Sleep-Wake Disorders
| Category | Disorder | Description | Management |
| Dyssomnias (insufficient,excessive or altered timing of sleep) | Insomnia disorder | Difficulty initiating/maintaining sleep or early-morning awakening with inability to return to sleep; can be acute or chronic (≥3 months) | Sleep hygiene measures CBT for insomnia Non-benzodiazepines (zopiclone /zolpidem) Antidepressants (trazodone, amitriptyline) |
| Hypersomnolence disorder | Excessive daytime sleepiness despite sleeping at least 7 h; difficulty being fully awake after awakening at least 3 times per wk for at least 3 mo | Modafinil or stimulant drugs Scheduled napping | |
| Narcolepsy | Classic tetrad consists of recurrent attacks of irrepressible need to sleep (sleep attacks), REM-related sleep phenomena, hypnagogic or hypnopompic hallucinations, and cataplexy (sudden loss of tone evoked by strong emotion without LOC) | Sleep hygiene Amphetamines (methamphetamine) Non-amphetamines (Modafinil, sodium oxybate) | |
| Circadian rhythm sleep-wakedisorders | Insomnia or excessive sleepiness due to misalignment or alteration in endogenous circadian rhythm | Melatonin Bright light phototherapy Modafinil if severe | |
| Restless legs syndrome | Uncomfortable, frequent urge to move legs at night; relief with movement and aggravation with inactivity | Dopamine agonists and benzodiazepines are first-line Replace iron if low ferritin Modify medications that may be exacerbating symptoms | |
| Substance/medication-inducedsleep disorder | Disturbance in sleep (insomnia or daytime sleepiness) caused by substance/ medication intoxication or withdrawal | ||
| Breathing-RelatedSleep Disorders | Obstructive sleep apneahypopnea | Breathing issues due to repetitive collapse of the upper airway during sleep -resulting in nonrestorative sleep and excessive daytime sleepiness; snoring,disrupted sleep, and morning headaches are common signs | Continuous positive airway pressure (CPAP)Weight loss/exerciseSurgery |
| Central sleep apnea | Breathing issues due to aberrant brain signalingMore common among chronic opioid users | CPAP/bilevel positive airway pressure (BiPAP) Supplemental oxygen | |
| Sleep-related hypoventilation | Breathing issues due to decreased responsiveness to carbon dioxide levels (decreased respiration) | CPAP/BiPAP Medications that support breathing | |
| Parasomnias(unusual sleep-related behaviours) | Non-rapid eye movement sleep arousal disorders | Incomplete awakening from sleep, complex motor behaviour without conscious awareness; amnesia regarding episodes; includes symptoms of: Sleepwalking: rising from bed and walking about, blank face, unresponsive, awakened with difficulty Sleep terrors: recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream, intense fear, and autonomic arousal; relativeunresponsiveness to comfort during episodes Specifiers: sleep-related sexual behaviour (sexsomnia) and sleep-related eating | Most cases do not require treatment aside from addressing precipitating factors and education regarding sleep hygiene Severe cases may respond to low-dose clonazepam Often self-limited and benign |
| Nightmare disorder | Repeated extended, extremely dysphoric, often very vivid, well-remembered dreams that usually involve significant threats; rapid orientation and alertnesson awakening with autonomic arousal | Reassurance Desensitization/imagery rehearsal therapy Prazosin can be helpful for those with PTSD | |
| Rapid eye movement sleep | Arousal during sleep, associated with vocalization and/or complex motor behaviours; can cause violent injuries; rapid orientation and alertness on awakening | Melatonin Clonazepam Discontinuation of causative medications such as TCAs, SSRIs andSNRIs | |
| behaviour disorder |