DSM_Sleep-Wake Disorders

What is the high-yield picture of Insomnia Disorder?

"Difficulty initiating/maintaining sleep or early awakening despite opportunity, with daytime impairment.

Timeline/onset: 3+ nights/week for 3+ months

Spectrum/severity: Yes: episodic/persistent/recurrent course

Important note: Specify comorbid conditions."

What timeframe, age, or number is most important for Insomnia Disorder?

3+ nights/week for 3+ months

How do you differentiate Insomnia Disorder on an exam vignette?

Vs. circadian disorder: insomnia persists despite adequate timing/opportunity rather than a shifted internal schedule.

What is the high-yield picture of Hypersomnolence Disorder?

"Excessive sleepiness despite adequate main sleep, recurrent lapses, long unrefreshing sleep, or difficulty fully awakening.

Timeline/onset: 3+ times/week for 3+ months

Spectrum/severity: Yes: acute/subacute/persistent and severity

Important note: Rule out narcolepsy and sleep apnea."

What timeframe, age, or number is most important for Hypersomnolence Disorder?

3+ times/week for 3+ months

How do you differentiate Hypersomnolence Disorder on an exam vignette?

Vs. narcolepsy: no required cataplexy/REM abnormalities.

What is the high-yield picture of Narcolepsy?

Recurrent irresistible sleep attacks plus cataplexy, hypocretin deficiency, or characteristic REM findings.

Timeline/onset: 3+ times/week for 3+ months

Spectrum/severity: Yes: severity

Important note: Several subtypes based on cataplexy/hypocretin/medical cause.

What timeframe, age, or number is most important for Narcolepsy?

3+ times/week for 3+ months

How do you differentiate Narcolepsy on an exam vignette?

Cataplexy and REM phenomena distinguish from hypersomnolence.

What is the high-yield picture of Obstructive Sleep Apnea Hypopnea?

Repeated upper-airway obstruction during sleep with snoring/gasping and daytime symptoms or polysomnographic evidence.

Timeline/onset: Based on sleep study, not a psychiatric duration threshold

Spectrum/severity: Yes by apnea-hypopnea severity

Important note: Medical sleep diagnosis.

What timeframe, age, or number is most important for Obstructive Sleep Apnea Hypopnea?

Based on sleep study, not a psychiatric duration threshold

How do you differentiate Obstructive Sleep Apnea Hypopnea on an exam vignette?

Vs. insomnia: breathing disruption is the primary cause.

What is the high-yield picture of Central Sleep Apnea?

Repeated cessation/reduction of breathing effort during sleep due to central control problems.

Timeline/onset: Sleep-study based

Spectrum/severity: Varies

Important note: Idiopathic, Cheyne-Stokes, opioid-induced, etc.

What timeframe, age, or number is most important for Central Sleep Apnea?

Sleep-study based

How do you differentiate Central Sleep Apnea on an exam vignette?

Vs. obstructive apnea: central apnea lacks respiratory effort.

What is the high-yield picture of Sleep-Related Hypoventilation?

Sleep-related decreased respiration causing elevated carbon dioxide.

Timeline/onset: Sleep-study/medical evidence

Spectrum/severity: Varies

Important note: Idiopathic, congenital, medical/medication related.

What timeframe, age, or number is most important for Sleep-Related Hypoventilation?

Sleep-study/medical evidence

How do you differentiate Sleep-Related Hypoventilation on an exam vignette?

Differentiate from apnea by sustained hypoventilation rather than discrete breathing pauses.

What is the high-yield picture of Circadian Rhythm Sleep-Wake Disorder?

Sleep disturbance due to mismatch between internal circadian rhythm and required schedule.

Timeline/onset: Persistent/recurrent pattern

Spectrum/severity: No

Important note: Delayed phase, advanced phase, irregular, non-24-hour, shift work.

What timeframe, age, or number is most important for Circadian Rhythm Sleep-Wake Disorder?

Persistent/recurrent pattern

How do you differentiate Circadian Rhythm Sleep-Wake Disorder on an exam vignette?

Vs. insomnia: sleep may be normal when person follows preferred schedule.

What is the high-yield picture of Non-REM Sleep Arousal Disorder?

Recurrent incomplete awakenings with sleepwalking or sleep terrors, limited dream recall, and amnesia.

Timeline/onset: No fixed minimum

Spectrum/severity: No

Important note: Sleepwalking or sleep-terror type.

What timeframe, age, or number is most important for Non-REM Sleep Arousal Disorder?

No fixed minimum

How do you differentiate Non-REM Sleep Arousal Disorder on an exam vignette?

Occurs in NREM sleep; distinguish from nightmare disorder, where dreams are recalled.

What is the high-yield picture of Nightmare Disorder?

Repeated dysphoric, well-remembered dreams with rapid alertness on awakening and distress/impairment.

Timeline/onset: No fixed minimum

Spectrum/severity: Yes: acute/subacute/persistent and severity

Important note: Often occurs during REM sleep.

What timeframe, age, or number is most important for Nightmare Disorder?

No fixed minimum

How do you differentiate Nightmare Disorder on an exam vignette?

Vs. sleep terrors: nightmares are remembered and awakening is alert.

What is the high-yield picture of REM Sleep Behavior Disorder?

Repeated arousals with vocalization/complex movements associated with REM dreams and loss of normal REM atonia.

Timeline/onset: No fixed minimum

Spectrum/severity: No

Important note: Often later-life and neurologically associated.

What timeframe, age, or number is most important for REM Sleep Behavior Disorder?

No fixed minimum

How do you differentiate REM Sleep Behavior Disorder on an exam vignette?

Vs. NREM arousal: occurs in REM and dream content is often recalled.

What is the high-yield picture of Restless Legs Syndrome?

Urge to move legs with uncomfortable sensations, worse at rest/evening and relieved by movement.

Timeline/onset: 3+ times/week for 3+ months

Spectrum/severity: No

Important note: Rule out medical/substance causes.

What timeframe, age, or number is most important for Restless Legs Syndrome?

3+ times/week for 3+ months

How do you differentiate Restless Legs Syndrome on an exam vignette?

Distinct from anxiety restlessness because it is leg-focused, circadian, and relieved by movement.