Reference
Guide | Reference

31  Sleep, Circadian, and Arousal Regulation

31.1 Summary

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

31.2 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.”

31.3 Core Features

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

31.4 Boundary Markers

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

31.5 Variants / Spectrum

  • Insomnia (initiation, maintenance, early waking).
  • Hypersomnia or excessive sleepiness.
  • Circadian rhythm delay/advance.
  • Nightmare or parasomnia patterns.

31.6 Severity Anchors (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.

31.7 Time-Course Patterns

  • Acute, stress-related insomnia.
  • Chronic insomnia or circadian shift.
  • Fluctuating with schedule or substance use.

31.8 Functional Impact

  • Work/school: fatigue, concentration issues.
  • Relationships: irritability, withdrawal.
  • Self-care: reduced routine stability.

31.9 Common Mimics / Differential

  • Mood or anxiety disorders driving sleep disruption.
  • Substance effects or withdrawal.
  • Medical conditions (sleep apnea, pain).

31.10 Medical / Substance Rule-Outs

  • Sleep apnea or other sleep disorders.
  • Stimulants, alcohol, or sedatives.
  • Endocrine or neurologic contributors.

31.11 Developmental Expression

  • Childhood: bedtime resistance, nightmares.
  • Adolescence: delayed sleep phase.
  • Late life: early waking, fragmented sleep.

31.12 Cultural / Context Notes

  • Shift work or caregiving roles can drive sleep disruption.
  • Cultural norms influence sleep timing and reporting.

31.13 Measurement Prompts

  • Sleep diary or tracker.
  • Brief insomnia severity questions.

31.15 Documentation Snippet (1-2 lines)

  • “Reports chronic insomnia with delayed sleep phase; Arousal/Sleep 3; chronic course.”