Psychiatry: disorder groups
Sleep–wake disorders
Sleep-wake disorders include insomnia, excessive sleepiness, sleep-related breathing problems, circadian rhythm disorders and unusual behaviours during sleep. Psychiatrists treat them because poor sleep both causes and signals mental illness.
Depth by stage, Pre-U → Consultant (details)
What is it?
Sleep problems are among the most common complaints in psychiatry. Insomnia — difficulty falling or staying asleep, with daytime effects — accompanies depression, anxiety, bipolar disorder and substance use, and on its own raises the risk of later depression.
Other sleep disorders include narcolepsy (sudden sleep attacks), obstructive sleep apnoea (breathing pauses with loud snoring and daytime sleepiness), circadian rhythm disorders such as delayed sleep phase in young people and shift-work disorder, restless legs syndrome, and parasomnias such as sleepwalking, night terrors and REM sleep behaviour disorder.
ICD-11 places sleep-wake disorders in their own chapter, outside mental disorders, reflecting their mixed medical and psychological nature. Care often involves respiratory physicians, neurologists and sleep laboratories.
Why does a psychiatrist need it?
Psychiatrists must assess sleep in every patient, treat insomnia with CBT-I rather than relying on long-term sleeping pills, recognise sleep apnoea and narcolepsy, and understand how psychiatric drugs affect sleep. A sudden loss of need for sleep is also an early warning sign of mania.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalUnderstandsLearns sleep stages, EEG patterns and circadian physiology.
- ClinicalAwareAware of common sleep disorders and sleep hygiene advice.
- HousemanshipAwareManages night-time sleeplessness on wards and avoids unnecessary hypnotics.
- Medical officerUnderstandsAssesses sleep complaints in psychiatric patients and gives first-line advice.
- Psych traineeAppliesDiagnoses and treats insomnia and recognises other sleep disorders needing referral; examined in Paper A.
- Specialist / consultantAppliesIntegrates sleep management into complex care; a few develop special interest.
What are the key topics?
Sleep science
- Sleep stages (NREM 1–3, REM) and the sleep cycle
- Circadian rhythms, the suprachiasmatic nucleus and melatonin
- Neurotransmitters of wake and sleep (orexin/hypocretin, GABA, histamine, acetylcholine)
- Polysomnography and actigraphy basics
- Effects of psychiatric drugs, alcohol and caffeine on sleep
Conditions
- Chronic insomnia disorder
- Hypersomnolence disorders, including narcolepsy
- Obstructive sleep apnoea
- Circadian rhythm sleep-wake disorders (delayed phase, shift work, jet lag)
- Restless legs syndrome and periodic limb movements
- NREM parasomnias (sleepwalking, night terrors) and REM sleep behaviour disorder
- Nightmare disorder
Assessment and treatment
- Sleep history, sleep diary, Epworth Sleepiness Scale
- CBT for insomnia (CBT-I) as first-line treatment: stimulus control, sleep restriction, cognitive work
- Short-term hypnotic use and dependence risk
- Melatonin and other options
- Referral for sleep studies, CPAP for sleep apnoea
- REM sleep behaviour disorder as an early sign of Parkinson's disease or Lewy body dementia
How is it learned and assessed?
- Pre-clinical physiology (sleep and EEG)
- Clinical exposure in psychiatry, respiratory and neurology postings
- MRCPsych Paper A (neuroscience of sleep); MMed Part I and II
- Trainee clinics and liaison work
Typical textbooks and resources
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- Overcoming Insomnia and Sleep Problems — Colin Espie, Robinson; patient-friendly CBT-I
- Oxford Handbook of Sleep Medicine — Oxford University Press
- Kaplan & Sadock's Synopsis of Psychiatry — Wolters Kluwer
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Should sleeping pills be used for insomnia?
Usually only short term. Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first treatment because it works well and its benefits last; sleeping pills can cause tolerance and dependence.
Why do psychiatrists ask so much about sleep?
Sleep changes are early signs of depression, mania and relapse in many conditions, and poor sleep can worsen mental illness. Treating sleep often helps the main condition.