Psych · Specialty psychiatry — sleep medicine interface
Sleep disorders in psychiatry
Also known as Insomnia disorder · CBT-I · Cognitive behavioural therapy for insomnia · Obstructive sleep apnoea · OSA · Hypersomnia · Narcolepsy · Circadian rhythm sleep-wake disorder · Restless legs syndrome · Hypnotics · Z-drugs · Parasomnia
Exam-exhaustive fellowship reference on sleep disorders at the psychiatry interface — DSM-5-TR/ICSD-3 insomnia and hypersomnia nosology, OSA screening and CPAP framing, circadian and parasomnia boundaries, CBT-I first-line evidence, hypnotic risk/benefit and deprescribing, psychotropic effects on sleep, and suicide-risk implications. FRANZCP-primary, globally tagged.
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12 MCQs with explanations
Target exams
FRANZCPMRCPsychABPNMD-DNBNEET-SS
Red flags
Severe insomnia with active suicidal ideation, plan, or near-lethal self-harm — treat sleep and suicide risk together as psychiatric emergencyExcessive daytime sleepiness with near-miss or actual driving incidents — urgent fitness-to-drive assessment and hypersomnia/OSA work-upWitnessed apnoeas with cyanosis, cor pulmonale, or acute hypercapnic failure — medical emergency pathway, not psychiatry aloneNew dream-enactment behaviours (RBD) with injury risk — urgent sleep/neurology pathway; neurodegeneration counsellingCataplexy-related falls or suspected untreated narcolepsy with occupational hazardHypnotic-related falls, delirium, or intentional overdose — stop agent, medical stabilisation, deprescribe long-term benzodiazepines/Z-drugs
Meet the patient
A 52-year-old shift worker with "treatment-resistant depression" is on her third antidepressant. She snores loudly, wakes unrefreshed at 5 a.m. every morning, has gained 8 kg on mirtazapine, and tells you she "would rather not wake up at all." Her PHQ-9 is stuck at 18.[10][12][17]
The registrar wants to switch antidepressants again. The examiner wants to know: "What have you not yet assessed, and what is your first-line treatment for the sleep complaint?"[2][10]
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References28Show ledgerHide ledger
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