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Step 1
Evaluate for nightmare disorder that is characterized by repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security or self esteem. The awakenings generally occur during the second half of the sleep period. On wakening from the frightening dreams, the person rapidly becomes oriented and alert (in contrast to the confusion and disorientation seen in sleep terror disorder). The dream experience, or the sleep disturbance resulting from the awakening, causes significant distress or impairment in social, occupational, or other important areas of functioning. The nightmares do not occur exclusively during the course of another mental disorder and cannot be due to the direct physiological effects of a substance such as abuse of a drug or use of a medication.
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Step 2
Evaluate for symptoms of sleep terror disorder such as recurrent episodes of abrupt awakenings from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream. Look for intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode. There is relative unresponsiveness to efforts of others to comfort the person during the episode. No detailed dream is recalled and there is amnesia for the episode. The episodes cause significant distress or impairment in social, occupational, or other important areas of functioning. Once again, the disturbance cannot be due to the direct physiological effects of a substance or a general medical condition.
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Step 3
Evaluate for sleepwalking disorder such as repeated episodes of rising from bed during sleep and walking about, usually occurring during the first third of the major sleep episode. While sleepwalking, the person has a blank, staring face, is relatively unresponsive to the efforts of others to communicate with him or her, and can be awakened only with great difficulty. On wakening (either from the sleepwalking episode or the next morning), the person has amnesia for the episode. Within several minutes after awakening from the sleepwalking episode, there is no impairment of mental activity or behavior (although there may initially be a short period of confusion or disorientation). The sleepwalking must cause significant distress or impairment in social, occupational, or other important areas of functioning and the disturbance cannot be due to the direct physiological effect of a substance or a general medical condition.
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Step 4
Consult a physician or specialist in sleep disorders for a complete evaluation if there is confusion and a significant amount of concern or distress as related to any sleep disorder. A specialist can help to pinpoint that sleeping disorder may exist and lead to the proper treatment protocol.
