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.

1. Review of DSM5 Mental Disorders for NCMHCE Study

2.  Insomnia Disorder
 Hypersomnolence Disorder
 Narcolepsy
 Breathing-Related Sleep
Disorders
 Circadian Rhythm Sleep-
Wake Disorders
 Non-REM Sleep Arousal
Disorders
 Parasomnias
 Nightmare Disorder
 Restless Legs Syndrome
 Substance/Medication-
Induced Sleep Disorder

3. S1. Find Out
 Substance abuse
 Depression
 Medical conditions

4. Comorbidity
 Depressive disorders
 Anxiety disorders
 Autism
 ADHD
 OCD
 Adjustment disorder
 Dissociative disorders
 Feeding & Eating disorders
 Somatic Symptom disorders
 Neurocognitive disorders
Rule Out
 Depressive
disorders

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

7. S4.Treatment
Therapy
 CBT-Insomnia
 RelaxationTherapy
 CognitiveThought Stopping
 Bright LightTherapy
 Neurostimulation
Medication
 Melatonin
 Amphetamines
 Antidepressants
 Monoamine Oxidase
Inhibitors (MOIs)

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

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

15. S4.Treatments
Medications
 Amphetamines
 Antidepressants
 Monoamine Oxidase Inhibitors (MOIs)

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

19. S2. Assess & Refer
 Lab tests

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

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)

24. S1. Diagnosis II
Co-occurring: Rule Out:
 Lung disease
 Neuromuscular disorder
 Skeletal malformation

25. S2. Assess & Refer
 Lab tests

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

27. S5. Monitoring Progress
 Sleep diary
S6.Termination

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

30. S2. Assess & Refer
 Polysomnography

31. S4.Treatments
 Light therapy
 Dark therapy
 Melatonin supplements
 Sleep Deprivation Phase Advance

32. S5. Monitoring Progress
 Sleep diary
S6.Termination

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

38. S2. Assessments to Rule Out Options
 Polysomnography

39. S4.Treatments
 Avoidance of
neuroleptics or hypnotics
 Avoidance of alcohol
Medications
 Tricyclic
Antidepressants
 Benzodiazepine

40. S5. Monitoring Progress
 Sleep diary
6. Recommendations
afterTermination

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

43. S4.Treatments
Psychotherapy
 Scheduled Awakenings
Therapy very effective
 Increasing quality of sleep
Medications, in extreme
cases
 Tricyclic
Antidepressants
 Benzodiazepine

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

48. S5. Monitoring Progress
 Sleep diary
6.Termination

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

51. Diagnosis II
Co-occurring:
Periodic Limb Movement Disorder, where limbs jerk
during sleep
Neurologic conditions like Parkinsons disease
Renal disease

52. S4.Treatments
 Stretching, walking
(temporary)
 Iron supplements
Medications
 Benzodiazepines
 Anticonvulsants for pain
 Non-dopaminergic
Gabapentin or Pregabalin
 Dopamine Agonists,
cautiously

53. S5. Monitoring Progress
 Sleep diary
S6.Termination

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

58. S4.Treatments
Medications
 Clonazepam and
melatonin most effective
 Avoid sleep
deprivation, alcohol,
and certain
medications
 Make bedroom safe

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