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Sleep/Wake Disorders - Coggle Diagram

- - - - Difficulty Maintaining Sleep
      - Difficulty Initiating Sleep
      - Early Morning awakening with inability to return to sleep
  - - - Appear fatigued or “wired”
      - Have hyperarousal (physiological/cognitive)
      - Engage in maladaptive behaviors (e.g., clock-watching, erratic sleep schedules)
  - - - Runs in families (35–70% report family history, especially maternal)
      - Female sex, older age
      - Increased stress reactivity, sleep reactivity
- - - - Recurrent daytime sleep episodes
      - Prolonged unrefreshing sleep 9+ hours/day
      - Difficulty waking up (sleep inertia)
- - - - Cataplexy w intense emotions (T1)
      - hyprocretin deficiency (T1)
      - Nocturnal Polysomnography test
- - - - Either 1 or Both Evidence by polysomnopgrahy of atleast 5 obstructive apneas OR hyponeas/hour of sleep AND
        
        Snoring/Snorting/Gasping/Breathing Pauses
        
        Daytime Sleepiness/Fatigue/Unrefreshing Sleep despite the opportunity
        
        Snoring/Snorting/Gasping/Breathing Pauses
        
        Morning Headaches
        
        Difficulty Concentrating
        
        Irritability/mood changes
        
        Insomnia
    - - Repeated episodes of upper airway obstruction (complete or partial) during sleep.
      - Breathing pauses (apneas) or shallow breathing (hypopneas) result in oxygen desaturation and arousals from sleep.
      - Typically more frequent in REM sleep and supine position.
      - Diagnosed via polysomnography showing ≥5 apneas/hypopneas per hour with symptoms, or ≥15 regardless of symptoms.
    - - Anatomical Abnormalities (large tonsils, short neck, retrognathia)
      - Neuromuscular Factors
      - Risk Factors: older age, male, family history, smoking
      - Obesity
      - Alcohol or sedative use before bed
  - - - Repeated episodes of stopped or reduced breathing during sleep
      - Insomnia or frequent nighttime awakenings
      - Excessive daytime sleepiness
      - Difficulty concentrating
      - Awakening with shortness of breath (dyspnea)
    - - Cessation of breathing without respiratory effort due to diminished central respiratory drive.
      - Subtypes:
        
        Idiopathic CSA
        
        CSA with Cheyne-Stokes breathing (common in heart failure)
        
        CSA due to medical condition without Cheyne-Stokes
        
        CSA due to high-altitude periodic breathing
        
        CSA induced by drugs (especially opioids)
    - - Impaired feedback in the respiratory control system, commonly due to:
        
        Congestive heart failure
        
        Stroke
        
        Renal failure
        
        Opioid use
        
        High-altitude sleeping
      - Not typically associated with snoring or obesity like OSAH.
  - - - Characterized by elevated CO₂ levels (hypercapnia) during sleep not explained by other sleep disorders.
      - Ventilation is inadequate to maintain normal gas exchange.
      - Subtypes include:
        
        Idiopathic central alveolar hypoventilation
        
        Congenital central alveolar hypoventilation (Ondine's curse)
        
        Comorbid hypoventilation with conditions like COPD, neuromuscular disorders, obesity, or substance use
    - - Failure of the brain to regulate breathing during sleep, or mechanical restriction of airflow due to:
        
        Neurological diseases (e.g., Parkinson's, ALS)
        
        Obesity
        
        Chronic lung disease
        
        Chest wall deformities
        
        Use of sedative-hypnotics or opioids
    - - Insidious onset of:
        
        Poor sleep quality
        
        Daytime sleepiness
        
        Morning headaches
        
        Cognitive dysfunction
        
        Shortness of breath may be present during the day.
- - - - Delays or advances in circadian melatonin secretion or core body temperature
      - Abnormal light sensitivity
      - Genetic predisposition (e.g., familial advanced sleep phase syndrome)
    - - Inadequate exposure to light or irregular light cues
      - Social obligations or school/work demands misaligned with biological rhythms
    - - Adolescents often have a natural circadian delay, leading to delayed sleep phase type
      - Aging is associated with earlier sleep-wake timing (advanced sleep phase)
  - - - Insomnia
      - Excessove sleepines
    - - Delayed Sleep Phase Type
        
        Sleep is delayed by ≥2 hours relative to conventional bedtime
        
        Difficulty falling asleep and waking up on time
        
        Common in adolescents and young adults
      - Advanced Sleep Phase Type
        
        Sleep and wake times are earlier than desired
        
        Early evening sleepiness and very early morning awakening
        
        More common in older adults
      - Irregular Sleep-Wake Type
        
        Lack of clear sleep-wake pattern
        
        Sleep occurs in multiple short periods across the 24-hour day
        
        Common in individuals with neurocognitive disorders
      - Non-24-Hour Sleep-Wake Type
        
        Sleep and wake times gradually shift later each day
        
        Most common in individuals who are completely blind
      - Shift Work Type
        
        Misalignment between internal clock and rotating or night shift work
        
        Leads to insomnia and/or excessive sleepiness
        
        May increase risk for medical and mental health issues
- - - - Incomplete awakenings from NREM sleep, typically during first third of the night
      - Sleepwalking: rising from bed and walking with blank stare, unresponsive
      - Sleep terrors: abrupt awakening with screaming and autonomic arousal
      - No or minimal dream recall
      - Amnesia for the episode
    - - Occurs during NREM stage 3 (slow-wave sleep)
      - Usually in children, can persist or reemerge in adults
      - May result in injury or distress to others
      - Sleep deprivation, stress, or fever may trigger episodes
    - - Genetic predisposition (family history common)
      - Often exacerbated by:
        
        sleep deprivation
        
        alcohol/sedatives
        
        sleep disorders (sleep apnea)
        
        irregular sleep/wake schedules
  - - - Repeated extended, dysphoric, and well-remembered dreams (typically threats to survival or security)
      - Awakening occurs during second half of sleep (REM sleep)
      - Individual becomes quickly alert and oriented
      - Causes distress or interference in functioning
    - - Occurs during REM sleep, usually late in the night
      - Associated with poor sleep quality, anxiety, and mood disorders
      - More common in children and females
      - Increased risk of suicidal thoughts/behavior
    - - Often Triggered by:
        
        Traumatic experiences (e.g., PTSD)
        
        Stress
        
        Sleep deprivation
        
        Some medications (e.g., antidepressants)
      - May run in families
  - - - Repeated episodes of vocalizations or complex motor behaviors during REM sleep
      - Occurs after at least 90 minutes of sleep (REM period)
      - Behavior corresponds to dream content
      - Person becomes quickly alert upon awakening
    - - Typically affects men over 50
      - May result in injury to self or partner
      - Often a prodrome of neurodegenerative disease (e.g., Parkinson’s, Lewy body dementia)
    - - Associated with neurodegenerative brain disorders
      - Can be induced or worsened by:
        
        Antidepressants
        
        Withdrawal from alcohol/sedatives
        
        Brainstem lesions
- - - - Begins or worsens during periods of rest or inactivity
      - Partially or totally relieved by movement
      - Worse in the evening or at night
  - - - Antidepressants
      - Antihistamines
      - Dopamine antagonists