Temperamental. Substance use generally precipitates or accompanies insomnia in vul- nerable individuals. Thus, presence of insomnia in response to stress or change in sleep en- sleep disorder. A similar risk may be present for individuals with other sleep disorders (e.g., individuals with hypersomnia who use stimulants).
The consumption of substances, including prescribed medications, may depend in part on cultural background and specific local drug regulations.
Gender-specific prevalences (i.e., females affected more than males at a ratio of about 2:1) exist for patterns of consumption of some substances (e.g., alcohol). The same amount and duration of consumption of a given substance may lead to highly different sleep-related outcomes in males and females based on, for example, gender-specific differences in hepatic functioning.
Each of the substance/medication-induced sleep disorders produces electroencephalo- graphic sleep patterns that are associated with, but cannot be considered diagnostic of, other disorders. The electroencephalographic sleep profile for each substance is related to the stage of use, whether intake/ intoxication, chronic use, or withdrawal following discontinu- ation of the substance. All—night polysomnography can help define the severity of insomnia complaints, while the multiple sleep latency test provides information about the severity of daytime sleepiness. Monitoring of nocturnal respiration and periodic limb movements with havior. Sleep diaries for 2 weeks and actigraphy are considered helpful in confirming the presence of substance/medication-induced sleep disorder. Drug screening can be of use when the individual is not aware or unwilling to relate information about substance intake.
While there are many functional consequences associated with sleep disorders, the only unique consequence for substance/medication-induced sleep disorder is increased risk for relapse. The degree of sleep disturbance during alcohol withdrawal (e.g., REM sleep rebound predicts risk of relapse of drinking). Monitoring of sleep quality and daytime whether an individual is at increased risk for relapse.
Substance intoxication or substance withdrawal. Sleep disturbances are commonly en- countered in the context of substance intoxication or substance discontinuation/with- drawal. A diagnosis of substance/ medication-induced sleep disorder should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the sleep disturbance is predominant in the clinical picture and is sufficiently severe to war- rant independent clinical attention.
Delirium. If the substance/ medication-induced sleep disturbance occurs exclusively dur- ing the course of a delirium, it is not diagnosed separately.
Other sleep disorders. A substance/ medication—induced sleep disorder is distinguished from another sleep disorder if a substance/medication is judged to be etiologically related to the symptoms. A substance/medication-induced sleep disorder attributed to a prescribed medication for a mental disorder or medical condition must have its onset while the individual is receiving the medication or during discontinuation, if there is a discontinuation/with- drawal syndrome associated with the medication. Once treatment is discontinued, the sleep disturbance will usually remit within days to several weeks. If symptoms persist beyond 4 weeks, other causes for the sleep disturbancehrelated symptoms should be considered. Not infrequently, individuals with another sleep disorder use medications or drugs of abuse to self—medicate their symptoms (e.g., alcohol for management of insomnia). If the substance/ medication is judged to play a significant role in the exacerbation of the sleep disturbance, an additional diagnosis of a substance/medication-induced sleep disorder may be warranted.