Guide
Guide | Reference

21  Sleep, Circadian, and Arousal Regulation

21.1 Summary

  • Disruptions in sleep timing, sleep quality, or arousal level that shape mood, cognition, and function.

21.2 Patient-Language Phrases

  • “I can’t fall asleep no matter what.”
  • “I wake up all night and never feel rested.”
  • “My sleep schedule is flipped.”
  • “I’m wired at night and exhausted during the day.”

21.3 Core Features

  • Difficulty initiating or maintaining sleep.
  • Misaligned sleep timing (delayed or advanced phase).
  • Hyperarousal or low arousal states.

21.4 Boundary Markers

  • What it is: persistent sleep or arousal regulation problems affecting function.
  • What it is not: short-term sleep loss from temporary circumstances.

21.5 Quick Structure

  • Variants / Spectrum
    • Insomnia (initiation, maintenance, early waking).
    • Hypersomnia or excessive sleepiness.
    • Circadian rhythm delay/advance.
    • Nightmare or parasomnia patterns.
  • Severity (0-4)
    • 0: Restorative sleep, stable timing.
    • 1: Mild disruption, limited impact.
    • 2: Moderate disruption with daytime impairment.
    • 3: Severe, persistent disruption with functional impact.
    • 4: Extreme, disabling or unsafe.
  • Time-course
    • Acute, stress-related insomnia.
    • Chronic insomnia or circadian shift.
    • Fluctuating with schedule or substance use.
  • Functional impact
    • Work/school: fatigue, concentration issues.
    • Relationships: irritability, withdrawal.
    • Self-care: reduced routine stability.
  • Developmental expression
    • Childhood: bedtime resistance, nightmares.
    • Adolescence: delayed sleep phase.
    • Late life: early waking, fragmented sleep.
  • Cultural/context notes
    • Shift work or caregiving roles can drive sleep disruption.
    • Cultural norms influence sleep timing and reporting.