DMS IV - Sleep Disorders

1. Primary Insomnia
2. Primary Hypersomnia
3. Narcolepsy
4. Breathing-Related Sleep Disorders
5. Circadian Rhythm Sleep Disorder
6. Dyssomnia NOS

A primary sleep disorder of initiating and maintaining sleep or of excessive sleepiness. The dyssomnias are disorders of sleep or wakefulness per se, not a parasomnia.

A. difficulty initiating or maintaining sleep for at least 1 month.

B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. Does not occur exclusively during the course of Narcolepsy, Breathing-Related Sleep Disorder, Circadian Rhythm Sleep Disorder, or a Parasomnia.

D. Does not occur exclusively during the course of another mental disorder

E. Is not due to the direct physiological effects of a substance or a general medical condition.

A. Excessive sleepiness for at least 1 month occurring almost daily.

B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. Not better accounted for by Insomnia and does not occur exclusively during the course of another Sleep Disorder or by an inadequate amount of sleep.

D. Does not occur exclusively during the course of another mental disorder.

E. 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

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

B. One or both of the following:

(1) cataplexy (i.e., 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 or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes

C. Not due to the direct physiological effects of a substance or another general medical condition.

A. Sleep disruption, leading to excessive sleepiness or insomnia, judged to be due to a sleep-related breathing condition.

B. Not better accounted for by another mental disorder and is not due to the direct physiological effects of a substance or another general medical condition.

A. 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. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. Does not occur exclusively during the course of another Sleep Disorder or other mental disorder.

D. Is not due to the direct physiological effects of a substance or a general medical condition.

Specify type (code):
- Delayed Sleep Phase Type: an inability to fall asleep and awaken at a desired earlier time
- Jet Lag Type
- Shift Work Type
- Unspecified Type

1. Nightmare Disorder
2. Sleep Terror Disorder
3. Sleepwalking Disorder
4. Parasomnia NOS

Sleep disorder of arousal, partial arousal, or sleep stage transition. It represents an episodic disorder in sleep (such as sleepwalking) rather than a disorder of sleep or wakefulness per se. May be induced or exacerbated by sleep; not a dyssomnia.

A. Repeated awakenings due to extremely frightening dreams

B. 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. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. Do not occur exclusively during the course of another mental disorder and are not due to the direct physiological effects of a substance or a general medical condition.

A. Abrupt awakening from sleep with a panicky scream.

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

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. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. Is not due to the direct physiological effects of a substance or a general medical condition.

A. Rising from bed during sleep and walking about.

B. 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. The person has amnesia from the episode.

D. Within several minutes after awakening there is no impairment of mental activity or behavior.

E. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. Is not due to the direct physiological effects of a substance or a general medical condition.

A. Difficulty initiating or maintaining sleep for at least 1 month that is associated with daytime fatigue or impaired daytime functioning.

B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. Is judged to be related to another Axis I or Axis II disorder, but is sufficiently severe to warrant independent clinical attention.

D. The disturbance is not better accounted for by another Sleep Disorder.

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

A. Excessive sleepiness for at least 1 month that occur almost daily.

B. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. Is judged to be related to another Axis I or Axis II disorder, but is sufficiently severe to warrant independent clinical attention.

D. Is not better accounted for by another Sleep Disorder or by an inadequate amount of sleep.

E. Is not due to the direct physiological effects of a substance or a general medical condition.

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

B. Is the direct physiological consequence of a general medical condition.

C. Is not better accounted for by another mental disorder

D. Does not occur exclusively during the course of a delirium.

E. Does not meet the criteria for Breathing-Related Sleep Disorder or Narcolepsy.

F. 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

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

B. Evidence of either:

(1) symptoms developed during, or within a month of, Substance Intoxication or Withdrawal
(2) medication use is etiologically related to the sleep disturbance

C. Is not better accounted for by a Sleep Disorder that is not substance induced.

D. Does not occur exclusively during the course of a delirium.

E. Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Code for Specific Substance: Alcohol; Amphetamine, Caffeine, Cocaine, Opioid, Sedative, Hypnotic, or Anxiolytic, Other [or Unknown] Substance

Specify type:
- Insomnia Type
- Hypersomnia Type
- Parasomnia Type
- Mixed Type

Specify if:
- With Onset During Intoxication
- With Onset During Withdrawal