2. The involved substance/medication is capable of producing the symptoms in Crite- rion A.
C. The disturbance is not better explained by a sleep disorder that is not substance/ medication-induced. Such evidence of an independent sleep disorder could include the following:
The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced sleep disorder (e.g., a history of recurrent non-substance/medication-related episodes).
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning.
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.
Coding note: The ICD-9-CM and ICD-10-CM codes for the [specific substance/medica- tion]-induced sleep disorders are indicated in the table below. Note that the ICD—10-CM code depends on whether or not there is a comorbid substance use disorder present for the same class of substance. If a mild substance use disorder is comorbid with the sub- stance-induced sleep disorder, the 4th position character is “,"1 and the clinician should record “mild [substance] use disorder” before the substance-induced sleep disorder (e.g., “mild cocaine use disorder with cocaine-induced sleep disorder”). If a moderate or severe substance use disorder is comorbid with the substance-induced sleep disorder, the 4th po- sition character is “2," and the clinician should record “moderate [substance] use disorder” or “severe [substance] use disorder,” depending on the severity of the comorbid substance use disorder. If there is no comorbid substance use disorder (e.g., after a one-time heavy use of the substance). then the 4th position character is “9" and the clinician should record only the substance-induced sleep disorder. A moderate or severe tobacco use disorder is required in order to code a tobacco-induced sleep disorder; it is not permissible to code a comorbid mild tobacco use disorder or no tobacco use disorder with a tobacco—induced sleep disorder.
Specify whether:
Insomnia type: Characterized by difficulty falling asleep or maintaining sleep, frequent nocturnal awakenings, or nonrestorative sleep.
Daytime sleepiness type: Characterized by predominant complaint of excessive sleepiness/fatigue during waking hours or. less commonly, a long sleep period.
Parasomnia type: Characterized by abnormal behavioral events during sleep.
Mixed type: Characterized by a substance/medication-induced sleep problem charac- terized by multiple types of sleep symptoms, but no symptom clearly predominates.
Specify it (see Table 1 in the chapter “Substance—Related and Addictive Disorders" for di- agnoses associated with substance class):
With onset during intoxication: This specifier should be used if criteria are met for intoxication with the substance/medication and symptoms developed during the intox- ication period.
With onset during discontinuation/withdrawal: This specifier should be used it cri- teria are met for discontinuation/withdrawal from the substance/medication and symp- toms developed during. or shortly after, discontinuation of the substance/medication.
With use disorder, Without disorder, moderate use
Alcohol 291.82 F10.182 F10.282 F10.982
Caffeine 292.85 F15.182 F15.282 F15.982