Primary Insomnia

     A)     The predominant complaint is difficulty initiating or maintaining sleep, or non restorative sleep, for at least 1 month.

     B)      The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

   C)      The sleep disturbance does not occur exclusively during the course of Narcolepsy, Breathing-Related Sleep Disorder, Circadian Rhythm Sleep Disorder, or a Parasomnia.

      D)     The disturbance does not occur exclusively during the course of another mental disorder.

      E)     The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Primary Hypersomnia

    A)     The predominant complaint is excessive sleepiness for at least 1 month (or less if recurrent) as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily.

      B)     The excessive sleepiness causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

    C)      The excessive sleepiness is not better accounted for by insomnia and does not occur exclusively during the course of another Sleep Disorder (Narcolepsy, Breathing-Related Sleep Disorder, Circadian Rhythm Sleep Disorder, or a Parasomnia) and cannot be accounted for by an inadequate amount of sleep.

      D)     The disturbance does not occur exclusively during the course of another mental disorder.

      E)    The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Specify if:

Recurrent: if there are periods of excessive sleepiness that last at least 3 days occurring several times a year for at least 2 years

Narcolepsy

    A)     Irresistible attacks of refreshing sleep that occur daily over at least 3 months.

B)      The presence of one or both of the following:

1 – cataplexy (brief episodes of sudden bilateral loss of muscle tone, most often in association with intense emotion)

2 – recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic of hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes

     C)  The disturbance is not due to the direct physiological effects of a substance or another general medical condition.

Breathing-Related Sleep Disorder

    A)     Sleep disruption, leading to excessive sleepiness or insomnia, that is judged to be due to a sleep-related breathing condition (obstructive or central sleep apnea syndrome or central alveolar hypoventilation syndrome).

      B)      The disturbance is not better accounted for by another metal disorder and is not due to the direct physiological effects of a substance or another general medical condition (other than a breathing-related disorder).

Coding note: Also code sleep-related breathing disorder on Axis III.

Circadian Rhythm Sleep Disorder

(formerly Sleep-Wake Schedule Disorder)

    A)     A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep-wake schedule required by a person’s environment and his or her circadian sleep-wake pattern.

       B)   The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

      C)    The disturbance does not occur exclusively during the course of another Sleep Disorder or other mental disorder.

     D)  The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Delayed Sleep Phase Type: a persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time

Jet Lag Type: sleepiness and alertness that occur at an inappropriate time of day relative to local time, occurring after repeated travel across more than one time zone

Shift Work Type: insomnia during the major sleep period or excessive sleepiness during the major awake period associated with night shift work or frequently changing shift work

Unspecified type

Dyssomnia NOS

For insomnias, hypersomnias, or circadian rhythm disturbances that do not meet criteria for any specific Dyssomnia.  Examples include:

1 – Complaints of clinically significant insomnia or hypersomnia that are attributable to environmental factors (noise, light, frequent interruptions).

2 – Excessive sleepiness that is attributable to ongoing sleep deprivation.

3 – “Restless legs syndrome

4 – Periodic limb movements

5 – Situations when Dyssomnia is present, but etiology is unknown

Nightmare Disorder

   A)     Repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem.  The awakenings generally occur during the second half of the sleep period.

     B)      On awakening from the frightening dreams, the person rapidly becomes oriented and alert (in contrast to the confusion and disorientation seen in Sleep Terror Disorder and some forms of epilepsy).

     C)      The dream experience, or the sleep disturbance resulting from the awakening, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

      D)     The nightmares do not occur exclusively during the course of another mental disorder (a delirium, PTSD) and are not due to the direct physiological effects of a substance or a general medical condition.

Sleep Terror Disorder

     A)     Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream.

B)      Intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode.

     C)      Relative unresponsiveness to efforts of others to comfort the person during the episode.

  D)     No detailed dream is recalled and there is amnesia for the episode.

    E)      The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

      F)      The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Sleepwalking Disorder

     A)  Repeated episodes of rising from bed during sleep and walking about, usually occurring during the first third of the major sleep episode.

    B)      While sleepwalking, the person has a blank, staring face, is relatively unresponsive to the efforts of others to communicate with him or her, and can be awakened only with great difficulty.

   C)      On awakening (either from the sleepwalking episode or the next morning), the person has amnesia for the episode.

     D)   Within several minutes after awakening from the sleepwalking episode, there is not impairment of mental activity or behavior (although there may initially be a short period of confusion or disorientation).

E)      The sleepwalking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

     F)  The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Parasomnia NOS

Disturbances that are characterized by abnormal behavioral or physiological events during sleep or sleep-wake transitions, but that do not meet criteria for a more specific Parasomnia.  Examples include:

1 – REM sleep behavior disorder: motor activity, often of a violent nature, that arises during rapid eye movement (REM) sleep.  Unlike sleepwalking, these episodes tend to occur later in the night and are associated with vivid dream recall.

2 – Sleep paralysis: an inability to perform voluntary movement during the transition between wakefulness and sleep.  The episodes may occur at sleep onset (hypnagogic) or with awakening (hypnpompic).  The episodes are usually associated with extreme anxiety and, in some cases, fear of impending death.  Sleep paralysis occurs commonly as an ancillary symptom of Narcolepsy and, in such cases, should not be coded separately.

3 – Situations in which the clinician has concluded that a Parasomnia is present but the etiology is unknown.

Insomnia Related to

[Indicate the Axis I or Axis II disorder]

    A)     The predominant complaint is difficulty initiating or maintaining sleep, or nonrestorative sleep, for at least 1 month that is associated with daytime fatigue or impaired daytime functioning.

     B)  The sleep disturbance (or daytime sequelae) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

     C)      The insomnia is judged to be related to another Axis I or Axis II disorder (Major Depressive Disorder, GAD, Adjustment Disorder with Anxiety) but is sufficiently severe to warrant independent clinical attention.

     D) The disturbance is not better accounted for by another Sleep Disorder (Narcolepsy, Breathing=Related Sleep Disorder, a Parasomnia).

     E) The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Hypersomnia related to

[Indicate the Axis I or Axis II disorder]

    A)     The predominant complaint is excessive sleepiness for at least 1 month as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily.

      B)      The excessive sleepiness causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

      C)      The hypersomnia is judged to be related to another Axis I or Axis II disorder (Major Depressive Disorder, Dysthymic Disorder) but is sufficiently severe to warrant independent clinical attention.

      D)     The disturbance is not better accounted for by another Sleep Disorder (Narcolepsy, Breathing-Related Sleep Disorder, a Parasomnia) or by an inadequate amount of sleep.

     E)      The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Sleep Disorder Due to

[Indicate the General Medical Condition]

    A)     A prominent disturbance in sleep that is sufficiently severe to warrant independent clinical attention.

    B)      There is evidence from the history, physical examination, or laboratory findings that the sleep disturbance is the direct physiological consequence of a general medical condition.

    C)      The disturbance is not better accounted for by another mental disorder (an Adjustment Disorder in which the stressor is a serious medical illness).

     D)     The disturbance does not occur exclusively during the course of a delirium.

E)      The disturbance does not meet the criteria for Breathing-Related Sleep Disorder or Narcolepsy.

      F)      The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify type:

Insomnia Type

Hypersomnia Type

Parasomnia Type

Mixed Type

Coding note: Include the name of the general medical condition on Axis I; also code on Axis III.

Substance-Induced Sleep Disorder

     A)     A prominent disturbance in sleep that is sufficiently severe to warrant independent clinical attention.

    B)      There is evidence from the history, physical examination, or laboratory findings of either (1) or (2):

a.       The symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal

b.      Medication use is etiologically related to the sleep disturbance

   C)      The disturbance is not better accounted for by a Sleep Disorder that is not substance induced.  Evidence that the symptoms are better accounted for by a Sleep Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-related episodes).

     D)     The disturbance does not occur exclusively during the course of a delirium.

      E)      The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.