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Circadian Rhythm Sleep Disorder. A persistent or recurrent disorder characterised by the interruption of sleep leading to excessive somnolence or insomnia due to an imbalance between the sleep-waking cycle required by the environment in which the person lives and the subject’s own particular circadian sleep-waking rhythm. The alteration of sleep causes clinically significant distress or impairment of functioning at the social and occupational levels or in other important areas of the individual’s life. The alteration does not occur exclusively during the course of another sleep disorder or mental disorder. The alteration is not due to the direct physiological effects of a substance (that is, a substance of abuse or a medicine) or a general medical condition. For example, it may be caused by work shifts that force a person to follow an irregular sleep-waking rhythm.
Parasomnias. Six different disorders are described under this heading: the Nightmare Disorder, Sleep Terror Disorder (Pavor Nocturnus), Sleepwalking Disorder, Restless-Leg Syndrome, Bruxism and Nocturnal Enuresis.
The Nightmare Disorder occurs during the second half of the night, when sleep is deeper and causes terrifying dreams, characterised by vivid, highly emotional images, which make the subject wake up. On reawakening, the person can recall the terrifying dream in considerable detail and may present anxiety, fear and a difficulty in returning to sleep, tachycardia, sweating and tachypnea (accelerated breathing rhythm). At times, the nightmares return at various times during the same night, often with recurring themes. The nightmares often start in children between 3 and 6 years of age. Unlike in Sleep Terror, after a nightmare there is a complete reawakening and memory of the dream.
Sleep Terror (Pavor Nocturnus) appears during the first third of the night and manifests with a brusque reawakening often accompanied by shouting, crying, tachycardia, tachypnea (acceleration of the breathing rhythm), perspiration and dilated pupils. Sleep Terror is characterised by its greater emotional intensity with respect to the emotional disturbance caused by nightmares. Unlike nightmares, Sleep Terror manifests more as an anxiety crisis. The subject may remember only fragments of a dream, but not its entire content. The episode may last from 1 to 10 minutes and generally occurs between 4 and 12 years of age, and in some cases also in the third decade of life.
Sleepwalking Disorder. Somnambulism causes a person (the somnambulist or ‘sleepwalker’) to perform such actions as walking, eating, sitting on the bed etc. while he /she is still sleeping, and thus without being aware of what he or she is actually doing. This usually occurs at the beginning of the night, in the so-called NREM phase (see Anxiety and Insomnia). It is not an easy thing to wake a sleepwalker up and if one does manage to, the person may be confused and not understand the situation. A person suffering from somnambulism, if undisturbed, will often return to bed spontaneously after about 15 minutes with no recollection of what has occurred. Somnambulism usually appears between the ages of 4 and 8 and reaches its highest frequency in the period between childhood and adolescence.
Restless Leg Syndrome. This disorder is characterised by an uncomfortable sensation in the legs, which a person feels at the time of going to bed or in any case when he/she is resting. More specifically, the sensations experienced include: pins and needles, cramps, restlessness, itching, a difficulty in keeping one’s legs still and an irresistible urge to move them. This often induces the person to get up and walk about until he/she feels that the disturbance is passing. The Restless Leg Syndrome causes difficulty in falling asleep and possible frequent movements of the legs during sleep may cause reawakening. It is thus possible that during the daytime the person will feel tired and unfocused. Pregnant women and middle-aged people often suffer from this disorder. The disorder may get worse during pregnancy or when caffeine is consumed in excessive quantities, in cases of anaemia or if a person is exposed for prolonged periods of time to a hot or cold environment.
Nocturnal enuresis (or bed-wetting) is a disorder which causes difficulty with or an incapacity to control the release of urine during sleep. The phenomenon is quite common and can be considered normal if it presents in children under the age of 6. If it occurs later, causes should be identified, which, although uncommon, can be of a physical nature (infection of the urinary ducts, defects in the neurological functioning of the bladder etc.). There may be a perceptive disorder (i.e., the child cannot perceive the stimuli during the night) or, more frequently, a psychological cause (need for attention, particular changes that have occurred in the home, anxiety etc.). Enuresis can be hereditary, especially if the child has never been able to control its bladder since very early childhood.
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