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Psychiatry – Sleep Disorders
Whiteboard Animation Transcript
with Elliott Lee, MD
Sleep problems can be divided into complaints that people have:
1. One of the most common complaints is excessive daytime sleepiness. There are generally 5 major causes for excessive daytime sleepiness…
…the most common of which is an insufficient quantity of sleep. Many medical students suffer from this!
Next is a poor quality of sleep. Environmental disturbances (such as light, partner, pet), or other intrinsic sleep disorders such as sleep apnea or periodic limb movement disorder could be involved.
Thirdly, and less common, is a pathologic disorder of sleepiness during the day, including narcolepsy and idiopathic hypersomnia.
Fourthly, a medical or psychiatric disorder, such as a thyroid condition, cancer, medication side effect, or mood disorder can present with sleepiness.
Finally, a circadian rhythm disorder such as shift work, or jet lag could also be a culprit.
2. On the other hand, sometimes patients complain of difficulties initiating or maintaining sleep, or “insomnia”. This symptom can be a primary disorder on its own, but is usually the result of, or exacerbated by one or a combination of four factors:
An acute stressor. This is a common culprit in many cases of insomnia, but often is comorbid with other factors
Circadian rhythm issue – including shift work or a circadian rhythm disorder
A medical or neurologic condition – common culprits include medications or substances such as caffeine, alcohol, a thyroid problem, or other potential medical disorders, and
A psychiatric condition, especially mood or anxiety disorders.
3. Lastly, another presentation could be an unusual behavior at night. This is referred to as a parasomnia, or disorder of arousal. These are often classified according to what stage of sleep they emerge from:
NREM sleep parasomnias typically include sleepwalking, or night terrors,
While the classic REM parasomnia is REM behavior disorder, where patients act out their dreams.
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