Sleep-Wake Disorders Based on a Polysomnographic Diagnosis

Stanford University, Palo Alto, California, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 03/1982; 247(7):997-1003. DOI: 10.1001/jama.247.7.997
Source: PubMed


Under the organizational aegis of Project Sleep and the Association of Sleep Disorders Centers (ASDC), nearly 5,000 patient records from 11 sleep-wake disorders clinics were analyzed in a cooperative study. These cases represented the diagnostic experience of each of these centers over a two-year period. Each patient underwent polysomnographic study, and his or her condition was diagnosed according to the ASDC classification system, a new, standardized nosology of sleep disorders medicine. The most common major diagnostic category was 'disorders of excessive sleepiness (hypersomnia),' 42%; this was followed by 'disorders of initiating and maintaining sleep (insomnia),' 26%; 'penile tumescence evaluations for impotency,' 17%; 'parasomnias,' 3%; and 'disorders of the sleep-wake schedule,' 2%. If the impotency evaluations performed in the sleep clinics are removed from the total, leaving only the population that was studied because of sleep complaints, the proportions of the diagnostic categories are hypersomnia, 51%; insomnia, 31%; parasomnias, 15%; and sleep-wake schedule disturbances, 3%. The most prevalent diagnoses in the hypersomnia category were sleep apnea (43%) and narcolepsy (25%). Psychiatric disorders (35%) comprised the most frequent group of insomnia diagnoses, though a variety of other disorders were common. The applications of these results for the practicing physician are discussed.

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Available from: Thomas Roth, Sep 14, 2015
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    • "range of 9.2% to 40.3% (BaHammam, 2004; Coleman et al., 1982; Dorsey & Bootzin, 1997; Edinger et al., 2000). Although paradoxical insomnia appears to be a prevalent subtype of chronic insomnia, little is known about its etiology, the course of the disorder, or its treatment responsivity. "
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    ABSTRACT: This case study series investigated a new treatment for paradoxical insomnia patients as there is no standard treatment for this patient group at this time. Four paradoxical insomnia patients had a polysomnography (PSG) sleep study, an unsuccessful brief course of behavioral treatment for insomnia, and then a novel sleep education treatment comprising review of their PSG with video and exploration of the discrepancy between their reported and observed sleep experience. Two patients responded well to sleep education, mainly with improved self-reported sleep onset latency, total sleep time, and Insomnia Severity Index scores; and the other two, who exhibited sleep architecture anomalies, were unresponsive. These findings suggest that sleep education holds promise for some paradoxical insomnia patients. Suggestions for future studies are given.
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    • "The prevalence and pathogenesis of paradoxical insomnia are unknown, but it is estimated that it accounts for 5–9% of all insomnia, and that both organic and psychological factors may concur with its aetiology (American Academy of Sleep Medicine, 2006; Coleman et al., 1982; Edinger and Krystal, 2003). The current ICSD-2 criteria (American Academy of Sleep Medicine, 2006) state that paradoxical insomniacs show a Ôconsistent marked mismatchÕ between objective and subjective self-reported or diary estimations. "
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    • "However, other muscles can be involved. PLMs during sleep occur in 6-13% of the general population, either as an isolated phenomenon or with other sleep disorders.[9] [10] [11] PLMs were first documented polygraphically in the restless legs syndrome (RLS).[12] "

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