Def: insomnia and excessive sleepiness from work hours that overlap usual sleep timeMore common with night, early or rotating shifts than late or split shiftsPrevalence up to 38% in rotating shift workers Health and safety concernsSafety risk: occupational accidents, professional driversHigher rates of mental and physical health problemsEpidemiological links to metabolic and CV dzReports of… Continue reading
Irregular Sleep-Wake Rhythm Disorder
Def: no clearly defined sleep-wake cycle, disorganized sleep and wake spread across 24 hrsMultiple (usually >3) short, arrhythmic sleep episodes of varying length (usually <4 hrs)ICSD-3: sx ≥3 months, diary or actigraphy ≥7 days (ideally 14) showing ≥3 sleep bouts/24 hrs Associated conditionsUsually coexists with another condition PathophysiologyBiological: disruption of circadian pathwaysEnvironmental: weak daylight exposure… Continue reading
Non-24-Hour Sleep-Wake Rhythm Disorder
Def: sleep-wake cycle desynchronized from the solar cyclePeriod length typically >24 hrsSleep onset delays progressively, usually 20-60+ min per dayICSD-3: sx ≥3 months, diary or actigraphy ≥14 days showing daily delay EpidemiologySeen in blind (esp no light perception) and sighted pts≥50% of totally blind individuals may have Non-24 Associated conditions PathophysiologyTotally blind: no photic entrainment,… Continue reading
Advanced Sleep-Wake Phase Disorder
Def: chronic (>3 months) major advance (>2-3 hrs) in sleep-wake timing vs desired or required scheduleMain sx: early morning (terminal) insomnia EpidemiologyPrevalence <1%, possibly underreported since less disruptive than DSWPDMore common in older adultsRare autosomal dominant familial forms with PER2 and CSNK1D mutationsAssoc with neurodevelopmental d/o: Smith-Magenis syndrome, ASD, chromosomal microdeletions PathophysiologyInverse of DSWPD mechanismsExcess… Continue reading
Delayed Sleep-Wake Phase Disorder
Def: chronic (>3 months) major delay (>2-3 hrs) in sleep-wake timing vs desired or required schedulePrevalence 1-10%More common in teens and young adults, can start in childhoodFamily hx common (up to 40%) Consequences of social schedule:1. Sleep onset insomnia2. Difficulty waking at acceptable time, may cause sleep inertia (sleep drunkenness)3. Chronic sleep restriction4. EDS, esp… Continue reading