Page 62 - IDF Journal 2023

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wake up for school in the morning syndrome”. Advanced sleep phase syndrome is more common in elderly patients because sleep time advances naturally with age. These conditions can be hard to treat and adapting lifestyle to the timing of sleep is often preferable.
Movement disorders
This disparate group includes restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). These conditions are common and may be
regarded as sisters, either one occurring without the other or both together. RLS is common in middle-aged females
and constitutes a feeling of agitation
in the limbs with a desire to move
them. Patients may describe crawling
or electrical activity deep inside in the lower legs. It is driven by tiredness and therefore more common in the evening and at bedtime. PLMD will affect the bed partner when the patient persistently kicks with a periodicity between 30
and 90 seconds. The patient’s sleep
is also disturbed and it can lead to
excessive daytime sleepiness. These conditions are hard to treat and often tablet therapies will lead to augmentation, which is tolerance to the tablets and the worsening of symptoms earlier in the day.
Hypnic jerks are regarded as a normal variant of sleep and constitute a sudden contraction of the muscles at sleep onset which may wake the patient again. They do not require treatment unless causing extreme sleep disturbance.
TABLE 1. The International Classification of Sleep Disorders ICSD-3 (2013)
Insomnias
• Chronic insomnia
• Short-term insomnia disorder
• Other insomnia disorder
• Isolated symptoms/normal variants
• Excessive time in bed
• Short sleeper
Sleep related breathing disorders
• Obstructive sleep apnoea
• Central sleep apnoea
CSA with Cheyne-Stokes breathing
• Obesity hypoventilation syndrome
• Sleep related hypoxaemia
Central disorders of hypersomnolence
• Narcolepsy I+II
• Idiopathic hypersomnia
• Klein Levin Syndrome
• Insufficient sleep syndrome
• Nightmare disorder
Parasomnias
• Confusional arousal
• Sleep walking
• Night terrors
• Sleep related eating disorder
• REM behaviour disorder
• Recurrent isolated sleep paralysis
Circadian rhythm sleep disorders
• Delayed sleep phase syndrome
• Advanced sleep phase syndrome
• Irregular sleep/wake rhythm
• Non-24 hour sleep/wake rhythm
• Shift work related sleep disorder
• Jet lag disorder
Movement disorders
• Restless legs syndrome
• Periodic limb movement disorder
• Sleep-related cramps
• Sleep-related bruxism
• Sleep-related rhythmic movement disorder
• Benign sleep myoclonus of infancy
• Propriospinal myoclonus at sleep onset
• Normal variants
– Excessive fragmentary myoclonus
– Hypnogogic foot tremor and alternating leg muscle
activation
• Hypnic jerks
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Dr Peter Venn MBBS FRCA
Independent Consultant Sleep Physician
Registered address: Sussex Sleep Services, 49 Station Road, Polegate, East Sussex BN26 6EA
W: www.sussexsleepservices.com
E: peter.venn@sussexsleepservices. com