Kaplan & Sadock's Synopsis of Psychiatry - 11E (TruePDF) (UnitedVRG)

 

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6 :  N o rm al Sl eep an d S l eep-Wake D i so r de de r s

reach  pathological levels levels.. When sleep debt is added to sleep dis rption or a basic nerologic d!s"nction in sleep mechanisms# there is increasing risk that an individal $ill lapse ne%p ect edl! into slee p . Sleep onset in sch circmstances char acteristi acteristi call! occrs $ithot $arning. Sleepiness can be episodic and occr as irresistible sleep attacks# attacks# occr in the the morning as sleep drnk enne enne ss#   or be chronic. &atige# tiredness# and sleepine epiness ss are terms that are sed b! most people s!non!mosl!'  ho$ever# one can be tired bt not sleep!# sleep! bt not tired# or slee p!

-e ns tral  -  elated /! pe  per  r s om n  ia. (n somee som $omen# recrrent episodes o" h!persomnia are related to the the menstral c!cle# e%periencing inte intermitte rmittent nt episodes o" marked h!persom nia at# or shortl!  be " ore# ore# the onset o" their menses. )he s!mp toms t!picall! last "or 1 $eek and resolve $ith menstration.  Nonspeci"ic electroencephalogram 88:2 abnormalities similar  to those associated $ith 0leine-,evin s!ndrome have been doc mented in several instances. 8ndocrine "actors are  probabl  probabl! !

and tired. (n this section# the term sleepiness $ill re"er to dro$s iness# a  propensit! to lapse lapse in into to sleep# an and d $h $hen en e%treme# an inabilit! to maintain $ake"lne ss. Sleepiness adversel! a""ects attention# concentration# mem or!# and higher-order cognitive processes. Serios reslts o"  sleepiness inclde "ailre at school# loss o" emplo!ment# motor  vehicle accidents# and indstrial disasters. )he transportation indstr!# inclding tr cking cking# railroad# marine # and aviation# is  particlarl!  particlar l!  prone to sleep-related accidents. )here are man! sleep disorders associated $ith e%cessive da!time sleepine ss' ho$ever# sleep-di sleep-disordered sordered breathing breathing is b! "ar the most common d!ssomnia seen in sleep disorder centers. *rimar! h!persomnia is diagnosed diagnosed $hen no other case can be "ond "or e%cess e%cessiv ivee som somnol nolenc encee occrring "o "orr at least 1 mont month. h. Some persons are long sleepers $ho# as $ith short

involved# bt no speci"ic abnormalities in laborator! endocrine measres have been reported. )reatment $ith oral contracep tives is e"" ective# ective # and there"ore the disorder is believed to  be secondar! to a hormone imbalance.

( d i op ath ic /!persomnia. (diopathic h!persomnia 1(/2  presents in several "orms . (t ma! be associated $ith ver! long sleep periods# a"ter $hich the individal remains sleep!. (/ can also occr $ithot long sleep periods. (/ is a disorder o"  e%cessive sleepiness in $hich  patients do not have the ancil lar! s!mptoms associated $ith narcoleps!. ;nlike narc oleps! s!## sleep is sal sall! l! $ell preserved# and sleep e""icienc! remains high even in "orms associated $ith ver! e%tended sleep sched les  1  hors or more2 . &rthermore#  the  patient readil! "al "alls ls asleep i" given an opportnit! to nap the "ollo$ing da!. )here is o"ten o"ten elevated slo$ $ave $ave sleep sleep'' ho$ ho$eve ever# r# the 88: sleep  pat

sleepers# sho$ a normal variation. )heir sleep# althogh long# is tern is essentiall! the same as that "ond in normal indivi individa dals normal in architectre and ph!siolog!. ph!siolog!. Sleep e""icienc! e""icienc! and the $ho are sleep deprived. ;nlike a sleep-deprived individal# the sleep-$ake schedl schedlee are normal. )his  patt  pattern ern is $ith $ithot ot com sleep  patt  pattern ern contines in this pro"ile even a"ter several nights  plaints abot the +alit! o" sleep# da!time sleepiness# or di""icl o" e%tended slee p . 9s the name indic indicates# ates# the etiolog! etiolog! o" idio ties $i $ith th the a$a a$ake ke mo mood# od# motivation# and  per "  " orma ormance.  pathic h!persomnia is not kno$n ' ho$ ho$eve ever# r# a central nervos etime  pattern# ,ong sleep ma! be a li" etime  pattern# and it appears to have have a s!stem case is presmed. )hree general categories have  been "amilial incidence. an! persons are variable sleepers and ma! developed. Sbgrop 1 incldes individals $ho are /,9-C$5 sle epers at certain times in their lives  become long sleepers es..  posi tive # have atonomic nervos s!stem d!s" nctions# and Some persons pers ons have sb ective complaints o" "eeling slee p! have other a""ected "amil! members. Sbgrop  incldes sta have a tendenc! to ts  postviral in" ection $ithot ob ective "indings. )he! do not have ection  patients e.g.# :illain-  # mononcleosis# and at!pical viral ective signs . Clinicians shold tr! to rle ot clear-ct cases o"   pnemon  pnemonia2 ia2 . Sbgrop ? idiopathic h!persomnia patients are e%ces sive somnolence. non" amilial milial   and are not  postviral 1i.e.# trl! idiopathic2. 9ge o" onset is characteristicall! bet$een 1 5 and ? !ears# and an d the h!persomnia  becomes a li" elong (n elong  problem. )! pe  pess  o"  /! pe r somnia addi tion to the prolonge prolonged# d# ndistrbed# and nre"reshing 0leine-  ,evin S!n d  rome. 0leine-,evin s!ndrome is noctrnal sleep# (/ is associated $ith long nonre"reshing naps# a relati relativel! vel! rare condition consisting o" recrrent  periods di" di""ic "iclt lt! ! a$akening#  slee sleep p drnk enne enne ss#   an and atomatic o"  prolonge  prolonged d sleep "rom $hich  patients ma! be arosed2  behaviors $it nesi sia. a. @ther s!mptoms sggesting $ith h amne $ith intervening  periods o" normal sleep and alert $aking. atonomic nervos s!s tem d!s"nction are t!pical# inclding Dr ing th thee h!persomniac episodes# $ake"l  periods are migraine-like headache s# "ainting spells# s!ncope# orthostatic sall s all! ! ma marked rked  b! $ithdra$al "r "rom om social con contac tacts ts and h!potens !potension# ion# and  a!nad a!nad t!pe  phenomena $i $ith th cold han hands ds retrn to  bed at the "irst opportni opport nit!. t!. 0leine-,evin and "e "eet. et. s!ndrome s!ndr ome is the  be st recogni3ed recrre recrrent nt h!persomnia Some patients $ith (/ sleep less than 1 4 hors per night# have thogh it is ncommon. (t  predominantl! a""licts males in di"" di""iclt! iclt! a$akening#  a$ak a$akee nre" re re shed shed   and even con"sed# earl! adolescence' ho ho$e $eve ver# r# it can occr later in li"e and in and ma! take ni ninte ntentional# ntional# nre"res nre"reshing hing da!tim da!time e naps "emales. With "e$ e%ceptions# the "irst attack occrs bet$een  pr  provoked ovoked  b! the heir ir da!time somn somnolence. olence. @nset is t!picall! the ages o" 1 4 and 1 !ears. are instances o" onset in the  be " ore  ore  5 !ears !ears o" age# and the corse o" the disorder disorder is "orth and "i"th decades o" li"e have been reported. (n its  persistent and nremitting. classi cla ssicc "o "orm rm## the recrrent epi episode sodess ar associated ed $i $ith th are e associat e%tr e% trem emee slee sleepi piness ness  1  7-h 7-ho orr to -ho -hor r sl slee eep p  periods2# voracios eating# h!per h!perse%alit!# se%alit!# and disi disinhib nhibiti ition on e.g.# 9 64 -!ear-old acconta accontant nt complained o" e%cessive sleepiness t!picall! aggression2 agg ression2.. 8pisodes last "or a "e$ da!s p to and reported th that at he had to ta take ke ab abot ot "i "ive ve hal"-hor naps several $eeks and appear once to ten times per !ear. 9 mono throgh ot the da!. /e a$akened "eeling re"reshed  bt nless s!mptomatic h!persomnolent "orm can occr. )he he na pped he cold cold not "nction at $ork . /e did not not ab abse se "r e+enc! e+enc! o" the hman lekoc!te antigen /,92 is increased sbstances an and d narcoleps! $a $ass rled rled o ot' t' bt on hi histo stor! r! he in  patients $ith this s!ndrome me  . report rep orted ed th that at bo both th hi hiss "ather and  paternal grand"ather had the same sleep  pattern. /e $as