1. Sleep Disorders

2. Primary Insomnia • Difficulty initiating or maintaining sleep or having nonrestorative sleep for at least a month, causing distress or impairment, and not due to mental condition, substance or medical (or other sleep disorder) • Physiological, cognitive, or emotional arousal is heightened and becomes worse as one fears not sleeping.

3. Tx for insomnia • Sleep labs to rule out Apnea or other sleep related medical problems • Regular sleep schedule, no naps, no activities other than sleep and sex in the bed • Help reduce cognitive fears about not sleeping • Don’t lie in bed, get up and distract until tired • Aerobic daytime exercise • Masturbation or sexual activity with another • Relaxation exercises • Arrange bedroom to be a good sleep environment

4. Tx for Insomnia • Reduce alcohol, caffeine, and drug intake • Convince cl they may need less sleep than they think • Decrease catastrophizing • Medications

5. Primary Hypersomnia • Excessive sleep at least one month, clinically significant distress, not due to mental disorder, substance, medical condition or other sleep disorder • Recurrent specifier- at least 3 days, several times a year for 2 yrs

6. Tx Hypersomnia • Sleep lab to rule out apnea or other medical problems • No alcohol or hypnotics • May use stimulants or stimulating anti depressants • Increase exercise, schedule activities • Look for triggers of psychological distress and rule out depression

7. Narcolepsy • Sleep attacks daily over 3 months • Either loss of muscle tone for seconds to minutes or paralysis/dreamlike hallucinations • Neurological disorder • Use sleep labs to confirm diagnosis • Medications, stimulants

8. Other Sleep Disorders • Breathing Related Sleep Disorder • Circadian Rhythm Sleep Disorder • Specifiers: Jet lag, delayed sleep phase, shift work, unspecified type • Reset external and internal clocks, avoid caffeine and alcohol, get happy light and exercise at right times of day, Melatonin (by physician recommendation-not yours!) • Dyssomnia NOS

9. Other Sleep Disorders • Nightmare Disorder- nightmares leading to full awakening causing significant distress, not due to mental, substance or medical disorder. 60% due to stress/anxiety. • Sleep Terror Disorder- abrupt awakening from sleep usually with scream or cry and high physiological anxiety, person is difficult to fully awake or comfort, amnesia for event in morning, clinically significant distress (may cause avoidance of situations where others will find out about disorder), not due to substance or medical

10. Other Sleep Disorders • Sleep Walking Disorder- hereditary, medications, relaxations, and environmental safety plans • Parasomnia NOS- behaviors during sleep or sleep-wake transitions • Insomnia related to another mental disorder • Hypersomnia related to another mental disorder • Sleep disorder due to a General Medical Condition • Substance Induced Sleep Disorder