The document reviews several sleep disorders according to the DSM-5 including insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian rhythm sleep-wake disorders, non-REM sleep arousal disorders, parasomnias, nightmare disorder, and restless legs syndrome. It discusses the diagnostic criteria, comorbidities, assessments, and treatment options for each disorder in detail across several sections.
5. S2. Assess & Refer I
Evaluations
Polysomnography
Expensive and to be avoided if possible
Sleep diaries
Lab tests for neurotransmitter deficiencies, breathing
difficulties, etc.
6. S2. Assess & Refer II
Tests
STQ SleepTiming Questionnaire
SII Sleep Impairment Index
ISI Insomnia Severity Index
PSQI Pittsburgh Sleep Quality
Index
RBDSQ REM Sleep Behavior
Disorder Screening
REM Sleep Behavior
Questionnaires – Hong-Kong
GAD-7
PHQ-9
PROMIS Level 2 Sleep
Disturbance Patient
Reported Outcome
Measurement
Information System
Epworth Sleepiness Scale
SCQ Sleep Disorders
Questionnaire
SCI Sleep Condition
Indicator
CSM Composite Scale of
Morningingness
9. S1. Diagnosis I
Difficulty initiating or
maintaining sleep, or poor
quality sleep
At least 3 nights per week for at
least 3 months, despite
adequate opportunity for sleep
Not part of another SleepWake
disorder
Not due to substance effects
Types
1. Psychological
Worries about insomnia
so they cannot sleep
2. Sleep State Misperception
Believes they sleep poorly
but sleep quality is good
3. Hypnotic Dependent
Sleep Disorder
Due to withdrawal of
sleeping pills
10. S1. Diagnosis II
Co-occurring:
Depression or other
mental disorder
Chronic pain
Rule Outs:
Breathing related disorders
Circadian Rhythm Sleep
Disorder
Periodic limb movement
disorder
11. S4.Treatments
CBT
EEG feedback
Stimulus control
RelaxationTherapy
Psychoeducation
Sleep-restrictionTherapy
BehavioralTherapy, such
as regulating the circadian
clock
Lifestyle changes
Reduced stress
Exercise
Restricted caffeine
Medication
Melatonin
Brief use of hypnotics
12.
13. Diagnosis I
Recurrent episodes of
excessive daytime
sleepiness or prolonged
nighttime sleep
At least 3 times weekly
Naps repeatedly
throughout the day, with
no relief from symptoms
Common among
adolescents and young
adults
Often disoriented when
waking and may experience:
Anxiety
Increased irritation
Decreased energy
Restlessness
Slow thinking
Slow speech
Loss of appetite
Hallucinations
Memory difficulty
14. Diagnosis II
Co-occurring:
Other mental disorders, like depression
Medical conditions like head injury, multiple sclerosis,
encephalitis, epilepsy, or obesity
17. Diagnosis I
Requires:
Presence of
recurrent periods
of irrepressible
need to sleep,
lapsing into
sleep, or napping
occurring within
the same day
3x per week over
the past 3
months
Also at least one of the following:
Cataplexy
Brief episodes of sudden loss of
muscle tone, usually with intense
emotion like laughing or crying
Hypocretin neurotransmitter deficiency
Recurrent intrusions of rapid eye
movement (REM) sleep into the
transition between sleep and waking
With either hypnopompic or
hypnagogic hallucinations or sleep
paralysis at the beginning or end of
sleep episodes
18. Diagnosis II
Onset usually from childhood to
young adulthood, especially ages 5–
25 and 30–35
Onset can be abrupt or progressive
over years
Childhood onset most severe
Early Symptoms:
Sleepiness
Vivid dreaming
Excessive movements during REM
sleep
Co-occurring:
Sleep apnea
REM Sleep
Behavior
Disorder
20. S4.Treatments
Medications for sleepiness
Central Nervous System
Stimulants
Medications for sleepiness
Tricyclic Antidepressants
Medication for both
Sodium Oxybate
Lifestyle changes
Reduced stress
Exercise
Restricted caffeine
21. Cataplexy: Brief episodes
of sudden bilateral loss of
muscle tone in neck, jaw,
arms, legs, or whole body,
resulting in head bobbing,
jaw dropping, or complete
falls, most often in
association with intense
emotion, like laughing
Apnea: No breathing
airflow during sleep
Hypoapnea: Reduced
airflow
22.
23. S1. Diagnosis I
Nocturnal breathing
disturbances, pauses or
gasping/snorting for air
during the night
Often resulting in
daytime sleepiness
Patient unaware
Requires:
Repeated episodes, at least 5
per hour of sleep per night, of
upper airway obstruction
during sleep
Apneas (no airflow) or
hypopneas (restricted airflow)
26. S4.Treatments
1. Physical devices
Positive Airway Pressure mask over face
Mouth device
Higher upper body position
2. Neurostimulation
3. Surgery and weight loss
29. S1. Diagnosis I
Affects timing of sleep; unable to sleep
and wake at the times required
Requires:
1. Pattern of sleep disruption mainly due
to an alteration of the circadian
system
Or misalignment between the internal
circadian rhythm and the sleep-wake
schedule required
2.The sleep disruption leads to excessive
sleepiness or insomnia, or both
Specify:
Episodic: Lasts 1 to 3
months
Persistent: Lasts 3
months or more
Recurrent:Two or
more episodes occur
within 1 year
34. Diagnosis I
Episodes of incomplete awakenings during sleep
1. Sleep walking
2. Sleep terrors
35. Diagnosis Ill
Co-occurring in children
Restless Leg Syndrome
Sleep Breathing Disorder
Bed-wetting (Enuresis)
Co-occurring in adults:
Delirium
Seizure disorder
Drug toxicity
Schizophrenia
Anxiety disorders
Migraine headaches
Tourette Syndrome
36. Diagnosis Il
Most common among children and adolescents
Requires:
1. Rising from bed during sleep and walking about
Usually during the first third of sleep period
2.While sleepwalking, they have a blank, staring face, are
relatively unresponsive to communicate efforts, and can be
awakened only with great difficulty
3. No memory of the episode upon awakening
4. Shortly after awakening, there is no impairment of mental
activity or behavior
May be an initial short period of disorientation
37. S1. Find Out S2. Assess & Refer
Polysomnography
41. Diagnosis II
More likely in young people
Requires:
1. Recurrent periods where the individual
abruptly wakes from sleeping with a
scream
2. Experience of intense fear and
symptoms of autonomic arousal, like
rapid heart rate, heavy breathing and
sweating
3. Cannot be soothed during the episode
4. Unable to remember details of the
dream or episode
Co-occurring
Neurological
disease
Hypoglycemia
Poor nutrition
42. S1. Find Out S2. Assess & Refer
Polysomnography
45. Diagnosis I
Requires:
Repeated awakenings with recollection of terrifying dreams,
usually involving threats to survival, or safety
During REM sleep, after 90 minutes
Awakes alert and able to recall the dream well
May be anxious and unable to fall back asleep
Onset from childhood to adolescence, improvement with age
46. Diagnosis II
Rule out:
SleepTerrors: Cannot recall dream
Side effect of illicit drugs, like cocaine
and amphetamines
Side effect of prescribed drugs, for
blood pressure, depression,
Parkinson’s
PTSD
Co-occurring:
Dissociative
disorders
Borderline
Personality
disorder
47. S4.Treatments
Therapy
Dealing with frightening dream themes
RelaxationTherapy
Hypnosis
Stress reduction
Medications
Prazosin, used in PTSD
50. Diagnosis I
Desire to move the
legs or arms, usually
associated with
sensations described
as creeping,
crawling, tingling,
burning or itching
Worse when at rest
Requires:
1. An urge to move the legs, related to
uncomfortable sensations in the
legs, characterized by all of the
following:
Begins or worsens during periods of
rest or inactivity
Partially or totally relieved by
movement
Worse in the evening or occurs only
in the evening
2. Occurs at least 3 times/week, for at
least 3 months
55. Diagnosis I
Requires:
Repeatedly
waking up
after REM
sleep
Movements
related to
dreams
Requires:
1. Repeated episodes of arousal during sleep,
associated with vocalization and/or complex
motor behaviors
2. During rapid eye movement (REM) sleep,
usually 90 minutes after sleep onset and more
frequent later in sleep period
3. Awakening alert and not disoriented
4. Either of the following:
Polysomnographic confirmation of REM sleep
without normal muscle paralysis
History suggestive of this disorder and
diagnosis of Parkinson’s or related diseases
56. Diagnosis II
Onset usually from childhood to
young adulthood, especially at ages
15–25 years and ages 30–35 years
Onset can be abrupt or progressive
over years
Childhood onset most severe
Early Symptoms: Sleepiness, vivid
dreaming, and excessive movements
during REM sleep
Co-occurring:
Other sleep
disorders
Parkinson’s
disease
Multiple System
Atrophy and
Lewy Body
Dementia
57. S1. Find Out S2. Assess& Refer
Lab tests
RBDSQ Rapid Eye
Movement (REM) Sleep
Behavior Disorder
Screening
Questionnaire
REM Sleep Behaviour
Questionnaires – Hong-
Kong
59. Cataplexy: Brief episodes
of sudden bilateral loss of
muscle tone in neck, jaw,
arms, legs, or whole body,
resulting in head bobbing,
jaw dropping, or complete
falls, most often in
association with intense
emotion, like laughing
Apnea: No breathing airflow
during sleep
Hypoapnea: Reduced airflow
Akathisia: Movement
disorder characterized by a
feeling of restlessness and a
compelling need to be in
constant motion
Atonia: Muscle paralysis, as in
normal sleep