Environmental and behavioral sleep disorders

Shalini Paruthi MD (Dr. Paruthi, Director of the Pediatric Sleep and Research Center at Saint Louis University School of Medicine has no relevant financial relationships to disclose.)
Raman Malhotra MD (Dr. Malhotra, Co-Director of the SLUCare Sleep Disorders Center at Saint Louis University School of Medicine, received honorariums from Teva for speaking engagements.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released January 18, 1994; last updated February 2, 2014; expires February 2, 2017

This article includes discussion of environmental and behavioral sleep disorders, extrinsic sleep disorders, adjustment sleep disorder, environmental sleep disorder, food allergy insomnia, limit-setting sleep disorder, nocturnal eating or drinking syndrome, sleep-onset association disorder, toxin-induced sleep disorder. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Environmental and behavioral sleep disorders encompass all disorders that cause sleep disruption or excessive daytime sleepiness. They are the result of exogenous factors, ie, the causes originate from outside the body. Removal of these external factors leads to resolution of the sleep disorder. In this clinical summary, the authors review environmental and behavioral sleep disorders. This clinical article update reflects the organization system found in the International Classification of Sleep Disorders, 2nd edition (ICSD-2).

Key points

 

• Behavioral and environmental sleep disorders may appear at any age.

 

• Multiple environmental sleep disorders may occur simultaneously in the same patient, which may pose challenges to treatment.

 

• Removal of the inciting environmental factor can ultimately lead to resolution of the subsequent sleep disorder.

Historical note and terminology

The previous International Classification of Sleep Disorders (ICSD) listed 13 extrinsic sleep disorders (American Sleep Disorders Association 1997). Extrinsic sleep disorders are those that cause sleep disruption or excessive daytime sleepiness as a result of causes that arise outside the body. This is in contrast to intrinsic sleep disorders, which lead to sleep disruption or excessive daytime sleepiness due to factors that are based within various body systems. The International Classification of Sleep Disorders, 2nd edition (ICSD-2), does not use the term “extrinsic sleep disorders.” Instead, diagnoses previously listed in this category now fall into various categories: insomnia; hypersomnias of central origin not due to a circadian rhythm sleep disorder, sleep-related breathing disorder, or other cause of disturbed nocturnal sleep; circadian sleep disorders; and other sleep disorders (American Academy of Sleep Medicine 2005). The clinical manifestations, etiology, pathophysiology, diagnostic evaluation, and management of each diagnosis will be discussed in this clinical article.

Table 1. Extrinsic Sleep Disorders

Sleep Disorder

ICSD-2 Category

Inadequate sleep hygiene

I

Environmental sleep disorder

VII

Adjustment insomnia

I

Behaviorally induced insufficient sleep syndrome

III

Behavioral insomnia of childhood, limit-setting type

I

Behavioral insomnia of childhood, sleep-onset type

I

Insomnia due to drug or substance

I

Hypersomnia due to drug or substance

III

Other circadian rhythm sleep disorder due to drug or substance

IV

Table 2. Categories According to ICSD-2

I.

Insomnias

II.

Sleep-related breathing disorders

III.

Hypersomnia of central origin not due to a circadian rhythm sleep disorder, sleep-related breathing disorder, or other cause of disturbed nocturnal sleep

IV.

Circadian rhythm sleep disorders

V.

Parasomnias

VI.

Sleep-related movement disorders

VII.

Other sleep disorders

Pediatric Section

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.