Dys Somnia
Dyssomnias may be extrinsic (having an external cause), or intrinsic (having their cause in the body). A dyssomnia may also be caused by problems with a person's circadian rhythm, or internal clock.
Daytime sleepiness, poor concentration, and the inability to feel refreshed and rested in the morning are caused due to all types of insomnia. Dyssomnias are disorders of the amount, quality, or timing of sleep.
Dyssomnia NOS (not otherwise specified) refers to any insomnia, hypersomnia, or circadian rhythm disturbance that does not meet the full criteria for a specific dyssomnia.
Dyssomnia covers a range of specific sleep disorders, Insomnia, Sleeplessness, the Inability to Sleep, Wakefulness. Chronic and persistent difficulty in either; falling asleep, remaining asleep through the night, or waking up too early. The Dyssomnias are disorders of sleep or wakefulness they are not Parasomnias. Dysosomias therefore include the following specific disorders:
- Insomnia
- Apnea
Causes of Dyssomnia
Here is the list of some of the common causes of dyssomnia :
- Jet lag, work shifts.
- Delayed sleep phase e.g. working late evenings, late night studies.
- Advance sleep phase e.g. people who believe in "early to bed, early to rise", elderly folk.
- People who conform to a 25hr-27hour schedule e.g. blind people or people with personality disorders.
- Excessive sleep during the day
- Worry, anxiety or stress
- Depression or major depression
- Excessive physical or intellectual stimulation at bedtime
- Jet lag
- Abruptly stopping a medication
- Nicotine, alcohol, caffeine, food, or stimulants at bedtime
- Shift work
- Not getting enough bright-light exposure during waking hours
- Wake-sleep pattern disturbances
- Restless leg syndrome
- Aging
- Overactive thyroid
- Alcoholism or abruptly stopping alcohol after long-term use
- Side effect of a new medication
Associated Features of Dyssomnias:
- Obstructive Apnea Syndrome
- Central Apnea Syndrome
- Mixed Apnea Syndrome
- Narcolepsy
- Periodic Leg Movements and Leg-Related Syndrome
- Alveolar Hypoventilation
- Recurrent Hypersomnia
- Psycho-Physiologic Insomnia
- Idiopathic
Clinical Features
1. A persistent or recurrent pattern of sleep disruption leading to excess sleepiness or insomnia due to the mismatch between the sleep-wake cycle.
2. Significant distress, irritability.
3. Impairment of social, occupational or other areas of functioning.
4. Feeling of uncomfortable sensation in the legs e.g. crawling sensations, discomfort, restlessness, limb jerks.
Treatment of Dyssomnia
Good sleep habits can prevent many cases from developing dyssomnias.
Medical disorders, psychiatric disorders, and stress may precipitate or aggravate parasomnias. A careful history of psychosocial stresses, alcohol or drug use, and symptoms of depression should be obtained. Also, a detailed Mental Status Examination should be performed.
Recommendations from sleep experts include:
- Don't go to bed unless you are tired.
- Have a comfortable, dark, quiet sleeping environment.
- Use the bed only for sex and sleep.
- Wake up at the same time every morning.
- Avoid alcohol, caffeine, and other drugs, especially after dinner.
- Avoid excessive daytime naps. A person should take only one nap a day, if any, and the nap should be less than 1 hour.
Treatment of any primary psychiatric condition may prevent some sleep problems from occurring. Avoidance of obesity may prevent some cases of sleep apnea. Some sleep disorders cannot be prevented.
Management
- Try to sleep at a fixed time daily.
- Arise at the same time daily.
- Avoid caffeine, nicotine, alcohol or stimulant drugs.
- Avoid sleep during daytime.
- Regular exercise twice daily.
- Substitute reading for TV.
- Regular eating hours and change way of life.
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