Section 14about 4 min · no rush

A gentle note before you read: symptom lists make almost everyone recognise themselves somewhere. That is a normal effect of reading, not a diagnosis. If something here sits on your mind, a conversation with a professional helps more than re-reading.

14

Sleep-wake disorders

Sleep is the most sensitive indicator of a client's mental state, and the thing you can most reliably improve in the first three sessions. DACUM lists "assess sleep disturbances" and "assess nightmare" as separate tasks.

awake deep 10 pm · · · · · a full night · · · · · 6 am REM First third: deep NREM sleep terrors · sleepwalking (no recall) Second half: REM-rich nightmares (vivid recall) · REM behaviour disorder
One night, mapped. Deep non-REM sleep piles up in the first third of the night: that is where sleep terrors and sleepwalking erupt, with no memory after. REM stretches lengthen toward morning: that is where nightmares (remembered vividly) and REM sleep behaviour disorder live. The exam question "terror or nightmare?" is answered by the clock and the memory.

Insomnia Disorder; the one you will meet most

Beyond curriculum307.42 · F51.01
DSM-5 Criteria
  1. Dissatisfaction with sleep quantity or quality, with one or more of: difficulty initiating sleep · difficulty maintaining sleep · early-morning awakening without return to sleep.
  2. Clinically significant distress or impairment (daytime fatigue, concentration, mood, work).
  3. At least 3 nights per week;
  4. for at least 3 months;
  5. despite adequate opportunity for sleep.
  6. Not better explained by another sleep-wake disorder;
  7. not attributable to a substance;
  8. coexisting mental and medical conditions do not adequately explain it.
DisorderCodeCore feature
Hypersomnolence disorderF51.11Excessive sleepiness despite ≥7 h sleep; unrefreshing naps
NarcolepsyG47.41xIrresistible sleep attacks + cataplexy / hypocretin deficiency / SOREMPs
Obstructive sleep apnoeaG47.33≥5 apnoeas-hypopnoeas/hour + snoring or daytime sleepiness, or ≥15/hour regardless of symptoms
Circadian rhythm disordersG47.2xBody clock misaligned with required schedule (shift work, delayed phase)
NREM arousal disordersF51.3/.4Sleepwalking · sleep terrors: first third of night, no recall
Nightmare disorderF51.5Extended dysphoric dreams, second half of night, vivid recall
REM sleep behaviour disorderG47.52Dream enactment: REM without muscle paralysis
Restless legs syndromeG25.81Urge to move legs, worse at rest and night, relieved by movement
Nepal

"Nindra lagdaina" is among the most common presenting complaints in Nepali primary care, and often the socially acceptable doorway to depression, anxiety, or trauma underneath. Ask about tea (strong, late, many cups), load-shedding-era phone habits, shift work in security and transport jobs, and crowded sleeping rooms. Sleep hygiene plus stimulus control is a counselor-deliverable intervention with fast, credibility-building results. No national prevalence figure exists for sleep disorders; the survey has no sleep-disorder row. See Nepal in numbers for what it did measure.

A skill to try · two minutes

The wind-down hour. Screens away one hour before bed; same wake time daily, even after a bad night; the 4-in 6-out breath once in bed. Awake more than 20 minutes? Get up, sit in dim light, return only when sleepy: the bed must mean sleep, not struggle.

A coping skill, not a treatment: it supports care, it does not replace it.

Key points
  1. Insomnia is trouble falling or staying asleep at least three nights a week for three months, with daytime cost.
  2. Sleep is the most sensitive sign of mental state and the easiest thing to improve early in counselling.
  3. Same wake time daily, screens away, bed only for sleep: the wind-down routine beats sleeping pills over time.
Quick check

Three friendly questions to settle what you just read. This is reassurance, not a test: a wrong tap is part of learning, and you can try again.

Insomnia disorder's thresholds:

Sleep terrors differ from nightmares because terrors:

The counselor's first sleep intervention is:

Learn more

Pick one, not all: these are chosen to be light, not exhaustive.

Video · 5 minWhat causes insomnia? (TED-Ed): The vicious cycle of trying too hard to sleep.
Video · 19 minSleep is your superpower (Matt Walker, TED): Motivation for clients who think sleep is wasted time.
Book chapterWhy We Sleep (Matthew Walker): ch. 1–2: Readable science of the hypnogram above.

In the flow? The next chapter is one click below. Tired? Stopping here is also progress.