Insomnia is a common comorbidity of many medical conditions, including diabetes, cor- onary heart disease, chronic obstructive pulmonary disease, arthritis, fibromyalgia, and other chronic pain conditions. The risk relationship appears to be bidirectional: insomnia increases the risk of medical conditions, and medical problems increase the risk of insom- nia. The direction of the relationship is not always clear and may change over time; for this reason, comorbid insomnia is the preferred terminology in the presence of coexisting in- somnia with another medical condition (or mental disorder).
Individuals with insomnia disorder frequently have a comorbid mental disorder, par- ticularly bipolar, depressive, and anxiety disorders. Persistent insomnia represents a risk factor or an early symptom of subsequent bipolar, depressive, anxiety, and substance use disorders. Individuals with insomnia may misuse medications or alcohol to help with nighttime sleep, anxiolytics to combat tension or anxiety, and caffeine or other stimulants to combat excessive fatigue. In addition to worsening the insomnia, this type of substance use may in some cases progress to a substance use disorder.
Relationship to International Classification of
There are several distinct insomnia phenotypes relating to the perceived source of the in- somnia that are recognized by the International Classification of Sleep Disorders, 2nd Edition (ICSD—Z). These include psychophysiologicul insomnia, idiopathic insomnia, sleep—stute mispercep- tion, and inadequate sleep hygiene. Despite their clinical appeal and heuristic value, there is limited evidence to support these distinct phenotypes.
Diagnostic Criteria 780.54 (647.10)
A. Self—reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms: 1. Recurrent periods of sleep or lapses into sleep within the same day.
2. A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unretreshing).
3. Difficulty being fully awake after abrupt awakening.
B. The hypersomnolence occurs at least three times per week, for at least 3 months.
C. The hypersomnolence is accompanied by significant distress or impairment in cogni- tive, social, occupational, or other important areas of functioning.
D. The hypersomnolence is not better explained by and does not occur exclusively during the course of another sleep disorder (e.g., narcolepsy, breathing-related sleep disor- der, circadian rhythm sleep-wake disorder, or a parasomnia).
E. The hypersomnolence 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 adequately explain the predominant complaint of hypersomnolence.
Specify it:
With mental disorder, including substance use disorders
Coding note: The code 780.54 (647.10) applies to all three specifiers. Code also the relevant associated mental disorder, medical condition, or other sleep disorder im- mediately after the code for hypersomnolence disorder in order to indicate the associ- ation.
Specify if:
Acute: Duration of less than 1 month.
Subacute: Duration of 1—3 months.
Persistent: Duration of more than 3 months.
Specify current severity:
Specify severity based on degree of difficulty maintaining daytime alertness as manifested by the occurrence of multiple attacks of irresistible sleepiness within any given day occur- ring, for example, while sedentary, driving, visiting with friends, or working.
Mild: Difficulty maintaining daytime alertness 1—2 days/week.
Moderate: Difficulty maintaining daytime alertness 3—4 days/week.
Severe: Difficulty maintaining daytime alertness 5—7 days/week.