders of childhood and how they affect families. Developmental failures in achieving consolidated nighttime sleep and daytime wakefulness, in going to bed and falling asleep easily, in maintaining continuity of sleep, and in circadian regulation of sleep-wake cycles are significant risk factors for potential sleep disorders in infants, children, and adolescents.
Sleep Disorders- Introduction
- DSM-IV Classification of Sleep Disorders
- Evaluation of Sleep Disorders
- General Principles of Treatment
- Treatment of Specific Sleep Disorders
- Sleep Disorders Related to Another Mental Disorder
- Sleep Disorders Due to a General Medical Condition
- Substance-Induced Sleep Disorder
An understanding of childhood sleep disorders is facilitated by knowledge about the development of both sleep-state architecture and sleep-wake-state temporal organization. The maturation of sleep-wake states has been reviewed elsewhere (Anders and Eiben 1997; Coons and Guilleminault 1982), and only a summary is provided here.
Developmental Aspects of Sleep-Wake Organization
Newborns spend 50% of their sleep time in rapid eye movement (REM) sleep (also known as active sleep or dreaming sleep) and 50% of their sleep time in non-REM (NREM) sleep (also known as quiet sleep or slow-wave sleep). By adolescence, the relative proportion of REM sleep during sleep time has diminished to 20%, whereas NREM sleep has increased proportionally to 80% of sleep time. Four stages of NREM sleep (Stages 1-4) can begin to be differentiated from patterns on the electroencephalogram (EEG) by age 3-4 months. REM and NREM periods alternate with each other in 50- to 60-minute (i.e., ultradian) sleep cycles. A period of 30 minutes of REM sleep is followed by 30 minutes of NREM sleep in a sleep cycle, and three to four sleep cycles constitute a 4-hour episode of sleep for the newborn. At age 3 months, diurnal influences begin to affect sleep-cycle organization (Ferber 1999).
Early sleep cycles have 40-50 minutes of NREM sleep and 10-20 minutes of REM sleep; in sleep cycles later in the night, the reverse is true. Thus, NREM sleep, especially Stage 4 NREM sleep, shifts to the beginning of a sleep period, and REM sleep predominates later in the sleep period. As the continuous periods of sleep consolidate and lengthen, the number of REM-NREM sleep cycles increases. However, the 50- to 60-minute sleep cycle itself does not lengthen until adolescence, when the 90-minute sleep cycle of mature adults is achieved. Another noteworthy developmental landmark occurs at sleep onset. When young infants make the transition from wakefulness to sleep at the beginning of their night, their initial sleep-onset state is typically REM sleep. By age 3 months, sleep-onset REM periods begin to be replaced by sleep-onset NREM periods. By the time the child is 1 year old, transitions from waking directly to REM sleep are rare.
Appreciating these maturational changes is useful for clinicians in differentiating many of the common sleep disorders that affect infants, children, and adolescents.
Rapid eye movement (REM) sleep
Rapid eye movement sleep, or REM, is one of the five stages of sleep that most people experience nightly....
The prognosis varies widely, depending on the cause of the insomnia or other sleep disorder. For example, insomnia due to OSA resolves with successful treatment of the apnea, whereas insomnia due to refractory major depression is itself refractory until a successful treatment can be found for the depression.
Chronic insomnia is associated with an increased risk of depression and accompanying danger of suicide, anxiety, excess disability, reduced quality of life, and increased use of health care resources.
Insufficient sleep can result in industrial and motor vehicle crashes, somatic symptoms, cognitive dysfunction, depression, and decrements in daytime work performance owing to fatigue or sleepiness.
Yaffe et al suggest that older women with sleep-disordered breathing (characterized by recurrent arousals from sleep and intermittent hypoxemia) have an increased risk of developing cognitive impairment compared with those without sleep-disordered breathing.
One study suggests that among police officers in the United States and Canada, sleep disorders are common and are significantly associated with an increased risk of self-reported adverse outcomes in terms of health, performance, and safety.
Daily Sleep Care News
Trouble sleeping? The size of your tongue and tonsils could be why
The best time to identify signs of obstructive sleep apnea may not be at night while snoozing in bed but, instead, while sitting in the dentist’s chair. According to a new study led by University at Buffalo orthodontic researcher Thikriat Al-Jewair, dentists are in…
The best time to identify signs of obstructive sleep apnea may not be at night while snoozing in bed but, instead, while sitting in the dentist’s chair.
According to a new study led by University at Buffalo orthodontic researcher Thikriat Al-Jewair, dentists are in…