Insomnia
According to the DSM-5-TR, about one-third of adults report experiencing symptoms of insomnia, with the first episode most common in young adulthood. Insomnia Disorder (F51.01) is characterized by a predominant complaint or dissatisfaction with sleep quantity or quality. Individuals may experience difficulty falling asleep, difficulty maintaining sleep, or waking up early in the morning with an inability to return to sleep. This sleep difficulty must occur at least three times a week and cause significant clinical, social, occupational, educational, academic, or behavioral impairment (APA, 2022).
Sleepwalking and Sleep Terrors
Sleepwalking and sleep terrors may have been sensationalized, but those experiencing these symptoms may feel like they are in a bad movie. Sleepwalking symptoms include a person rising from bed during sleep and walking around. The individual has a blank, staring face and is unresponsive to communication, and can only be awakened with great difficulty. Sleep terror symptoms usually begin with an abrupt scream, followed by somatic symptom responses, e.g., rapid heartbeat, increased sweating, and often a lack of responsiveness to comfort (APA, 2022).
Impact and Prevalence
Sleepwalking and sleep terrors cause clinically significant distress or impairment in social, occupational, and other important areas of functioning. Both are characterized by recurrent episodes of incomplete sleep with little or no dream imagery recalled, and no memory, or amnesia, of the episodes. The prevalence of sleep terror disorder is currently unknown in the general population; however, sleep terror episodes affect approximately 35% of toddlers at 18 months of age (APA, 2022).
Differential Diagnosis
The differential diagnoses of sleepwalking, sleep terror disorder, and insomnia disorder may lead to similar outcomes of a person feeling unrested, but the symptoms are quite different. Insomnia symptoms follow a person’s sleep cycle—or lack thereof. Their inability to sleep may occur at the beginning, middle, or end of their desired sleep schedule. In the criteria listed in the DSM-5-TR, there is no reference to amnesia or remembering dreams, which is an important criterion for sleepwalking and sleep terror disorder. Insomnia is far more prevalent in adults than the previously mentioned disorders and is described as a “universal experience” in the DSM-5-TR.
References
- DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders. (2022). American Psychiatric Association.