Reference
Guide | Reference

42  Arousal, Sleep, and Circadian Regulation

42.1 Summary

  • A dimensional construct describing dysregulation in sleep quality, timing, or arousal that affects function and symptom expression.

42.2 Core Construct

  • Difficulty achieving restorative sleep or stable circadian timing.

42.3 Subdimensions

  • Insomnia or sleep fragmentation.
  • Hypersomnia or excessive sleepiness.
  • Circadian phase delay/advance.
  • Hyperarousal or low arousal states.

42.4 Severity Anchors (0-4)

  • 0: Restorative sleep, stable timing.
  • 1: Mild disruption with limited impact.
  • 2: Moderate disruption with daytime impairment.
  • 3: Severe, persistent disruption with functional impact.
  • 4: Extreme, disabling or unsafe.

42.5 Time-Course Patterns

  • Acute, stress-linked insomnia.
  • Chronic insomnia or circadian shift.
  • Fluctuating with schedule or substance use.

42.6 Functional Impact

  • Work/school: fatigue, concentration issues.
  • Relationships: irritability, withdrawal.
  • Self-care: reduced routine stability.

42.7 Developmental Expression

  • Childhood: bedtime resistance, nightmares.
  • Adolescence: delayed sleep phase.
  • Late life: fragmented sleep, early waking.

42.8 Cultural / Context Notes

  • Shift work or caregiving roles can drive sleep disruption.
  • Cultural norms influence sleep timing and reporting.

42.9 Differential and Rule-Outs

  • Mood or anxiety disorders driving sleep disruption.
  • Substance effects or withdrawal.
  • Sleep apnea or other primary sleep disorders.
  • Medical pain or neurologic contributors.

42.10 Measurement Prompts

  • Sleep diary or tracker.
  • Brief insomnia severity questions.

42.11 Treatment-Relevant Correlates (non-prescriptive)

  • Severe disruption often amplifies other domains.

42.13 Documentation Snippet (1-2 lines)

  • “Sleep/circadian dysregulation with chronic insomnia; Arousal/Sleep 3; chronic course.”