Sleep apnea can worsen pre-existing cardiovascular disease, highlighting a significant health risk associated with this sleep disorder.

Association between Sleep Apnea and Cardiovascular Disease

Key indicators of sleep apnea include loud snoring and observable pauses in breathing during sleep, which are often first reported by a sleeping partner. Although individuals with the condition may not recall these events, they commonly suffer from increased levels of fatigue.

Common Indicators of Sleep Apnea

Being overweight is a significant risk factor that makes sleep apnea much more common in this demographic. However, the disorder is not exclusive to this group, and it is recommended that anyone who snores loudly or gasps for air during sleep be medically evaluated.

Risk Factors for Sleep Apnea

While individuals with sleep apnea may not be conscious of the breathing disruptions during sleep, they often face significant adverse consequences from the resulting lack of sufficient rest. These can include cognitive impairments like difficulty concentrating and excessive sleepiness, which may jeopardize their careers and personal safety.

Consequences of Untreated Sleep Apnea

Sleep apnea is classified into two forms: obstructive sleep apnea, which involves a blocked airway during sleep, and central sleep apnea, which involves disrupted brain signals that regulate breathing.

Types of Sleep Apnea

Analyze the patient's and his partner's reports. What is the most probable underlying condition causing his daytime sleepiness, and what specific evidence from the case supports this conclusion?

Analyzing Patient Symptoms for a Sleep Disorder

Sleep apnea is a disorder characterized by episodes in which a person's breathing stops during sleep. These cessations can last for 10-20 seconds or longer and often result in brief arousals. Although individuals with sleep apnea may be unaware of these repeated sleep disruptions, they frequently experience significant daytime fatigue. The condition is commonly associated with loud snoring and is more prevalent in overweight people.

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The DSM-5-TR separates Sleep-Wake Disorders into the following specific disorders and groups:
-	Insomnia Disorder
-	Hypersomnolence Disorder
-	Narcolepsy
-	Breathing Related Sleep-Disorders*
-	Circadian Rhythm Sleep-Wake Disorders*
-	Parasomnias*
-	Restless Leg Syndrome
-	Substance / Medication-Induced Sleep Disorder
-	Other Specified Insomnia Disorder
-	Unspecified Insomnia Disorder
-	Other Specified Hypersomnolence Disorder
-	Unspecified Hypersomnolence Disorder
-	Other Specified Sleep-Wake Disorder
-	Unspecified Sleep-Wake Disorder

Note: * Groups that separate into further specific disorders

[DSM-5-TR] List of Sleep-Wake Disorders

Breedlove, S. & Watson, N. (2017). Behavioral neuroscience, eighth edition. Oxford University Press.

Behavioral Neuroscience 8th Edition

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Non-Rapid Eye Movement Sleep Arousal (NREM) Disorders are characterized by repeated episodes incomplete awakenings during sleep that usually last about 1-10 minutes but can also last as long as 1 hour without any recollection. Little to no dream imagery is recalled. 

NREM Sleep Arousal Disorders


Narcolepsy is a sleep disorder characterized by an uncontrollable urge to fall asleep at inopportune times. These sleep episodes are frequently accompanied by cataplexy, a sudden loss of muscle tone. Narcoleptic attacks often exhibit features characteristic of REM sleep; for instance, about a third of those with the disorder report experiencing vivid, dream-like hallucinations during an episode.

Narcolepsy

Sleep Apnea

A sleep disorder that consists of not getting enough sleep.

Insomnia

A sleep disorder in which someone physically acts out their dream. This disorder typically presents after age 50, is more common in men than women, and usually followed by Parkinson’s and/or dementia symptoms, suggesting it’s the start of widespread neurodegeneration. Usually controlled by anti-anxiety drugs like benzodiazepines at night. 

REM Behavior Disorder

Somnambulism, or sleepwalking, is a condition more common in childhood that can persist into adulthood. It involves episodes of complex behaviors, lasting from seconds to minutes, which are often not remembered. While these episodes most frequently occur during stage 3 slow-wave sleep (SWS), they can happen at any time during a sleep period. Sleepwalkers are not acting out their dreams.

Somnambulism

Insomnia is a common health concern that causes significant distress and disruption in daily life, due to difficulty with and lack of sleep. Insomnia tends to be associated with an increased risk of developing physical health problems, anxiety, and depression.

Insomnia 

Substance/medication-induced sleep disorders are characterized by a severe sleep disturbance that occurs during or soon after substance intoxication, medication exposure, or substance/medicine withdrawal.

Substance/Medication-Induced Sleep Disorder

* Obstructive Sleep Apnea Separate Specific Disorder
* Central Sleep Apnea
* Sleep-Related Hypoventilation


Specific Breathing Sleep-Related Disorders

Circadian rhythm sleep-wake disorders happen when constant patterns of sleep disturbances occur. These disturbances can be caused by a new circadian rhythm or discrepancies between the person’s circadian rhythm and the sleep-wake schedule that is demanded by the person’s social life, occupation, or environment.

Circadian Rhythm Sleep-Wake Disorders

Hypersomnolence disorder consists of sleeping for too many hours at night, trouble staying completely awake after being woken up, or frequent episodes of sleep throughout the day. 

Hypersomnolence Disorder

Reference for Sleep-Wake Disorders

Insomnia, the most prevalent sleep disorder, is characterized by a persistent difficulty in initiating or maintaining sleep. Individuals with this condition often experience significant delays before falling asleep and may wake up frequently during the night, struggling to resume sleep. According to diagnostic criteria, these sleep disturbances must occur at least three nights a week for a minimum of one month.

REM behavior disorder (RBD), sleepwalking, restless leg syndrome, and night terrors are examples of parasomnias, which involve unwanted motor behaviors or experiences during the sleep cycle.

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