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Presentation comparison
UrgentCovers insomnia, circadian disorders, reduced sleep need, and psychiatric or substance-related causes.
4 of 8 diagnoses compared
| CriteriaComparison detail | Major depressive disorderEmergency |
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Sleep disturbance sits inside a broader syndrome. Reduced need for sleep is one of the most decisive bipolar bedside clues.
Clinical reference — not validated decision support. Review before use.
| Generalised anxiety disorderUrgent |
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| PTSDUrgent |
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| Bipolar maniaUrgent |
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| Mixed stateUrgentNot selected |
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| Primary insomniaUrgentNot selected |
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| OSAUrgentNot selected |
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| Substance- or medication-related insomniaUrgentNot selected |
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| Why it fits | Early-morning waking, low energy, anhedonia, tiredness with poor sleep | Difficulty initiating sleep because of worry, physiological tension, rumination | Trauma-linked insomnia, nightmares, startle, hypervigilance, fear of sleeping | Marked drop in sleep time with overactivity, feeling energised | Insomnia plus despair, irritability, internal agitation, racing thoughts, suicidal risk | Chronic sleep difficulty without broader syndrome | Snoring, witnessed apnoeas, morning headaches, daytime somnolence, leg discomfort | After stimulants, caffeine excess, corticosteroids, antidepressant activation, withdrawal, alcohol rebound |
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| What argues against | Applies to the whole presentationReview locally. | |||||||
| Must-not-miss | Psychotic depression, suicidality, severe self-neglect, catatonic retardation | Severe panic, escalating substance self-medication, exhaustion-related collapse | Night terrors, marked dissociation, severe suicidality | Psychosis, severe disinhibition, mixed state | ||||
| Bedside question | Applies to the whole presentationSleep disturbance sits inside a broader syndrome. Reduced need for sleep is one of the most decisive bipolar bedside clues. | |||||||
| Immediate action | Applies to the whole presentationStabilise and reassess. | |||||||
| Investigations | Applies to the whole presentationGuided by presentation. | |||||||
| Mimics / overlap | Applies to the whole presentationReview overlap locally. | |||||||
Scroll horizontally to review more candidate differentials. Clinical reference — not validated decision support. Review before use.
Review locally.
Sleep disturbance sits inside a broader syndrome. Reduced need for sleep is one of the most decisive bipolar bedside clues.
Stabilise and reassess.
Guided by presentation.
Review overlap locally.
Early-morning waking, low energy, anhedonia, tiredness with poor sleep
Psychotic depression, suicidality, severe self-neglect, catatonic retardation
Difficulty initiating sleep because of worry, physiological tension, rumination
Severe panic, escalating substance self-medication
Trauma-linked insomnia, nightmares, startle, hypervigilance, fear of sleeping
Night terrors, marked dissociation,
Marked drop in sleep time with overactivity, feeling energised
Psychosis, severe disinhibition,
Based on current selection
Create a concise comparison summary for documentation or handoff.
Source pending review
v10 | Local content only
Last updated: Pending review
Open a selected differential to review its clinical record.
Based on current selection
Create a concise comparison summary for documentation or handoff.
Source pending review
v10 | Local content only
Last updated: Pending review
| High near-term suicide risk, impulsive self-harm |
| Sleep deprivation causing accidents, severe functional decline, hidden sleep apnoea |
| Severe daytime sleepiness, falls, dream-enactment violence, Lewy body clues |
| Stimulant toxicity, alcohol/benzo withdrawal, antidepressant-induced switch, steroid psychosis |