Def: no clearly defined sleep-wake cycle, disorganized sleep and wake spread across 24 hrs
Multiple (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 conditions
Usually coexists with another condition
- Neurodevelopmental d/o: Smith-Magenis, Angelman, Williams syndromes
- Neurodegenerative d/o: Alzheimer’s dz, parkinsonism, Huntington’s dz
- TBI
- Post-CNS infection, esp basal meningitis
- Psych d/o, esp schizophrenia
Pathophysiology
Biological: disruption of circadian pathways
Environmental: weak daylight exposure and lack of routine
Assessment
Can be difficult, actigraphy may not separate sleep from rest in elderly
Strongly consider neuro referral, MRI, genetic or psychometric testing, psych evaluation
Look for and treat other causes of fragmented sleep or napping: poor sleep behavior, poor sleep environment, medical comorbidities
Treatment
Focus on strengthening time cues:
a. Structured, consistent social and physical activity
b. Consistent meal times
c. Visible time cues (clocks), quiet signs at night
d. Separate sleeping and living areas
e. Avoid prolonged bed rest
f. Scheduled and enhanced light-dark cycles
g. Increase daylight exposure in care homes
Low-dose melatonin 2 hrs before desired bedtime may help, esp in younger pts
- Oxford Handbook of Sleep Medicine 2022