Misdiagnosing sleep disorders as primary psychiatric conditions

Gregory Stores is Professor of Developmental Neuropsychiatry and Fellow of Linacre College in the University of Oxford (University Section, Park Hospital, Old Road, Headington, Oxford OX3 7LQ, UK) and an honorary consultant to the Oxfordshire Mental Healthcare NHS Trust. His main clinical and research interests are sleep and its disorders in children and adults, on which he has published extensively.

Sleep disorders are relevant to psychiatric practice in a number of ways, including the possibility that they may be misdiagnosed as fundamentally psychiatric conditions in patients of all ages. This risk exists in a wide range of collectively very common sleep disorders which need to be considered in explaining insomnia, excessive sleepiness or disturbed episodes of behaviour associated with sleep (parasomnias). Examples given include circadian sleep–wake cycle disorders (such as the delayed sleep phase syndrome), obstructive sleep apnoea, narcolepsy, Kleine–Levin syndrome, sleep paralysis and rapid eye movement (REM) sleep behaviour disorder. Failure to recognise and treat such disorders is likely to cause and perpetuate psychological problems. Correct recognition requires familiarity with the range and manifestations of sleep disorders.