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ICSD-2 Classification

VII. Isolated Symptoms, etc

• Long Sleeper

• Short Sleeper

• Snoring

• Sleep Talking

• Sleep Starts (Hypnic jerks)

• Benign Myoclonus of Infancy

• Hypnagogic Foot Tremor and Alternating Leg Muscle Activation During Sleep

• Propriospinal Myoclonus at Sleep Onset

• Excessive Fragmentary Myoclonus

Long Sleeper

• Consistently sleeps longer than 10 hrs with normal sleep quality and no daytime effects

• There is EDS if there is insufficient sleep

• PSG not required but at least 10 hrs of sleep

• MSLT normal when getting enough sleep

Short Sleeper

• Concerns about not sleeping as much as others

• Typically sleeps < 5 hrs / night

• Short sleeping is spontaneous, NOT a volitional decrease in sleep

• No catch-up sleep on weekends

Snoring

• FKA primary snoring

• Diagnostic Criteria:

– Audible snoring

– No complaints of insomnia, EDS, disrupted sleep that is attributed to snoring or airflow limitation

– PSG not required for diagnosis but shows snoring that is not associated with airflow limitation, arousals, desats, or arrhythmias

Sleep talking

• Diagnostic Criteria

– Talking during sleep

• Reported by bed partner, rarely recognized by the patient

• Idiopathic or related to RBD, sleepwalking, SRED

Sleep Starts (Hypnic Jerks)

• Diagnostic Criteria

– Sudden brief jerks at onset of sleep involving arms or legs

– Sensation of falling, sensory flash, or hypnagogic dream

• Has been reported in up to 60-70%

Hypnagogic Foot Tremor (HFT) and Alternating Leg Muscle Activation (ALMA)

• Are considered together, are likely inter-related

• HFT reported in patient with RLS or SRBD

• ALMA reported in patients with SRBD or PLMD (75% on antidepressants)

Hypnagogic Foot Tremor

• Diagnostic Criteria

– Reports foot movements that occur at the wake-sleep transition

– PSG with:

• Recurrent EMG potentials or foot movements at 1-2 Hz

• Burst potential > 250 msec, < 1 sec

• Trains lasting >=10 sec

Alternating Leg Muscle Activation During Sleep

• Diagnostic Criteria

– PSG: pattern of brief repeated activation of anterior tibialis alternating between legs

– At least 4 discrete and alternating muscle activations with < 2 sec between activations

– Individual activations last 0.1-0.5 sec and occur at frequency 0.5-3 Hz

Propriospinal Myoclonus at Sleep Onset

• Diagnostic Criteria

– Sudden jerks of the abdomen, trunk and neck

– Jerks arise during drowsiness and disappear with mental activation or sleep onset

• Often associated with severe initiation insomnia

• PSM occurs during drowsiness while Hypnic jerks arise during light sleep

Excessive Fragmentary Myoclonus

• Diagnostic Criteria

– Small movements of fingers, toes, corner of the mouth or small muscle twitches

– In many cases there are no visible movements and patients are typically unaware of these activities (often incidental PSG finding)

– PSG demonstrates recurrent and persistent very brief 75-150 msec EMG potentials

– > 5 potentials /min sustained for at least 20 min of Stage 2-4 sleep

Reference:

The International Classification of Sleep Disorders, Second Edition. The American Academy of Sleep Medicine Press, 2005. Can be purchased at the AASM store online!