DSM-5 Sleep-wake disorders
Sleep-wake disorders encompass 10 disorders or disorder groups. Items in bold are covered as part of the NCCPA PANCE/PANRE Psychiatry Blueprint and include narcolepsy and the parasomnias. The two important categories of parasomnias include the NREM sleep arousal disorders (of which I have included sleepwalking and sleep terrors) and the REM sleep behavior disorders, of which I have included nightmare disorder. Sleep-wake disorders are NOT covered as part of the PAEA EOR™ Psychiatry Topic List. Included are brief descriptions of insomnia disorder and hypersomnolence disorder as well as restless legs syndrome because they are important to know - but they are not included as part of the PANCE/PANRE Psychiatry Blueprint. |
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Insomnia disorder
Hypersomnolence disorder Breathing-related sleep disorders Circadian rhythm sleep-wake disorders |
Parasomnias:
Restless legs syndrome Substance/medication-induced sleep disorder |
PANCE/PANRE Sleep-wake disorders
Narcolepsy | A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times. |
Parasomnias | Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, NREM sleep, and REM sleep, and their combinations.
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Narcolepsy
Patient will present as → a 19-year-old female complaining of an irresistible urge to sleep at sudden times throughout the day. This has disturbed her school functioning. She sometimes feels like she “is paralyzed” for several minutes when she wakes up. She “passed out” one day at school when she was startled by her boyfriend. Narcolepsy presents with a classic tetrad:
Caused by: Hypocretin deficiency in lateral hypothalamus (per DSM-V)
Diagnosed with polysomnography Treatment: modafinil (Provigil), methylphenidate (Ritalin), or amphetamines |
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Parasomnias
Patient will present as → a 49-year-old female who reports feeling an uncomfortable deep crawling and aching sensation in her legs. The patient notes that she typically experiences this sensation at night when she gets into bed. Also associated is a strong urge to move her legs and she has to get up several times each night to relieve the feeling. She denies associated low back pain or recent blood donation. The neurologic and vascular examination is normal. Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, NREM sleep, and REM sleep, and their combinations. NREM sleep arousal disorder: Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either one of the following:
REM sleep behavior disorder: Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors that arise during REM sleep and therefore usually occur more than 90 minutes after sleep onset, are more frequent during the later portions of the sleep period, and uncommonly occur during daytime naps.
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Restless leg syndrome
Patient will present as → 56-year-old female reports feeling an uncomfortable deep crawling and aching sensation in her legs. The patient notes that she typically experiences this sensation at night when she gets into bed. Also associated is a strong urge to move her legs and she has to get up several times each night to relieve the feeling. She denies associated low back pain or recent blood donation. Neurologic and vascular examination is normal. RLS is a condition in which patients are unable to lie still and report experiencing unpleasant creeping, crawling, or tingling sensations in the legs. Must occur at least 3 x per week x 3 months.
Diagnosis:
Treatments
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Insomnia disorder | Difficulty initiating or maintaining sleep at least 3 times per week for 3 months |
Hypersomnolence disorder | Excessive nighttime or daytime sleep for > 1 month |
References: Merck Manual