1.  General guidelines about Sleep Disorder

·       Conditions characterized by disturbances of usual sleep patterns or behaviors; divided into three major categories: dyssomnias (i.e. Disorders characterized by insomnia or hypersomnia), parasomnias (abnormal sleep behaviors), and sleep disorders secondary to medical or psychiatric disorders.

·       The most common kinds are

Ø  Insomnia                         - a hard time falling or staying asleep

Ø  sleep apnea                      - breathing interruptions during sleep

Ø  restless legs syndrome- a tingling or prickly sensation in the legs

Ø  narcolepsy                      - daytime "sleep attacks"

Nightmares, night terrors, sleepwalking, sleep talking, head banging, wetting the bed and grinding your teeth are kinds of sleep problems called parasomnias.

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by dream-enactment behaviors that emerge during a loss of REM sleep atonia. RBD dream enactment ranges in severity from benign hand gestures to violent thrashing, punching, and kicking. Patients typically present to medical attention with a concern related to injurious or potentially injurious actions to themselves and/or their bed partner.

Non rapid eye movement (NREM) parasomnias are abnormal behaviors arising primarily but not exclusively during non-REM stage three (N3) sleep. Phenotypes include sleepwalking, sleep terrors, confusional arousals, sexsomnia, and sleep-related eating disorder (SRED)

People may experience

o   Excessive daytime sleeping

o   Irregular breathing or increased movement during sleep

o   Irregular sleep and wake cycle

o   Difficulty falling sleep

o   Restless

o   Feeling an uncomfortable urge to move while trying to fall asleep

o   Behavioural changes like difficulty focusing or paying attention

o   Mood changes like irritability and trouble managing emotions

History taking and examination including MSE                      Annexure 1 Special emphasis

·       Medical history

2.  a) Investigations required

a.  Psychometric investigations: Insomnia Severity Index (ISI)

b.  Laboratory: (if physical complications are present)

b)  Comorbidity: Depression, anxiety and ADHD

c)   Differential Diagnosis:PTSD, Depression, Anxiety Disorder, Substance abuse and Bipolar Disorder

3.  Treatment

a)  Psychopharmacology

Refer to benzodiazepines and SSRIs given for treatment in General Anxiety Disorder

b)  Psychosocial Intervention

a.  If patient is in early stage

i)     Psychoeducation: Nature of illness, etiology, progression, consequences, prognosis, treatment.

ii)  Sleep hygiene – changing sleep routine to promote regular sleep schedule and proper sleep hygiene

·     10 Points in Sleep Hygiene

–          Maintain a consistent sleep timing going to bed and waking including the weekend

–          Bedroom should be comfortable, quiet, dark, relaxing and    pleasant temperature

–          Avoid/Reduce screen time

–          Avoid/Reduce large heavy dinner

–          Avoid/Reduce caffeine, tea, alcohol

–          Be physically active during the day, exercises/meditation

–          Avoid heavy exercises at night

–          Avoid napping during the day

–          Associate bed with sleeping alone

iii)  Creating comfortable sleep environment

b.  If patient is in mid or late stage

i)  Cognitive Behaviour Therapy

4.  Follow-up

a.  Physical check-up at OPD

·       Initially once in two weeks for 2 months

·       Monthly check up for 1 year.

b.  Physical check-up at OPD

c.  Through telephonic conversation/TeleManas 14416/18008914416

5.  Referrals

a.   Depending upon the severity and complications of the patient, he/she may need to be referred to Psychiatry/medicine department.

b.  To TeleManas

c.  To the nearest DMHP

d.  To psychiatry OPD at Kulikawn Hospital and ZMC

e.  To higher centers outside Mizoram through Referral Board.