Insomnia Diagnoses

Primary insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or waking up too early, without an identifiable underlying medical, psychiatric, or environmental cause. It is diagnosed when the insomnia is not directly attributable to other conditions such as anxiety, depression, or a physical illness.

Key Features of Primary Insomnia:

1. Chronic Sleep Difficulty:

   • Trouble falling asleep (sleep-onset insomnia).
   • Frequent awakenings during the night (sleep maintenance insomnia).
   • Waking up too early and being unable to return to sleep (terminal insomnia).

   

1. Daytime Impairment:

   • Fatigue or low energy.
   • Irritability or mood disturbances.
   • Difficulty concentrating or decreased performance in work or social activities.

2. Duration:

   • Symptoms persist for at least three nights per week for at least three months.

3. Exclusion of Secondary Causes:

   • The insomnia is not due to a physical or mental health disorder, substance use, or environmental disruptions.

Causes of Primary Insomnia:

The exact cause is often unclear, but it may involve:

• Hyperarousal: Excessive physical or mental activity, making it hard to relax and fall asleep.
• Stress: Chronic stress or overthinking may lead to conditioned arousal around bedtime.
• Poor Sleep Habits: Inconsistent sleep schedules, excessive caffeine or screen time, and irregular routines can exacerbate insomnia.
• Genetics: Some research suggests a genetic predisposition to insomnia.

Treatment Approaches:

1. Cognitive Behavioral Therapy for Insomnia (CBT-I):

   • Focuses on identifying and changing negative thought patterns and behaviors related to sleep.

2. Sleep Hygiene:

   • Maintaining a regular sleep schedule.
   • Creating a comfortable sleep environment.
   • Avoiding stimulants like caffeine or electronics before bed.

3. Relaxation Techniques:

   
   
   
   
   
   • Meditation, deep breathing exercises, or progressive muscle relaxation.

4. Medications (if necessary):

   • Short-term use of sleep aids or sedative-hypnotic medications, under medical supervision.

•  F51.3 Sleepwalking [somnambulism]
•  F51.4 Sleep terrors [night terrors]
•  F51.5 Nightmare disorder
•  F51.8 Other sleep disorders not due to a substance or known physiological condition
•  F51.9 Sleep disorder not due to a substance or known physiological condition, unspecified

Parasomnias are a category of sleep disorders characterized by abnormal behaviors, experiences, or physiological events that occur during sleep or during transitions between sleep and wakefulness. These disorders can involve movements, behaviors, emotions, perceptions, or dreams that are unusual or disruptive.

Types of Parasomnias

Parasomnias are classified into three main categories based on when they occur in the sleep cycle:

1. Non-REM-Related Parasomnias:

These occur during slow-wave sleep (deep sleep) and are typically associated with incomplete arousal. Examples include:

• Sleepwalking (Somnambulism): Walking or performing other complex behaviors while still asleep.
• Sleep Terrors (Night Terrors): Sudden episodes of intense fear, screaming, or flailing, often accompanied by a rapid heart rate and confusion upon waking.
• Confusional Arousals: Episodes of confusion or disorientation during partial awakening, often without full awareness.

2. REM-Related Parasomnias:

These occur during the REM (Rapid Eye Movement) stage of sleep, where dreaming is most prevalent. Examples include:

• REM Sleep Behavior Disorder (RBD): Acting out vivid dreams, often involving violent or dramatic movements.
• Recurrent Isolated Sleep Paralysis: Temporary inability to move or speak during sleep transitions, often accompanied by hallucinations.
• Nightmares: Disturbing dreams that can cause awakening with strong emotional responses such as fear or anxiety.

3. Other Parasomnias:

These may not fit neatly into the Non-REM or REM categories:

• Sleep-Related Eating Disorder (SRED): Eating or drinking during the night while partially asleep, often without memory of the event.
• Exploding Head Syndrome: A sensation of a loud noise or explosion in the head upon waking or falling asleep, without an actual sound.

Causes of Parasomnias

Parasomnias can arise from various factors:

• Genetics: A family history of parasomnias may increase risk.
• Sleep Deprivation: Lack of sufficient sleep can trigger parasomnias.
• Stress or Anxiety: Emotional distress can exacerbate these episodes.
• Medications or Substances: Certain drugs, alcohol, or stimulants may play a role.
• Other Sleep Disorders: Conditions like sleep apnea can increase the likelihood of parasomnias.
• Neurological or Psychiatric Conditions: Some parasomnias are linked to brain injuries, Parkinson's disease, or PTSD.

1. Delayed Sleep-Wake Phase Disorder (DSWPD):

• What it is: A significant delay in the sleep-wake cycle, causing difficulty falling asleep at conventional times and waking up late.
• Symptoms:
  • Trouble falling asleep until very late (e.g., 2–6 AM).
  • Difficulty waking up early for work, school, or other obligations.
• Common in: Teenagers and young adults.

2. Advanced Sleep-Wake Phase Disorder (ASWPD):

• What it is: A shift to earlier sleep and wake times, resulting in early evening sleepiness and waking up too early in the morning.
• Symptoms:
  • Falling asleep very early (e.g., 6–9 PM).
  • Waking up in the early morning hours (e.g., 3–5 AM).
• Common in: Older adults.

3. Irregular Sleep-Wake Rhythm Disorder:

• What it is: A fragmented sleep pattern without a clear circadian rhythm. Sleep is distributed in multiple short periods throughout the day and night.
• Symptoms:
  • No consistent bedtime or wake time.
  • Sleep occurring in irregular bouts of several hours.
• Common in: People with neurodegenerative disorders (e.g., Alzheimer’s disease).

4. Non-24-Hour Sleep-Wake Rhythm Disorder (Non-24):

• What it is: A sleep pattern that is not synchronized to the 24-hour day, typically seen in individuals who are totally blind.
• Symptoms:
  • Gradual drift in sleep and wake times.
  • Periods of good alignment with social norms followed by misalignment.
• Common in: People with complete blindness due to lack of light perception.

5. Shift Work Disorder:

• What it is: Sleep disturbances due to working non-traditional hours, such as night shifts, rotating shifts, or early morning shifts.
• Symptoms:
  • Difficulty sleeping during the day.
  • Excessive sleepiness during night shifts.
• Common in: Shift workers, such as healthcare professionals, factory workers, and truck drivers.

6. Jet Lag Disorder:

• What it is: Temporary misalignment of the circadian rhythm caused by rapid travel across time zones.
• Symptoms:
  • Fatigue, insomnia, and difficulty concentrating.
  • Gastrointestinal discomfort.
• Common in: Frequent travelers.

Causes of Circadian Rhythm Sleep Disorders

• Lifestyle Factors:
  • Irregular schedules, late-night screen use, or lack of exposure to natural light.
• Genetic Factors:
  • Variations in genes controlling the biological clock.
• Medical Conditions:
  • Blindness or neurodegenerative diseases.
• Environmental Factors:
  • Shift work or frequent time zone changes.

•  G47.2 Circadian rhythm sleep disorders
  •  G47.20 Circadian rhythm sleep disorder, unspecified type
  •  G47.21 Circadian rhythm sleep disorder, delayed sleep phase type
  •  G47.22 Circadian rhythm sleep disorder, advanced sleep phase type
  •  G47.23 Circadian rhythm sleep disorder, irregular sleep wake type
  •  G47.24 Circadian rhythm sleep disorder, free running type
  •  G47.25 Circadian rhythm sleep disorder, jet lag type
  •  G47.26 Circadian rhythm sleep disorder, shift work type
  •  G47.27 Circadian rhythm sleep disorder in conditions classified elsewhere
  •  G47.29 Other circadian rhythm sleep disorder