# 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.

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

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.

| Disorder | Code | Core feature |
| --- | --- | --- |
| Hypersomnolence disorder | F51.11 | Excessive sleepiness despite ≥7 h sleep; unrefreshing naps |
| Narcolepsy | G47.41x | Irresistible sleep attacks + cataplexy / hypocretin deficiency / SOREMPs |
| Obstructive sleep apnoea | G47.33 | ≥5 apnoeas-hypopnoeas/hour + snoring or daytime sleepiness, or ≥15/hour regardless of symptoms |
| Circadian rhythm disorders | G47.2x | Body clock misaligned with required schedule (shift work, delayed phase) |
| NREM arousal disorders | F51.3/.4 | Sleepwalking · sleep terrors: first third of night, no recall |
| Nightmare disorder | F51.5 | Extended dysphoric dreams, second half of night, vivid recall |
| REM sleep behaviour disorder | G47.52 | Dream enactment: REM without muscle paralysis |
| Restless legs syndrome | G25.81 | Urge 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](https://manoatlas.com/data.md) 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.
Learn more

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

Video · 5 min[What causes insomnia? (TED-Ed)](https://www.youtube.com/watch?v=j5Sl8LyI7k8): The vicious cycle of trying too hard to sleep.

Video · 19 min[Sleep is your superpower (Matt Walker, TED)](https://www.ted.com/talks/matt_walker_sleep_is_your_superpower): Motivation for clients who think sleep is wasted time.

Book chapter**Why We Sleep (Matthew Walker): ch. 1–2**: Readable science of the hypnogram above.


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*Source: https://manoatlas.com/sleep · Licence: CC BY-NC-SA 4.0. Mano Atlas is an educational resource, not a diagnostic tool.*