Sleep Disorders
Differential Overview
Insomnia
❑ Stress
❑ Drugs
❑ Medical disorders
❑ Phase shift
❑ Sleep apnea
❑ Conditioned insomnia
❑ Depression
❑ Restless leg syndrome
❑ Nocturnal myoclonus
❑ Nightmares
Hypersomnia
❑ Drugs
❑ Medical disorders
❑ Adolescence
❑ Narcolepsy
Diagnostic Approach
Insomnia may occur as difficulty falling asleep, multiple awakenings from sleep, or awakening early and being unable to fall back to sleep. If the presenting symptom is excessive daytime somnolence or fatigue, the problem may have to be reframed as one of insomnia.
Clinical Findings
Stress Transient insomnia is common with major life stress. Rumination occurs during the sleeplessness.
Drugs Insomnia: Stimulant drugs such as caffeine, amphetamines, xanthines, nicotine, and phenylpropanolamine may cause insomnia. Benzodiazepines produce rebound anxiety and insomnia. Hypersomnia: Alcohol sedates, but the sleep is shallow and not restive. Tricyclic antidepressants, benzodiazepines, narcotics, and antihistamines are among the more common causes.
Medical disorders Insomnia: Hyperthyroidism, congestive heart failure, COPD, nocturia, and pain are common causes. Hypersomnia: Those conditions producing fatigue, such as infectious mononucleosis, low cardiac output, renal failure, and hypothyroidism, cause hypersomnia.
Phase shift When the sleep–wake cycle is reset, as in alternating shift work or international travel, insomnia results. Day–night reversal is a common problem in dementia.
Sleep apnea The roommate reports heavy snoring and interruption of breathing, which is followed by an inspiratory gasp. Patients fall asleep at inappropriate times during the day, and they may manifest behavioral abnormalities. Alcohol and sedatives worsen this condition by depressing respiratory function and REM sleep. On examination the patient is often obese, has a thick neck, and a crowded posterior pharynx.
Conditioned insomnia A learned behavior may result in bedtime being associated with frustration and anxiety. Patients will often sleep well in a bed other than their own.
Depression Insomnia may be the chief complaint, manifesting as difficulty falling asleep or early awakening with inability to fall back to sleep. The manic phase of bipolar disorder will exhibit hyperactivity, racing thoughts, and speech with grandiosity.
Restless leg syndrome It is experienced as a crawling sensation deep within the muscles, relieved by movement.
Nocturnal myoclonus The patient may be awakened by repetitive twitching or jerking of the legs.
Nightmares These are dream anxiety attacks, from which the patient will awaken perspiring and with a rapid pulse.
Adolescence Changes in the biological time clock and need for sleep are physiologic for adolescents.
Narcolepsy This is recognized by the distinctive features of cataplexy (sudden collapse due to loss of muscle tone precipitated by strong emotion, surprise, or laugh), hypnagogic hallucinations (visual or auditory waking dreams), and sleep paralysis (brief inability to move upon awakening).
Book Source Details
- Book Title: Field Guide to Bedside Diagnosis
- Author(s): David S. Smith
- Year of Publication: 2007
- Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Sleep symptoms
Read excerpts from these other book chapters related to Sleep symptoms:
Medical Books Excerpts
- INSOMNIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- INSOMNIA
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Insomnia
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Insomnia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Insomnia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Insomnia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Insomnia
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- INSOMNIA
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2008 Williams & Wilkins.
More About Causes of Sleep symptoms
|
|
More About This Book:
Title: Field Guide to Bedside Diagnosis
Authors: David S. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 0-78178-165-5
|
|
» Next page: Insomnia (Signs & Symptoms: A 2-in-1 Reference for Nurses)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
