• Those in which  causes such as gmc, drug, etc. are not responsible for the disturbance
• arise from endogenous abnormalities in sleep-wake generating and timing mechanisms

• characterized by abnormalities in the amount, quality, or timing of sleep
• a derivative of primary sleep disorder

• characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-wake transitions
• ex sleep walking
• derivative of primary sleep disorders

1st stage: non REM sleep

• a transition from wakefulnes to sleep
• occupy about 5% of time spent asleep in healthy adult

2nd stage: nonREM sleep

• characterized by specific EEG waveforms (sleep spindles and K complexes)
• occupy about 50% of time spent asleep

3rd & 4th stage: nonREM sleep

• also known as slow-wave sleep
• are the deepest levels of sleep
• occupy 10-20% of sleep time
• tend to occur in the 1st 1/3 to 1/2 of the night
• and increase in duration in response to sleep deprivation

REM (rapid eye movement) -

• period where storylike dreams occur
• occupy about 20-25% ot total sleep
• occur cyclically through the night
• alternating w/NREM sleep about q80-100 mins

• difficulty in initiating sleep or 
• maintaining sleep or
• nonrestorative sleep for at least 1mth

• feeling  that your sleep was restless, light, or of poor quality
• feel tiring or unrefreshed
• least common complaint of primary insomnia disorder

• Primary insomnia is often associated with increased physiological, cognitive, or emotional arousal in combination with this concept for sleep
• is a psychological state caused by self-induced stress and anxiety of needing to achieve sleep;
• particularly, it refers to an incapability to sleep at night in one's own bed.
• A marked preoccupation with or distress due to the inability to sleep may contributeto the development of a victious cycle:
• the more you strive to sleep, the more frustrated and distressed you become and associate environmental cues, the less you are unable to fall asleep

Read more: http://www.sleepdisordersguide.com/sleep-disorders-glossary-n.html#ixzz2Od4gKKsJ

• hx of light or easy sleep disturbance
• anxiety or depression
• increased daytime irritability
• poor concentration
• severe - lead to accidents
• fatigue
• tension headaches

• begins in young adulthood, or middle age
• chronic symptoms lasting more than 1yr
• or episodic course with periods of better or worse sleep
• heightened arousal and negative conditioning persists for a long time

Circadian rhythm disorder vs Primany insomnia: Time distortion

• distinguished by recent hx of transmeridian travel or shift work
• individuals with Delayed Sleep Phase type report having difficulty falling asleep or staying asleep during socially normal times - when they sleep at their normal times

Parasomnia vs Primary insmnia:

• characterized by unusual behavior or events during sleep

Narolepsy vs Primary insomnia:

• distinguished by symptoms of prminent daytime sleepiness, cataplexy, and sleep-related hallucinations

The present of 1 or more of the following symptoms:

1. Cataplexy - brief episodes of sudden bilateral muscle tone loss most often after an intense emotional stressor
2. Recurrent intrusions of elements of REM sleep (stage 5) into the transition between sleep and wakefulness manifested as either hypnagogic or hypnopompic hallucinations or sleep paralysis

• is the sudden muscle weakness associated with narcolepsy. It is a temporary decrease or complete loss of muscle control triggered by an emotional response that is often seen in narcoleptics.
• It is often triggered by emotional stimulus such as anger, surprise, laughter, and exhilaration. It is a symptom of narcolepsy, a neurologic disorder that causes excessive sleepiness.
  
  Read more: http://www.sleepdisordersguide.com/sleep-disorders-glossary-c.html#ixzz2OdHnkKlj

Hypnagogic or hypnopompic hallucinations are visual, tactile, auditory, or other sensory events, usually brief but occasionally prolonged,

that occur at the transition from wakefulness to sleep (hypnagogic) or from sleep to wakefulness (hypnopompic).

• is a phenomenon in which people, either when falling asleep or wakening, temporarily experience an inability to move.
• More formally, it is a transition state between wakefulness and rest characterized by complete muscle atonia (muscle weakness).
• It can occur at sleep onset or upon awakening, and it is often associated with terrifying visions (e.g. an intruder in the room), to which one is unable to react due to paralysis.
• It is believed a result of disrupted REM sleep, which is normally characterized by complete muscle atonia that prevents individuals from acting out their dreams.
• Sleep paralysis has been linked to disorders such as narcolepsy, migraines, anxiety disorders, and obstructive sleep apnea; however, it can also occur in isolation.^[1][2]
• When linked to another disorder, sleep paralysis commonly occurs in association with the neuromuscular disorder narcolepsy.

• sleep episodes generally last q10-20 minutes or upto 1hr uninterrupted
• clts typically have 2-6 sleep episodes daily
• cataplexy may lead to falling, dropping objects; muscle weakness last few seconds upto 1/2hr reported
• cataplexy is triggered by strong emotional stimuli
• people experience dream-like imagery before falling asleep or just after awakening
• people experience sleep paralysis just on falling asleep or waking up - last a few seconds to minutes and terminates abrupty

• clts experience generalized daytime sleepiness between attacks
• automatic behavior unconsciously can occur with profound sleepiness
• severely limit daytime activities due to sleep attack episodes
• people try to prevent the attacks by controlling their emotions
• at risk for accidents due to sudden sleep onset

• daytime sleepiness 1st symptom of narcolepsy
• onset childhood, adolescence, preschool, early school age
• cause acute psychosocial stressors or altered sleep patterns trigger onset
• cataplexy may appear concurrent with sleepiness or years after
• course stable
• hallucinations may go into remission while sleep attack persist

Narcolepsy vs Primary Hypersomnia:

• generally describe prolonged and less disrupted nocturnal sleep
• consists of more prolonged, unfreshed sleep periods
• no dreaming or hallucinations

Narcolepsy vs Breathing-Related Sleep disorder:

• distinguished by a hx of loud snoring, breathing pauses that disrupt nocturnal sleep; lengthy daytime unfreshed sleep episodes
• no primary symptoms of narcolepsy

This syndrome consists of symptoms that include excessive sleepiness and a lack of daytime alertness in people who travel across time zones. Symptoms occur after extensive travel

This sleep disorder affects people who frequently rotate shifts or work at night. They have insomnia during major sleep period or excessive sleep during major wake period associated with night shift or frequent shift changes

• This is a disorder of sleep timing. People with DSPS tend to fall asleep very late at night and have difficulty waking up in time for work, school, or social engagements in appropriate waking hours.

Advanced Sleep Phase Syndrome (ASPD): This is a disorder in which a person goes to sleep earlier and wakes earlier than desired. ASPD results in symptoms of evening sleepiness, going to bed earlier (for example, between 6 p.m. and 9 p.m.), and waking up earlier than desired (for example, between 1 a.m. and 5 a.m.)

• Non 24-Hour Sleep Wake Disorder: This is a disorder in which an individual has a normal sleep pattern, but lives in a 25-hour day. Throughout time, the person's sleep cycle will be affected by inconsistent insomnia that occurs at different times each night. People will sometimes fall asleep at a later time and wake up later, and sometimes fall asleep at an earlier time and wake up earlier

• Circadian rhythm disorders are disruptions in a person's circadian rhythm -- a name given to the "internal body clock" that regulates the (approximately) 24-hour cycle of biological processes in animals and plants. The term circadian comes from Latin words that literally mean around the day. There are patterns of brain wave activity, hormone production, cell regeneration, and other biological activities linked to this 24-hour cycle.
• The circadian "clock" in humans is located mainly in the suprachiasmatic nucleus (SCN), which is a group of cells located in the hypothalamus (a portion of the brain). Circadian rhythms are important in determining human sleeping patterns
• People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs.
• They are generally able to get enough sleep if allowed to sleep and wake at the times dictated by their body clocks.
• Unless they have another sleep disorder, their sleep is of normal quality.

• DSTP clts experience sleep drunkness - extreme difficulty waking up, confusion, and inappropriate behavior; performance peak in late evening hours
• Jet lag common in people who are morning larks; symptoms are poor concentration, memory, lightheadedness, impaired coordination, fatigue, decreased appetite
• Shift work common in clts who are morning types. symptoms are impaired concentration, alertness, performance, and attention

• onset in DSTP teenagers late childhood and early adulthood
• onset in late middle-aged and elderly in Jet lag and Shift work types
• DSTP course lasts for years/decades but maybe self-correcting
• Shift work type symptoms reverse within 2wks once the clt returns back to their normal sleep-wake schedule
• Jet lag type it takes 1dy per time zone travel for circadian system to ressynchronize itself to the the new local time

Jet lag and Shift work type vs Primary Insomnia and Hypersomnia:

can distinguish by hx of jet lag and shift work, with undisturbed sleep on other schedules

Jet lag and Shift work types vs Breath-Related SD:

it maybe a BRSD if the clts do not reverse to their normal sleep schedule.

• During REM sleep, rapid eye movements occur, breathing becomes irregular, blood pressure rises, and there is loss of muscle tone (paralysis); and violent motor activity
• However, the brain is highly active, and the electrical activity recorded in the brain by EEG during REM sleep is similar to that recorded during wakefulness. REM sleep is usually associated with dreaming. REM sleep accounts for 20%-25% of the sleep period.
• In a person with REM sleep behavior disorder (RBD), the sleep paralysis that normally occurs during REM sleep is incomplete or absent, allowing the person to "act out" his or her dreams.
• Its the inability to perform voluntary movement during transition  between wakefulness and sleep; the episodes may occur during hypnagogic and hypnopompic states
• RBD is characterized by the acting out of dreams that are vivid, intense, and violent and occurs at night
• Dream-enacting behaviors include talking, yelling, punching, kicking, sitting, jumping from bed, arm flailing, and grabbing.
• An acute form may occur during withdrawal from alcohol or sedative-hypnotic drugs.
• Clinician to rule out gmc, or substance induced