2. Sleep terrors: Recurrent episodes of abrupt terror arousals from sleep, usually be- ginning with a panicky scream. There is intense fear and signs of autonomic arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode. There is relative unresponsiveness to efforts of others to comfort the individual during the episodes.
. No or little (e.g., only a single visual scene) dream imagery is recalled.
. Amnesia for the episodes is present.
. The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
F. Coexisting mental and medical disorders do not explain the episodes of sleepwatking or sleep terrors.
Coding note: For ICD-9-CM, code 307.46 for all subtypes. For ICD-10-CM, code is based on subtype.
Specify whether: 307.46 (F51.3) Sleepwalking type
Specify if: 307.46 (F51.4) Sleep terror type
The essential feature of non—rapid eye movement (NREM) sleep arousal disorders is the repeated occurrence of incomplete arousals, usually beginning during the first third of the major Sleep episode (Criterion A), that typically are brief, lasting 1—10 minutes, but may be protracted, lasting up to 1 hour. The maximum duration of an event is unknown. The eyes are typically open during these events. Many individuals exhibit both subtypes of arousals on different occasions, which underscores the unitary underlying pathophysiology. The subtypes reﬂect varying degrees of simultaneous occurrence of wakefulness and NREM sleep, resulting in complex behaviors arising from sleep with varying degrees of conscious awareness, motor activity, and autonomic activation.
The essential feature of Sleepwalking is repeated episodes of complex motor behavior initiated during sleep, including rising from bed and walking about (Criterion A1). Sleep- walking episodes begin during any stage of NREM sleep, most commonly during slow- wave sleep and therefore most often occurring during the first third of the night. During episodes, the individual has reduced alertness and responsiveness, a blank stare, and rel- ative unresponsiveness to communication with others or efforts by others to awaken the individual. If awakened during the episode (or on awakening the following morning), the individual has limited recall for the episode. After the episode, there may initially be a brief period of confusion or difficulty orienting, followed by full recovery of cognitive function and appropriate behavior.
The essential feature of sleep terrors is the repeated occurrence of precipitous awaken- ings from sleep, usually beginning with a panicky scream or cry (Criterion A2). Sleep ter- rors usually begin during the first third of the major sleep episode and last 1—10 minutes, but they may last considerably longer, particularly in children. The episodes are accom- panied by impressive autonomic arousal and behavioral manifestations of intense fear.
During an episode, the individual is difficult to awaken or comfort. If the individual awak- ens after the sleep terror, little or none of the dream, or only fragmentary, single images, are recalled. During a typical episode of sleep terrors, the individual abruptly sits up in bed screaming or crying, with a frightened expression and autonomic signs of intense anx- iety (e.g., tachycardia, rapid breathing, sweating, dilation of the pupils). The individual may be inconsolable and is usually unresponsive to the efforts of others to awaken or com- fort him or her. Sleep terrors are also called “night terrors” or “pavor nocturnus.”