Non-Rapid Eye Movement Sleep Arousal (NREM) Disorders are characterized by repeated episodes incomplete awakenings during sleep that usually last about 1-10 minutes but can also last as long as 1 hour without any recollection. Little to no dream imagery is recalled. 

NREM Sleep Arousal Disorders


Narcolepsy is a sleep disorder characterized by an uncontrollable urge to fall asleep at inopportune times. These sleep episodes are frequently accompanied by cataplexy, a sudden loss of muscle tone. Narcoleptic attacks often exhibit features characteristic of REM sleep; for instance, about a third of those with the disorder report experiencing vivid, dream-like hallucinations during an episode.

Narcolepsy

Sleep apnea is a disorder characterized by episodes in which a person's breathing stops during sleep. These cessations can last for 10-20 seconds or longer and often result in brief arousals. Although individuals with sleep apnea may be unaware of these repeated sleep disruptions, they frequently experience significant daytime fatigue. The condition is commonly associated with loud snoring and is more prevalent in overweight people.

Sleep Apnea

A sleep disorder that consists of not getting enough sleep.

Insomnia

A sleep disorder in which someone physically acts out their dream. This disorder typically presents after age 50, is more common in men than women, and usually followed by Parkinson’s and/or dementia symptoms, suggesting it’s the start of widespread neurodegeneration. Usually controlled by anti-anxiety drugs like benzodiazepines at night. 

REM Behavior Disorder

Somnambulism, or sleepwalking, is a condition more common in childhood that can persist into adulthood. It involves episodes of complex behaviors, lasting from seconds to minutes, which are often not remembered. While these episodes most frequently occur during stage 3 slow-wave sleep (SWS), they can happen at any time during a sleep period. Sleepwalkers are not acting out their dreams.

Somnambulism

Insomnia is a common health concern that causes significant distress and disruption in daily life, due to difficulty with and lack of sleep. Insomnia tends to be associated with an increased risk of developing physical health problems, anxiety, and depression.

Insomnia 

Substance/medication-induced sleep disorders are characterized by a severe sleep disturbance that occurs during or soon after substance intoxication, medication exposure, or substance/medicine withdrawal.

Substance/Medication-Induced Sleep Disorder

* Obstructive Sleep Apnea Separate Specific Disorder
* Central Sleep Apnea
* Sleep-Related Hypoventilation


Specific Breathing Sleep-Related Disorders

Circadian rhythm sleep-wake disorders happen when constant patterns of sleep disturbances occur. These disturbances can be caused by a new circadian rhythm or discrepancies between the person’s circadian rhythm and the sleep-wake schedule that is demanded by the person’s social life, occupation, or environment.

Circadian Rhythm Sleep-Wake Disorders

Hypersomnolence disorder consists of sleeping for too many hours at night, trouble staying completely awake after being woken up, or frequent episodes of sleep throughout the day. 

Hypersomnolence Disorder

Reference for Sleep-Wake Disorders

Insomnia, the most prevalent sleep disorder, is characterized by a persistent difficulty in initiating or maintaining sleep. Individuals with this condition often experience significant delays before falling asleep and may wake up frequently during the night, struggling to resume sleep. According to diagnostic criteria, these sleep disturbances must occur at least three nights a week for a minimum of one month.

REM behavior disorder (RBD), sleepwalking, restless leg syndrome, and night terrors are examples of parasomnias, which involve unwanted motor behaviors or experiences during the sleep cycle.

Examples of Parasomnias

The DSM-5-TR separates Sleep-Wake Disorders into the following specific disorders and groups:
-	Insomnia Disorder
-	Hypersomnolence Disorder
-	Narcolepsy
-	Breathing Related Sleep-Disorders*
-	Circadian Rhythm Sleep-Wake Disorders*
-	Parasomnias*
-	Restless Leg Syndrome
-	Substance / Medication-Induced Sleep Disorder
-	Other Specified Insomnia Disorder
-	Unspecified Insomnia Disorder
-	Other Specified Hypersomnolence Disorder
-	Unspecified Hypersomnolence Disorder
-	Other Specified Sleep-Wake Disorder
-	Unspecified Sleep-Wake Disorder

Note: * Groups that separate into further specific disorders

Georgetown University

University of California, Berkeley

University of Toledo

State University of New York at Buffalo

Sleep-Wake Disorders are defined using a multidimensional approach due to the expectations for co-existing or comorbid diagnosis in both mental and neurological health. They are largely characterized by individual’s interpretation of having dissatisfying sleep quality, timing, or amount of sleep. These complaints are often expressed alongside issues of distress or impairment during expected daytime activities. 

Sleep-Wake Disorders

Breedlove, S. & Watson, N. (2017). Behavioral neuroscience, eighth edition. Oxford University Press.

Behavioral Neuroscience 8th Edition

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

[DSM-5-TR] List of Sleep-Wake Disorders

The DSM-5-TR takes a section to briefly define important terminology related to sleep-wake disorders. These terms are broadly separated into two categories based on the type or stage of sleep, and the use of polysomnography and measurement of sleep. 
-	Sleep Stages Terms
-	Polysomnography and Measurement Terms


[DSM-5-TR] Key Concepts and Terms for Sleep-Wake Disorders

The DSM-5-TR makes a note to mention the common occurrence of co-occurring disorders that are diagnosed alongside a sleep-wake disorder. These co-occurring conditions frequently involve depression, anxiety, and cognitive changes. It is also recognized that sleep disturbances are recognized risk factors for developing other mental disorders (e.g., substance use disorder). Thus, when evaluating sleep disturbances as a differential diagnosis, the rule is to consider co-existence rather than differential diagnosis. Because of the importance of sleep on other mental or physical conditions, as well as the inverse effect of mental and physical conditions on sleep, it is important to plan treatment using a multidimensional approach that encompasses all the conditions of the patient. 

[DSM-5-TR] Note of Co-Occurring Disorders and Differential Diagnosis to Sleep-Wake Disorders

The DSM-5-TR makes an important note to specify the connection that sleep-wakes disorders, such as insomnia, have to suicidal thoughts, behavior, and death. Multiple studies, even when adjusting for depression, have correlated sleep-wake disorders and nightmares, increasing the risk of suicidal thoughts and behaviors. Some data collected on college students showed that 31.3% of those with sleep problems had suicidal thoughts, and inversely, 82.7% of those with suicidal thoughts, had sleep problems. Additionally, the American Academy of Sleep Medicine has also concluded that for teenagers, less than 8 hours of sleep is associated with increased risk for self-harm and suicidal thoughts and/or behaviors. 

[DSM-5-TR] Note of Sleep-Wake Disorders Association With Suicidal Thoughts or Behaviors

This list includes disorders or conditions that are related to states or features of sleeping, waking, or the processes that occur in between, but are not currently directly or officially included in the DSM. These disorders include:
-	Sleep Enuresis (Bedwetting)
-	Sleep Paralysis
-	Sleep-State Misperception
-	Sudden Infant Death Syndrome (SIDS)


List of Other Recognized Sleep-Wake Disorders

This list includes different types of methods for treating and/or managing different sleep-wake disorders. These include:
-	Narcolepsy Treatment 
-	Mindfulness and Effects on Insomnia
-	Insomnia Treatment Differences Between CBT-I & MBTI

Treatment & Management Methods for Sleep-Wake Disorders

This list includes different theories or concepts that are used to explain, define, or otherwise provide further insight into the workings of sleep-wake disorders. These include:
- Current Scales to Measure Sleep-Wake Disorder Symptoms


Theories & Concepts Relevant to Sleep-Wake Disorders

This includes the intersection of connections and/or research related to sleep-wake disorders as a general category in other fields of study and research. Such fields include:
-	TBD

Note: Add subjects as needed

Interdisciplinary Connections & Research Related to Sleep-Wake Disorders

The collection of references pertaining to sleep-wake disorders.

References for Sleep-Wake Disorders

Key learning objectives for understanding common sleep disorders include the ability to describe the symptoms and treatments for insomnia, sleep apnea, and narcolepsy. Additionally, one should be able to recognize the symptoms of various parasomnias and identify the risk factors and preventive measures associated with sudden infant death syndrome (SIDS).

Learning Objectives for Common Sleep Disorders

Studies indicate that a significant portion of the population, ranging from 30% to 50%, will experience a sleep disorder at some point during their lifetime. The exact percentage can vary depending on the specific population and disorder being examined (Bixler, Kales, Soldatos, Kaels, & Healey, 1979; Hossain & Shapiro, 2002; Ohayon, 1997, 2002; Ohayon & Roth, 2002).

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