Sleep disorders (redirected from Dysfunctions associated with sleep, sleep stages or partial arousal)

Sleep Disorders 

Definition

Sleep disorders are a group of syndromes characterized by disturbance in the patient's amount of sleep, quality or timing of sleep, or in behaviors or physiological conditions associated with sleep. There are about 70 different sleep disorders. To qualify for the diagnosis of sleep disorder, the condition must be a persistent problem, cause the patient significant emotional distress, and interfere with his or her social or occupational functioning.

Although sleep is a basic behavior in animals as well as humans, researchers still do not completely understand all of its functions in maintaining health. In the past 30 years, however, laboratory studies on human volunteers have yielded new information about the different types of sleep. Researchers have learned about the cyclical patterns of different types of sleep and their relationships to breathing, heart rate, brain waves, and other physical functions. These measurements are obtained by a technique called polysomnography.

There are five stages of human sleep. Four stages have non-rapid eye movement (NREM) sleep, with unique brain wave patterns and physical changes occurring. Dreaming occurs in the fifth stage, during rapid eye movement (REM) sleep.

• Stage 1 NREM sleep. This stage occurs while a person is falling asleep. It represents about 5% of a normal adult's sleep time.
• Stage 2 NREM sleep. In this stage, (the beginning of "true" sleep), the person's electroencephalogram (EEG) will show distinctive wave forms called sleep spindles and K complexes. About 50% of sleep time is stage 2 REM sleep.
• Stages 3 and 4 NREM sleep. Also called delta or slow wave sleep, these are the deepest levels of human sleep and represent 10-20% of sleep time. They usually occur during the first 30-50% of the sleeping period.
• REM sleep. REM sleep accounts for 20-25% of total sleep time. It usually begins about 90 minutes after the person falls asleep, an important measure called REM latency. It alternates with NREM sleep about every hour and a half throughout the night. REM periods increase in length over the course of the night.

Sleep cycles vary with a person's age. Children and adolescents have longer periods of stage 3 and stage 4 NREM sleep than do middle aged or elderly adults. Because of this difference, the doctor will need to take a patient's age into account when evaluating a sleep disorder. Total REM sleep also declines with age.

The average length of nighttime sleep varies among people. Most people sleep between seven and nine hours a night. This population average appears to be constant throughout the world. In temperate climates, however, people often notice that sleep time varies with the seasons. It is not unusual for people in North America and Europe to sleep about 40 minutes longer per night during the winter.

Description

Sleep disorders are classified based on what causes them. Primary sleep disorders are distinguished from those that are not caused by other mental disorders, prescription medications, substance abuse, or medical conditions. The two major categories of primary sleep disorders are the dyssomnias and the parasomnias.

Dyssomnias

Dyssomnias are primary sleep disorders in which the patient suffers from changes in the amount, restfulness, and timing of sleep. The most important dyssomnia is primary insomnia, which is defined as difficulty in falling asleep or remaining asleep that lasts for at least one month. It is estimated that 35% of adults in the United States experience insomnia during any given year, but the number of these adults who are experiencing true primary insomnia is unknown. Primary insomnia can be caused by a traumatic event related to sleep or bedtime, and it is often associated with increased physical or psychological arousal at night. People who experience primary insomnia are often anxious about not being able to sleep. The person may then associate all sleep-related things (their bed, bedtime, etc.) with frustration, making the problem worse. The person then becomes more stressed about not sleeping. Primary insomnia usually begins when the person is a young adult or in middle age.

Hypersomnia is a condition marked by excessive sleepiness during normal waking hours. The patient has either lengthy episodes of daytime sleep or episodes of daytime sleep on a daily basis even though he or she is sleeping normally at night. In some cases, patients with primary hypersomnia have difficulty waking in the morning and may appear confused or angry. This condition is sometimes called sleep drunkenness and is more common in males. The number of people with primary hypersomnia is unknown, although 5-10% of patients in sleep disorder clinics have the disorder. Primary hypersomnia usually affects young adults between the ages of 15 and 30.

Nocturnal myoclonus and restless legs syndrome (RLS) can cause either insomnia or hypersomnia in adults. Patients with nocturnal myoclonus wake up because of cramps or twitches in the calves. These patients feel sleepy the next day. Nocturnal myoclonus is sometimes called periodic limb movement disorder (PLMD). RLS patients have a crawly or aching feeling in their calves that can be relieved by moving or rubbing the legs. RLS often prevents the patient from falling asleep until the early hours of the morning, when the condition is less intense.

Kleine-Levin syndrome is a recurrent form of hypersomnia that affects a person three or four times a year. Doctors do not know the cause of this syndrome. It is marked by two to three days of sleeping 18-20 hours per day, hypersexual behavior, compulsive eating, and irritability. Men are three times more likely than women to have the syndrome. Currently, there is no cure for this disorder.

Narcolepsy is a dyssomnia characterized by recurrent "sleep attacks" that the patient cannot fight. The sleep attacks are about 10-20 minutes long. The patient feels refreshed by the sleep, but typically feels sleepy again several hours later. Narcolepsy has three major symptoms in addition to sleep attacks: cataplexy, hallucinations, and sleep paralysis. Cataplexy is the sudden loss of muscle tone and stability ("drop attacks"). Hallucinations may occur just before falling asleep (hypnagogic) or right after waking up (hypnopompic) and are associated with an episode of REM sleep. Sleep paralysis occurs during the transition from being asleep to waking up. About 40% of patients with narcolepsy have or have had another mental disorder. Although narcolepsy is often regarded as an adult disorder, it has been reported in children as young as three years old. Almost 18% of patients with narcolepsy are 10 years old or younger. It is estimated that 0.02-0.16% of the general population suffer from narcolepsy. Men and women are equally affected.

Breathing-related sleep disorders are syndromes in which the patient's sleep is interrupted by problems with his or her breathing. There are three types of breathing-related sleep disorders:

• Obstructive sleep apnea syndrome. This is the most common form of breathing-related sleep disorder, marked by episodes of blockage in the upper airway during sleep. It is found primarily in obese people. Patients with this disorder typically alternate between periods of snoring or gasping (when their airway is partly open) and periods of silence (when their airway is blocked). Very loud snoring is a clue to this disorder.
• Central sleep apnea syndrome. This disorder is primarily found in elderly patients with heart or neurological conditions that affect their ability to breathe properly. It is not associated with airway blockage and may be related to brain disease.
• Central alveolar hypoventilation syndrome. This disorder is found most often in extremely obese people. The patient's airway is not blocked, but his or her blood oxygen level is too low.
• Mixed-type sleep apnea syndrome. This disorder combines symptoms of both obstructive and central sleep apnea.

Circadian rhythm sleep disorders are dyssomnias resulting from a discrepancy between the person's daily sleep/wake patterns and demands of social activities, shift work, or travel. The term circadian comes from a Latin word meaning daily. There are three circadian rhythm sleep disorders. Delayed sleep phase type is characterized by going to bed and arising later than most people. Jet lag type is caused by travel to a new time zone. Shift work type is caused by the schedule of a person's job. People who are ordinarily early risers appear to be more vulnerable to jet lag and shift work-related circadian rhythm disorders than people who are "night owls." There are some patients who do not fit the pattern of these three disorders and appear to be the opposite of the delayed sleep phase type. These patients have an advanced sleep phase pattern and cannot stay awake in the evening, but wake up on their own in the early morning.

PARASOMNIAS. Parasomnias are primary sleep disorders in which the patient's behavior is affected by specific sleep stages or transitions between sleeping and waking. They are sometimes described as disorders of physiological arousal during sleep.

Nightmare disorder is a parasomnia in which the patient is repeatedly awakened from sleep by frightening dreams and is fully alert on awakening. The actual rate of occurrence of nightmare disorder is unknown. Approximately 10-50% of children between three and five years old have nightmares. They occur during REM sleep, usually in the second half of the night. The child is usually able to remember the content of the nightmare and may be afraid to go back to sleep. More females than males have this disorder, but it is not known whether the sex difference reflects a difference in occurrence or a difference in reporting. Nightmare disorder is most likely to occur in children or adults under severe or traumatic stress.

Sleep terror disorder is a parasomnia in which the patient awakens screaming or crying. The patient also has physical signs of arousal, like sweating, shaking, etc. It is sometimes referred to as pavor nocturnus. Unlike nightmares, sleep terrors typically occur in stage 3 or stage 4 NREM sleep during the first third of the night. The patient may be confused or disoriented for several minutes and cannot recall the content of the dream. He or she may fall asleep again and not remember the episode the next morning. Sleep terror disorder is most common in children four to 12 years old and is outgrown in adolescence. It affects about 3% of children. Fewer than 1% of adults have the disorder. In adults, it usually begins between the ages of 20 and 30. In children, more males than females have the disorder. In adults, men and women are equally affected.

Sleepwalking disorder, which is sometimes called somnambulism, occurs when the patient is capable of complex movements during sleep, including walking. Like sleep terror disorder, sleepwalking occurs during stage 3 and stage 4 NREM sleep during the first part of the night. If the patient is awakened during a sleepwalking episode, he or she may be disoriented and have no memory of the behavior. In addition to walking around, patients with sleepwalking disorder have been reported to eat, use the bathroom, unlock doors, or talk to others. It is estimated that 10-30% of children have at least one episode of sleepwalking. However, only 1-5% meet the criteria for sleepwalking disorder. The disorder is most common in children eight to 12 years old. It is unusual for sleepwalking to occur for the first time in adults.

Unlike sleepwalking, REM sleep behavior disorder occurs later in the night and the patient can remember what they were dreaming. The physical activities of the patient are often violent.

Sleep disorders related to other conditions

In addition to the primary sleep disorders, there are three categories of sleep disorders that are caused by or related to substance use or other physical or mental disorders.

SLEEP DISORDERS RELATED TO MENTAL DISORDERS. Many mental disorders, especially depression or one of the anxiety disorders, can cause sleep disturbances. Psychiatric disorders are the most common cause of chronic insomnia.

SLEEP DISORDERS DUE TO MEDICAL CONDITIONS. Some patients with chronic neurological conditions like Parkinson's disease or Huntington's disease may develop sleep disorders. Sleep disorders have also been associated with viral encephalitis, brain disease, and hypo- or hyperthyroidism.

SUBSTANCE-INDUCED SLEEP DISORDERS. The use of drugs, alcohol, and caffeine frequently produces disturbances in sleep patterns. Alcohol abuse is associated with insomnia. The person may initially feel sleepy after drinking, but wakes up or sleeps fitfully during the second half of the night. Alcohol can also increase the severity of breathing-related sleep disorders. With amphetamines or cocaine, the patient typically suffers from insomnia during drug use and hypersomnia during drug withdrawal. Opioids usually make short-term users sleepy. However, long-term users develop tolerance and may suffer from insomnia.

In addition to alcohol and drugs that are abused, a variety of prescription medications can affect sleep patterns. These medications include antihistamines, corticosteroids, asthma medicines, and drugs that affect the central nervous system.

Sleep disorders in children and adolescents

Pediatricians estimate that 20-30% of children have difficulties with sleep that are serious enough to disturb their families. Although sleepwalking and night terror disorder occur more frequently in children than in adults, children can also suffer from narcolepsy and sleep apnea syndrome.

Causes and symptoms

The causes of sleep disorders have already been discussed with respect to the classification of these disorders.

The most important symptoms of sleep disorders are insomnia and sleepiness during waking hours. Insomnia is by far the more common of the two symptoms. It covers a number of different patterns of sleep disturbance. These patterns include inability to fall asleep at bedtime, repeated awakening during the night, and/or inability to go back to sleep once awakened.

Diagnosis

Diagnosis of sleep disorders usually requires a psychological history as well as a medical history. With the exception of sleep apnea syndromes, physical examinations are not usually revealing. The patient's sex and age are useful starting points in assessing the problem. The doctor may also talk to other family members in order to obtain information about the patient's symptoms. The family's observations are particularly important to evaluate sleepwalking, kicking in bed, snoring loudly, or other behaviors that the patient cannot remember.

Sleep logs

Many doctors ask patients to keep a sleep diary or sleep log for a minimum of one to two weeks in order to evaluate the severity and characteristics of the sleep disturbance. The patient records medications taken as well as the length of time spent in bed, the quality of the sleep, and similar information. Some sleep logs are designed to indicate circadian sleep patterns as well as simple duration or restfulness of sleep.

Psychological testing

The doctor may use psychological tests or inventories to evaluate insomnia because it is frequently associated with mood or affective disorders. The Minnesota Multiphasic Personality Inventory (MMPI), the Millon Clinical Multiaxial Inventory (MCMI), the Beck Depression Inventory, and the Zung Depression Scale are the tests most commonly used in evaluating this symptom.

SELF-REPORT TESTS. The Epworth Sleepiness Scale, a self-rating form recently developed in Australia, consists of eight questions used to assess daytime sleepiness. Scores range from 0-24, with scores higher than 16 indicating severe daytime sleepiness.

Laboratory studies

If the doctor is considering breathing-related sleep disorders, myoclonus, or narcolepsy as possible diagnoses, he or she may ask the patient to be tested in a sleep laboratory or at home with portable instruments.

POLYSOMNOGRAPHY. Polysomnography can be used to help diagnose sleep disorders as well as conduct research into sleep. In some cases the patient is tested in a special sleep laboratory. The advantage of this testing is the availability and expertise of trained technologists, but it is expensive. As of 2001, however, portable equipment is available for home recording of certain specific physiological functions.

MULTIPLE SLEEP LATENCY TEST (MSLT). The multiple sleep latency test (MSLT) is frequently used to measure the severity of the patient's daytime sleepiness. The test measures sleep latency (the speed with which the patient falls asleep) during a series of planned naps during the day. The test also measures the amount of REM sleep that occurs. Two or more episodes of REM sleep under these conditions indicates narcolepsy. This test can also be used to help diagnose primary hypersomnia.

REPEATED TEST OF SUSTAINED WAKEFULNESS (RTSW). The repeated test of sustained wakefulness (RTSW) is a test that measures sleep latency by challenging the patient's ability to stay awake. In the RTSW, the patient is placed in a quiet room with dim lighting and is asked to stay awake. As with the MSLT, the testing pattern is repeated at intervals during the day.

Treatment

Treatment for a sleep disorder depends on what is causing the disorder. For example, if major depression is the cause of insomnia, then treatment of the depression with antidepressants should resolve the insomnia.

Medications

Sedative or hypnotic medications are generally recommended only for insomnia related to a temporary stress (like surgery or grief) because of the potential for addiction or overdose. Trazodone, a sedating antidepressant, is often used for chronic insomnia that does not respond to other treatments. Sleep medications may also cause problems for elderly patients because of possible interactions with their other prescription medications. Among the safer hypnotic agents are lorazepam, temazepam, and zolpidem. Chloral hydrate is often preferred for short-term treatment in elderly patients because of its mildness. Short-term treatment is recommended because this drug may be habit forming.

Narcolepsy is treated with stimulants such as dextroamphetamine sulfate or methylphenidate. Nocturnal myoclonus has been successfully treated with clonazepam.

Children with sleep terror disorder or sleepwalking are usually treated with benzodiazepines because this type of medication suppresses stage 3 and stage 4 NREM sleep.

Psychotherapy

Psychotherapy is recommended for patients with sleep disorders associated with other mental disorders. In many cases the patient's scores on the Beck or Zung inventories will suggest the appropriate direction of treatment.

Sleep education

"Sleep hygiene" or sleep education for sleep disorders often includes instructing the patient in methods to enhance sleep. Patients are advised to:

• wait until he or she is sleepy before going to bed
• avoid using the bedroom for work, reading, or watching television
• get up at the same time every morning no matter how much or how little he or she slept
• avoid smoking and avoid drinking liquids with caffeine
• get some physical exercise early in the day every day
• limit fluid intake after dinner; in particular, avoid alcohol because it frequently causes interrupted sleep
• learn to meditate or practice relaxation techniques
• avoid tossing and turning in bed; instead, he or she should get up and listen to relaxing music or read

Lifestyle changes

Patients with sleep apnea or hypopnea are encouraged to stop smoking, avoid alcohol or drugs of abuse, and lose weight in order to improve the stability of the upper airway.

In some cases, patients with sleep disorders related to jet lag or shift work may need to change employment or travel patterns. Patients may need to avoid rapid changes in shifts at work.

Children with nightmare disorder may benefit from limits on television or movies. Violent scenes or frightening science fiction stories appear to influence the frequency and intensity of children's nightmares.

Surgery

Although making a surgical opening into the windpipe (a tracheostomy) for sleep apnea or hypopnea in adults is a treatment of last resort, it is occasionally performed if the patient's disorder is life threatening and cannot be treated by other methods. In children and adolescents, surgical removal of the tonsils and adenoids is a fairly common and successful treatment for sleep apnea. Most sleep apnea patients are treated with continuous positive airway pressure (CPAP). Sometimes an oral prosthesis is used for mild sleep apnea.

Alternative treatment

Some alternative approaches may be effective in treating insomnia caused by anxiety or emotional stress. Meditation practice, breathing exercises, and yoga can break the vicious cycle of sleeplessness, worry about inability to sleep, and further sleeplessness for some people. Yoga can help some people to relax muscular tension in a direct fashion. The breathing exercises and meditation can keep some patients from obsessing about sleep.

Homeopathic practitioners recommend that people with chronic insomnia see a professional homeopath. They do, however, prescribe specific remedies for at-home treatment of temporary insomnia: Nux vomica for alcohol or substance-related insomnia, Ignatia for insomnia caused by grief, Arsenicum for insomnia caused by fear or anxiety, and Passiflora for insomnia related to mental stress.

Melatonin has also been used as an alternative treatment for sleep disorders. Melatonin is produced in the body by the pineal gland at the base of the brain. This substance is thought to be related to the body's circadian rhythms.

Key terms

Apnea — The temporary absence of breathing. Sleep apnea consists of repeated episodes of temporary suspension of breathing during sleep.

Cataplexy — Sudden loss of muscle tone (often causing a person to fall), usually triggered by intense emotion. It is regarded as a diagnostic sign of narcolepsy.

Circadian rhythm — Any body rhythm that recurs in 24-hour cycles. The sleep-wake cycle is an example of a circadian rhythm.

Dyssomnia — A primary sleep disorder in which the patient suffers from changes in the quantity, quality, or timing of sleep.

Electroencephalogram (EEG) — The record obtained by a device that measures electrical impulses in the brain.

Hypersomnia — An abnormal increase of 25% or more in time spent sleeping. Patients usually have excessive daytime sleepiness.

Hypnotic — A medication that makes a person sleep.

Hypopnea — Shallow or excessively slow breathing usually caused by partial closure of the upper airway during sleep, leading to disruption of sleep.

Insomnia — Difficulty in falling asleep or remaining asleep.

Jet lag — A temporary disruption of the body's sleep-wake rhythm following high-speed air travel across several time zones. Jet lag is most severe in people who have crossed eight or more time zones in 24 hours.

Kleine-Levin syndrome — A disorder that occurs primarily in young males, three or four times a year. The syndrome is marked by episodes of hypersomnia, hypersexual behavior, and excessive eating.

Narcolepsy — A life-long sleep disorder marked by four symptoms: sudden brief sleep attacks, cataplexy, temporary paralysis, and hallucinations. The hallucinations are associated with falling asleep or the transition from sleeping to waking.

Nocturnal myoclonus — A disorder in which the patient is awakened repeatedly during the night by cramps or twitches in the calf muscles. Nocturnal myoclonus is sometimes called periodic limb movement disorder (PLMD).

Non-rapid eye movement (NREM) sleep — A type of sleep that differs from rapid eye movement (REM) sleep. The four stages of NREM sleep account for 75-80% of total sleeping time.

Parasomnia — A primary sleep disorder in which the person's physiology or behaviors are affected by sleep, the sleep stage, or the transition from sleeping to waking.

Pavor nocturnus — Another term for sleep terror disorder.

Polysomnography — Laboratory measurement of a patient's basic physiological processes during sleep. Polysomnography usually measures eye movement, brain waves, and muscular tension.

Primary sleep disorder — A sleep disorder that cannot be attributed to a medical condition, another mental disorder, or prescription medications or other substances.

Rapid eye movement (REM) sleep — A phase of sleep during which the person's eyes move rapidly beneath the lids. It accounts for 20-25% of sleep time. Dreaming occurs during REM sleep.

REM latency — After a person falls asleep, the amount of time it takes for the first onset of REM sleep.

Restless legs syndrome (RLS) — A disorder in which the patient experiences crawling, aching, or other disagreeable sensations in the calves that can be relieved by movement. RLS is a frequent cause of difficulty falling asleep at night.

Sedative — A medication given to calm agitated patients; sometimes used as a synonym for hypnotic.

Sleep latency — The amount of time that it takes to fall asleep. Sleep latency is measured in minutes and is important in diagnosing depression.

Somnambulism — Another term for sleepwalking.

Practitioners of Chinese medicine usually treat insomnia as a symptom of excess yang energy. Cinnabar is recommended for chronic nightmares. Either magnetic magnetite or "dragon bones" is recommended for insomnia associated with hysteria or fear. If the insomnia appears to be associated with excess yang energy arising from the liver, the practitioner will give the patient oyster shells. Acupuncture treatments can help bring about balance and facilitate sleep.

Dietary changes like eliminating stimulant foods (coffee, cola, chocolate) and late-night meals or snacks can be effective in treating some sleep disorders. Nutritional supplementation with magnesium, as well as botanical medicines that calm the nervous system, can also be helpful. Among the botanical remedies that may be effective for sleep disorders are valerian (Valeriana officinalis), passionflower (Passiflora incarnata), and skullcap (Scutellaria lateriflora).

Prognosis

The prognosis depends on the specific disorder. Children usually outgrow sleep disorders. Patients with Kleine-Levin syndrome usually get better around age 40. Narcolepsy is a life-long disorder. The prognosis for sleep disorders related to other conditions depends on successful treatment of the substance abuse, medical condition, or other mental disorder. The prognosis for primary sleep disorders is affected by many things, including the patient's age, sex, occupation, personality characteristics, family circumstances, neighborhood environment, and similar factors.

Resources

Books

Moe, Paul G., and Alan R. Seay. "Neurologic & Muscular Disorders: Sleep Disorders." In Current Pediatric Diagnosis & Treatment, edited by William W. Hay Jr., et al. Stamford: Appleton & Lange, 1997.

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disorder /dis·or·der/ (dis-or´der) a derangement or abnormality of function; a morbid physical or mental state.

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acute stress disorder  an anxiety disorder characterized by development of anxiety, dissociative, and other symptoms within one month following exposure to an extremely traumatic event. If persistent, it may become posttraumatic stress disorder.

adjustment disorder  maladaptive reaction to identifiable stress (e.g., divorce, illness), which is assumed to remit when the stress ceases or when the patient adapts.

affective disorders  mood d's.

amnestic disorders  mental disorders characterized by acquired impairment in the ability to learn and recall new information, sometimes accompanied by inability to recall previously learned information.

anxiety disorders  mental disorders in which anxiety and avoidance behavior predominate, i.e., panic disorder, agoraphobia, social phobia, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, and substance-induced anxiety disorder.

attention-deficit/hyperactivity disorder  a controversial childhood mental disorder with onset before age seven, and characterized by inattention (e.g., distractibility, forgetfulness, not appearing to listen), by hyperactivity and impulsivity (e.g., restlessness, excessive running or climbing, excessive talking, and other disruptive behavior), or by a combination of both types of behavior.

autistic disorder  autism; a severe pervasive developmental disorder with onset usually before three years of age and a biological basis; it is characterized by qualitative impairment in reciprocal social interaction, verbal and nonverbal communication, and capacity for symbolic play, by restricted and unusual repertoire of activities and interests, and often by cognitive impairment.

behavior disorder  conduct d.

binge-eating disorder  an eating disorder characterized by repeated episodes of binge eating, as in bulimia nervosa, but not followed by inappropriate compensatory behavior such as purging, fasting, or excessive exercise.

bipolar disorders  mood disorders with a history of manic, mixed, or hypomanic episodes, usually with present or previous history of one or more major depressive episodes; included are bipolar I d., characterized by one or more manic or mixed episodes, bipolar II d., characterized by one or more hypomanic episodes but no manic episodes, and cyclothymic disorder. The term is sometimes used in the singular to denote either bipolar I disorder, bipolar II disorder, or both.

body dysmorphic disorder  a somatoform disorder characterized by a normal-looking person's preoccupation with an imagined defect in appearance.

breathing-related sleep disorder  any of several disorders characterized by sleep disruption due to some sleep-related breathing problem, resulting in excessive sleepiness or insomnia.

brief psychotic disorder  an episode of psychotic symptoms with sudden onset, lasting less than one month.

catatonic disorder  catatonia due to the physiological effects of a general medical condition and neither better accounted for by another mental disorder nor occurring exclusively during delirium.

character disorders  personality d's.

childhood disintegrative disorder  pervasive developmental disorder characterized by marked regression in various developmental skills, including language, play, and social and motor skills, after two to ten years of initial normal development.

circadian rhythm sleep disorder  a lack of synchrony between the schedule of sleeping and waking required by the external environment and that of a person's own circadian rhythm.

collagen disorder  an inborn error of metabolism involving abnormal structure or metabolism of collagen, e.g., Marfan syndrome, cutis laxa. Cf. collagen disease.

communication disorders  mental disorders characterized by difficulties with speech or language, severe enough to interfere academically, occupationally, or socially.

conduct disorder  a type of disruptive behavior disorder of childhood and adolescence marked by persistent violation of the rights of others or of age-appropriate societal norms or rules.

conversion disorder  a somatoform disorder characterized by conversion symptoms (loss or alteration of voluntary motor or sensory functioning suggesting physical illness) with no physiological basis and not produced intentionally or feigned; a psychological basis is suggested by exacerbation of symptoms during psychological stress, relief from tension (primary gain), or gain of outside support or attention (secondary gains).

cyclothymic disorder  a mood disorder characterized by alternating cycles of hypomanic and depressive periods with symptoms like those of manic and major depressive episodes but of lesser severity.

delusional disorder  a mental disorder marked by well-organized, logically consistent delusions of grandeur, persecution, or jealousy, with no other psychotic feature. There are six types: persecutory, jealous, erotomanic, somatic, grandiose, and mixed.

depersonalization disorder  a dissociative disorder characterized by intense, prolonged, or otherwise troubling feelings of detachment from one's body or thoughts, not secondary to another mental disorder.

depressive disorders  mood disorders in which depression is unaccompanied by manic or hypomanic episodes.

developmental coordination disorder  problematic or delayed development of gross and fine motor coordination skills, not due to a neurological disorder or to general mental retardation, resulting in the appearance of clumsiness.

disruptive behavior disorders  a group of mental disorders of children and adolescents consisting of behavior that violates social norms and is disruptive.

dissociative disorders  mental disorders characterized by sudden, temporary alterations in identity, memory, or consciousness, segregating normally integrated parts of one's personality from one's dominant identity.

dissociative identity disorder  a dissociative disorder characterized by the existence in an individual of two or more distinct personalities, with at least two of the personalities controlling the patient's behavior in turns. The host personality usually is totally unaware of the alternate personalities; alternate personalities may or may not have awareness of the others.

dream anxiety disorder  nightmare d.

dysthymic disorder  a mood disorder characterized by depressed feeling, loss of interest or pleasure in one's usual activities, and other symptoms typical of depression but tending to be longer in duration and less severe than in major depressive disorder.

eating disorder  abnormal feeding habits associated with psychological factors, including anorexia nervosa, bulimia nervosa, pica, and rumination disorder.

expressive language disorder  a communication disorder occurring in children and characterized by problems with the expression of language, either oral or signed.

factitious disorder  a mental disorder characterized by repeated, intentional simulation of physical or psychological signs and symptoms of illness for no apparent purpose other than obtaining treatment.

factitious disorder by proxy  a form of factitious disorder in which one person (usually a mother) intentionally fabricates or induces physical (Munchausen syndrome by proxy) or psychological disorders in another person under their care (usually their child) and subjects that person to needless diagnostic procedures or treatment, without any external incentives for the behavior.

female orgasmic disorder  consistently delayed or absent orgasm in a female, even after a normal phase of sexual excitement and adequate stimulation.

female sexual arousal disorder  a sexual dysfunction involving failure by a female either to attain or maintain lubrication and swelling during sexual activity, after adequate stimulation.

functional disorder  a disorder of physiological function having no known organic basis.

gender identity disorder  a disturbance of gender identification in which the affected person has an overwhelming desire to change their anatomic sex or insists that they are of the opposite sex, with persistent discomfort about their assigned sex or about filling its usual gender role.

generalized anxiety disorder  (GAD) an anxiety disorder characterized by excessive, uncontrollable worry about two or more life circumstances for six months or more.

hypoactive sexual desire disorder  a sexual dysfunction consisting of persistently or recurrently low level or absence of sexual fantasies and desire for sexual activity.

impulse control disorders  a group of mental disorders characterized by repeated failure to resist an impulse to perform some act harmful to oneself or to others.

induced psychotic disorder  shared psychotic d.

intermittent explosive disorder  an impulse control disorder characterized by multiple discrete episodes of loss of control of aggressive impulses resulting in serious assault or destruction of property that are out of proportion to any precipitating stressors.

learning disorders  a group of disorders characterized by academic functioning that is substantially below the level expected on the basis of the patient's age, intelligence, and education.

lymphoproliferative disorders  a group of malignant neoplasms arising from cells related to the common multipotential lymphoreticular cell, including lymphocytic, histiocytic, and monocytic leukemias, multiple myeloma, plasmacytoma, and Hodgkin's disease.

lymphoreticular disorders  a group of disorders of the lymphoreticular system, characterized by the proliferation of lymphocytes or lymphoid tissues.

major depressive disorder  a mood disorder characterized by the occurrence of one or more major depressive episodes and the absence of any history of manic, mixed, or hypomanic episodes.

male erectile disorder  a sexual dysfunction involving failure by a male to attain or maintain an adequate erection until completion of sexual relations.

male orgasmic disorder  consistently delayed or absent orgasm in a male, even after a normal phase of sexual excitement and stimulation adequate for his age.

manic-depressive disorder  former name for a mood disorder now known as bipolar I d. or bipolar II d. and often called bipolar d. (q.v.).

mendelian disorder  a genetic disease showing a mendelian pattern of inheritance, caused by a single mutation in the structure of DNA, which causes a single basic defect with pathologic consequences.

mental disorder  any clinically significant behavioral or psychological syndrome characterized by the presence of distressing symptoms, impairment of functioning, or significantly increased risk of suffering death, pain, or other disability.

minor depressive disorder  a mood disorder closely resembling major depressive disorder and dysthymic disorder but intermediate in severity between the two.

mixed receptive-expressive language disorder  a communication disorder involving both the expression and the comprehension of language, either spoken or signed.

monogenic disorder  mendelian d.

mood disorders  mental disorders characterized by disturbances of mood manifested as one or more episodes of mania, hypomania, depression, or some combination, the two main subcategories being bipolar disorders and depressive disorders.

motor skills disorder  any disorder characterized by inadequate development of motor coordination severe enough to restrict locomotion or the ability to perform tasks, schoolwork, or other activities.

multifactorial disorder  one caused by the interaction of genetic and sometimes also nongenetic, environmental factors, e.g., diabetes mellitus.

multiple personality disorder  dissociative identity d.

myeloproliferative disorders  a group of usually neoplastic diseases possibly related histogenetically, including granulocytic leukemias, myelomonocytic leukemias, polycythemia vera, and myelofibroerythroleukemia.

neurotic disorder  neurosis.

nightmare disorder  repeated episodes of nightmares that awaken the sleeper, with full orientation and alertness and vivid recall of the dreams.

obsessive-compulsive disorder  (OCD) an anxiety disorder characterized by recurrent obsessions or compulsions, which are severe enough to interfere significantly with personal or social functioning. Cf. obsessive-compulsive personality disorder, under personality .

obsessive-compulsive personality disorder  see under personality.

oppositional defiant disorder  a type of disruptive behavior disorder characterized by a recurrent pattern of defiant, hostile, disobedient, and negativistic behavior directed toward those in authority.

organic mental disorder  a term formerly used to denote any mental disorder with a specifically known or presumed organic etiology. It was sometimes used synonymously with organic mental syndrome.

orgasmic disorders  sexual dysfunctions characterized by inhibited or premature orgasm; see female orgasmic d., male orgasmic d., and premature ejaculation.

pain disorder  a somatoform disorder characterized by a chief complaint of severe chronic pain which is neither feigned nor intentionally produced, but in which psychological factors appear to play a major role in onset, severity, exacerbation, or maintenance.

panic disorder  an anxiety disorder characterized by attacks of panic (anxiety), fear, or terror, by feelings of unreality, or by fears of dying, or losing control, together with somatic signs such as dyspnea, choking, palpitations, dizziness, vertigo, flushing or pallor, and sweating. It may occur with or, rarely, without agoraphobia.

paranoid disorder  older term for delusional d.

personality disorders  a category of mental disorders characterized by enduring, inflexible, and maladaptive personality traits that deviate markedly from cultural expectations and either generate subjective distress or significantly impair functioning. For specific disorders, see under personality.

pervasive developmental disorders  disorders in which there is impaired development in multiple areas, including reciprocal social interactions, verbal and nonverbal communications, and imaginative activity, as in autistic disorder.

phagocytic dysfunction disorders  a group of immunodeficiency conditions characterized by disordered phagocytic activity, occurring as both extrinsic and intrinsic types. Bacterial or fungal infections may range from mild skin infection to fatal systemic infection.

phobic disorders  see phobia.

phonological disorder  a communication disorder characterized by failure to use age- and dialect-appropriate sounds in speaking, with errors occurring in the selection, production, or articulation of sounds.

plasma cell disorders  see under dyscrasia.

postconcussional disorder  see under syndrome.

posttraumatic stress disorder  (PTSD) an anxiety disorder caused by an intensely traumatic event, characterized by mentally reexperiencing the trauma, avoidance of trauma-associated stimuli, numbing of emotional responsiveness, and hyperalertness and difficulty in sleeping, remembering, or concentrating.

premenstrual dysphoric disorder  premenstrual syndrome viewed as a psychiatric disorder.

psychoactive substance use disorders  substance use d's.

psychosomatic disorder  one in which the physical symptoms are caused or exacerbated by psychological factors, as in migraine headaches, lower back pain, or irritable bowel syndrome.

psychotic disorder  psychosis.

reactive attachment disorder  a mental disorder of infancy or early childhood characterized by notably unusual and developmentally inappropriate social relatedness, usually associated with grossly pathological care.

rumination disorder  excessive rumination of food by infants, after a period of normal eating habits, potentially leading to death by malnutrition.

schizoaffective disorder  a mental disorder in which symptoms of a mood disorder occur along with prominent psychotic symptoms characteristic of schizophrenia.

schizophreniform disorder  a mental disorder with the signs and symptoms of schizophrenia but of less than six months' duration.

seasonal affective disorder  (SAD) depression with fatigue, lethargy, oversleeping, overeating, and carbohydrate craving recurring cyclically during specific seasons, most commonly the winter months.

separation anxiety disorder  prolonged, developmentally inappropriate, excessive anxiety and distress in a child concerning removal from parents, home, or familiar surroundings.

sexual disorders 

1. any disorders involving sexual functioning, desire, or performance.

2. specifically, any such disorder that is caused at least in part by psychological factors; divided into sexual dysfunctions and paraphilias.

sexual arousal disorders  sexual dysfunctions characterized by alterations in sexual arousal; see female sexual arousal d. and male erectile d.

sexual aversion disorder  feelings of repugnance for and active avoidance of genital sexual contact with a partner, causing substantial distress or interpersonal difficulty.

sexual desire disorders  sexual dysfunctions characterized by alteration in sexual desire; see hypoactive sexual desire d. and sexual aversion d.

sexual pain disorders  sexual dysfunctions characterized by pain associated with intercourse; it includes dyspareunia and vaginismus not due to a general medical condition.

shared psychotic disorder  a delusional system that develops in one or more persons as a result of a close relationship with someone who already has a psychotic disorder with prominent delusions.

sleep disorders  chronic disorders involving sleep, either primary (dyssomnias, parasomnias) or secondary to factors including a general medical condition, mental disorder, or substance use.

sleep terror disorder  a sleep disorder of repeated episodes of pavor nocturnus.

sleepwalking disorder  a sleep disorder of the parasomnia group, consisting of repeated episodes of somnambulism.

social anxiety disorder  social phobia.

somatization disorder  a somatoform disorder characterized by multiple somatic complaints, including a combination of pain, gastrointestinal, sexual, and neurological symptoms, and not fully explainable by any known general medical condition or the direct effect of a substance, but not intentionally feigned or produced.

somatoform disorders  mental disorders characterized by symptoms suggesting physical disorders of psychogenic origin but not under voluntary control, e.g., body dysmorphic disorder, conversion disorder, hypochondriasis, pain disorder, somatization disorder, and undifferentiated somatoform disorder.

somatoform pain disorder  pain d.

speech disorder  defective ability to speak; it may be either psychogenic (see communication d. ) or neurogenic. See also aphasia, aphonia, dysphasia, and dysphonia.

stereotypic movement disorder  a mental disorder characterized by repetitive nonfunctional motor behavior that often appears to be driven and can result in serious self-inflicted injuries.

substance-induced disorders  a subgroup of the substance-related disorders comprising a variety of behavioral or psychological anomalies resulting from ingestion of or exposure to a drug of abuse, medication, or toxin. Cf. substance use d's.

substance-related disorders  any of the mental disorders associated with excessive use of or exposure to psychoactive substances, including drugs of abuse, medications, and toxins. The group is divided into substance use d's and substance-induced d's .

substance use disorders  a subgroup of the substance-related disorders, in which psychoactive substance use or abuse repeatedly results in significantly adverse consequences. The group comprises substance abuse and substance dependence.

undifferentiated somatoform disorder  one or more physical complaints, not intentionally produced or feigned and persisting for at least six months, that cannot be fully explained by a general medical condition or the direct effects of a substance.

unipolar disorders  depressive d's.

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sleep

a period of rest during which volition and consciousness are in partial or complete abeyance and the bodily functions partially suspended; a behavioral state marked by characteristic immobile posture and diminished but readily reversible sensitivity to external stimuli.

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sleep deprivation

caused in animals by constant stimulation, e.g. preventing them from lying down, is followed by a compensatory period of prolonged sleep whenever the opportunity arises.

sleep disorders

see narcolepsy, cataplexy.

put to sleep

a common euphemism for euthanasia.

rapid eye movement sleep

that type of sleep characterized by low voltage but fast electroencephalographic activity and little muscular activity except of the ocular muscles. Believed to be the critical or necessary component of sleep. Called also 'sleep of the body' and paradoxical sleep. Called also REM.

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sleep disorders

Neurology Any disruptive pattern of sleep Categories (1) Difficulty with falling or staying asleep–insomnias; (2) falling asleep at inappropriate times; (3) excessive total sleep time; (4) abnormal behaviors associated with sleep. See Insomnia, Pseudoinsomnia, Sleep apnea syndrome. Cf Shift work.

Sleep disorders

Insomnias Difficulty in initiating and maintaining sleep

Hypersomnias Disorder of excessive somnolence–eg, narcolepsy, sleep deprivation and obstructive sleep apnea

Disorders of sleep-wake schedule–eg jet lag and shift work

Dysfunctions associated with sleep, sleep stages or partial arousal–eg night terrors and enuresis

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Patient discussion about Dysfunctions associated with sleep, sleep stages or partial arousal.

Q. is there anything i can do to help me get to sleep at night? Sincerely, Ashley Nicole Cross shipp i mean to be alittle bit more specific i have my thoughts at night everywhere and i was just wondering is this normal or is just me

A. melatonine, helps you relax and go to sleep

Q. I dont want to take sleeping pills but how do I fix this!? I have been sleeping on and off for a long time. I have taken sleeping pills once because I really needed the sleep, but I have just been letting it happen because I dont want to become addicted to sleeping pills. My mind doesnt stop! I toss and turn, sleep an hour, lie awake another... Some way to help this without medicine?! Please and thank you.

A. There is Valerian (it can be strong)also Hops (a potpori) bag under your pillow ,if it is hot or where your pain if you have it Liac is good to spray under the covers ,I don't know if their is a law again yet Kava Kava (look for high Kavalectones)is verty relaxing ,I figure if someone found out it can relax people it will be made illegal .With Valerian mix Hops and Peppermint leaves and flowers (Peppermint is for your stomach also) I worked when I was 16 for Dr Wu a very old Chinese Herbalogist he would travel to the patients house,because each person is differebnt with different needs . I do know yoga is wonderful and it got my wifes figure b ack for her after babies ,many Healthfood Stores have experts in Herbalogy and other things that will help you sleep ,but be it a pill from the Doc or the inocuous herbal tea try not to use every night and if your Doc is worth (his or her ,I have 9 specialist ,therapist NPs I see and all are women and I have the best health care I ever had

Q. My grandma passed away a month ago and since then my grandpa has been drinking himself to sleep every night I know it’s his way of grieving, but I am very worried about him. Right now he doesn’t stop drinking because he doesn’t want to, but if this will go on for a while, can’t it happen that when he will want to stop he won’t be able to? Is it at all possible to become an alcoholic at the age of 83? I mean are there even rehabs for seniors?

A. everyones grieving period is different,try getting all the family involved in supporting him to quit,get him out of the alot more,find him a hobby,something that will take his mind off things,get him to talk about his feelings,every little thing can help.