The weight of available evidence supports the superior performance characteristics (interrater reliability, as well as convergent, discriminant, and face validity) of simpler, less- differentiated approaches to diagnosis of sleep-wake disorders. The text accompanying each set of diagnostic criteria provides linkages to the corresponding disorders included in
ICSD-Z. The DSM-5 sleep-Wake disorders classification also specifies corresponding non- psychiatric listings (e.g., neurology codes) from the International Classification of Diseases (ICD).
The field of sleep disorders medicine has progressed in this direction since the publi- cation of DSM-IV. The use of biological validators is now embodied in the DSM—5 classi- fication of sleep-wake disorders, particularly for disorders of excessive sleepiness, such as narcolepsy; for breathing-related sleep disorders, for which formal sleep studies (i.e., polysomnography) are indicated; and for restless legs syndrome, which can often coexist with periodic limb movements during sleep, detectable via polysomnography.
Diagnostic Criteria 780.52 (647.00)
A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: 1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.) 2. Difficulty maintaining sleep, characterized by frequent awakenings or problems re- turning to sleep after awakenings. (In children, this may manifest as difficulty return- ing to sleep without caregiver intervention.) 3. EarIy-morning awakening with inability to return to sleep.
. The sleep disturbance causes clinically significant distress or impairment in social, oc- cupational, educational, academic, behavioral, or other important areas of functioning.
. The sleep difficulty occurs at least 3 nights per week.
. The sleep difficulty is present for at least 3 months.
The sleep difficulty occurs despite adequate opportunity for sleep.
The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep dis- order, a circadian rhythm sleep-wake disorder, a parasomnia).
G. The insomnia is not attributable to the physiological eftects of a substance (e.g., a drug of abuse, a medication).
H. Coexisting mental disorders and medical conditions do not adequately explain the pre- dominant complaint of insomnia.
Specify it:
With non-sleep disorder mental comorbidity, including substance use disorders
Coding note: The code 780.52 (647.00) applies to all three specifiers. Code also the relevant associated mental disorder, medical condition, or other sleep disorder imme- diately after the code for insomnia disorder in order to indicate the association.
.TIWUO
Specify if:
Episodic: Symptoms last at least 1 month but less than 3 months.
Persistent: Symptoms last 3 months or longer.
Recurrent: Two (or more) episodes within the space of 1 year.
Note: Acute and short-term insomnia (i.e., symptoms lasting less than 3 months but oth- erwise meeting all criteria with regard to frequency, intensity, distress, and/or impairment) should be coded as an other specified insomnia disorder.