Which diagnosis best fits duration, episodicity, and exclusions?
A
NREM sleep arousal disorder
Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either sleepwalking (complex behaviour without full consciousness) or sleep terrors (abrupt awakenings with intense fear/autonomic arousal; difficult to console)
AA. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either sleepwalking (complex behaviour without full consciousness) or sleep terrors (abrupt awakenings with intense fear/autonomic arousal; difficult to console) B. No or little dream imagery recalled C. Amnesia for the episodes
BA. Disturbance of attention (reduced ability to direct, focus, sustain, shift attention) and awareness (reduced orientation to environment) B. Develops over short period; represents change from baseline; tends to fluctuate during the day C. Additional disturbance in cognition (memory deficit, disorientation, language, visuospatial ability, or perception)
Common specifiers
ASleepwalking type; Sleep terror type; With sleep-related eating
BHyperactive; Hypoactive; Mixed level of activity; Acute
Differential flags
AREM sleep behaviour disorder (REM sleep; recall of dreams; no amnesia; second half of night); Nocturnal seizures (epileptiform discharges on EEG; stereotyped patterns); Delirium (global cognitive disturbance; not sleep-specific)
BMajor NCD (gradual onset; no fluctuation - delirium superimposed on NCD is common); MDD (no clouded consciousness); Psychotic disorder (gradual onset; consciousness intact)