Rosh Psychiatry Board Practice Exam

A 24-year-old man has incidents of intense fear after waking from sleep. What is the most likely diagnosis?

1. Sleep terrors

2. Panic disorder

3. Central sleep apnea

4. Insomnia disorder

The correct answer is: Panic disorder

The scenario depicts a 24-year-old man experiencing intense fear upon waking from sleep. This aligns closely with the characteristics of sleep terrors, which occur during non-REM sleep and typically involve episodes of terror, screaming, and confusion, often without full awakening. Individuals experiencing sleep terrors are generally not aware of the episode occurring and often have little memory of it afterward. In this context, the diagnosis of panic disorder would not be the most accurate choice. Panic disorder is characterized by recurrent, unexpected panic attacks that occur abruptly, often accompanied by physical symptoms such as palpitations, sweating, and a sense of impending doom. These attacks can happen at any time, including during sleep, but are not specifically linked to the act of waking from sleep or experiencing fear upon awakening. Sleep apnea involves disturbances in breathing during sleep, while insomnia disorder pertains to difficulty initiating or maintaining sleep, which does not fit the symptoms described in this case. Selecting sleep terrors acknowledges the specific onset of intense fear following awakening, which distinguishes it from the sudden and panic-based symptoms seen in panic disorder.