1) Insomnia Disorder
- complain of dissatisfaction with sleep quantity or quality
- difficulty iniating sleep
- difficulty maintaining sleep, frequent awakenings, problems returning to sleep
- early morning awakening with inability to return to sleep
- causes clinically significant distress in social, occupational, and other areas of functioning
- occurs atleast 3 nights per week
- present atleast 3 months
- sleep difficulty occurs despite adequate opportunity to sleep
- rule out: another sleep-wake disorder, physiological effects of substance, coexisting mental disorder
2) Hypersomnolence Disorder
- self-reported excessive sleepiness despite a sleep period at least 7 hours
- recurrent sleeps or lapses into sleep within the same day
- prolonged main sleep episode of more than 9 hours per day that is nonretorative or unrefreshing
- 3x per week for at least 3 months
- significant distress in cognitive, social, occupational and other areas of functioning
- rule out: another sleep disorders, physiological effect of substance, coexisting mental or medical disorders
3) Nacrolepsy
- recurrent irrepressible need to sleep, lapsing into sleep, napping occuring within same day
- 3x per week at least over 3 months
- episodes of cataplexy; brief loss of muscle tone with maintain consciousness that are precipitated by laughter or joking
- within 6 months onset, grimaces or jaw-opening episodes without any emotional triggers
- hypocretin deficiency
- nocturnal sleep polysomnography showing rapid eye movement
- sleep latency less than or equal to 8 minutes
4) Breathing-Related Sleep Disorder
a. Obstructive Sleep Apnea Hypopnea
- nocturnal breathing disturbances (snoring, gasping, breathing pauses)
- daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient sleep
- rule out: another sleep disorder
a1. Central Sleep Apnea
- evidence by polysomnography, 5 or more central apnea per hour of sleep
- Idiopathic CSA (repeated episodes of apnea and hypopnea, variability in respiratory effort)
- Clieyne Strokes Breathing (periodic cresendo-decresendo variation in tidal volume, at least 5 events per hour, frequent arousal
- CSA comorbid with Opioid Use (effects of opioids on the respiratory rhythm
- rule out: another sleep disorder
a2. Sleep Related Hypoventillation
- decreased respiration with elevated CO2 levels
-rule out: another sleep disorder
- specify whether; idiopathic, congenital central alveolar hypoventilation, comorbid sleep-related hypoventilation
a3. Circadian Rhythm Sleep-Wake Disorders
- recurrent pattern of sleep disruption due to alteration lf circadian system
- sleep disruption leads to exessive sleepiness or insomnia or both
- cause significant distress in social, occupational, other areas of functioning
- Advance Sleep Phase Type (inability to remain awake or asleep)
- Non-24 Hour Sleep-Wake Type (not synchronize to the 24-hour environment)
- Shift Work Type (insomina or excessive sleepiness with a shift work schedule)
- Unspecified Type
5) Parasomnias
a. Non-Rapid Eye Movement Sleep Arousal Disorder
- incomplete awakening from sleep
- first 3rd of the major sleep episode
- no dream imagery is recalled
- amnesia for the episodes is present
- causes significant distress to other areas of functioning
- rule out: physiological effect of substance, coexisting mental and medical disorders
a1. Sleep Walking
- rising from bed during sleep and walking about, has blank staring face, unresponsive to the efforts of others, can be awaken only with great difficulty
a2. Sleep Terrors
- abrupt terror arousal from sleep, with panicky scream, intense fear (mydriasis, tachycardia, rapid breathing, sweating), unresponsive to the efforts of others
b. Nightmare Disorder
- extremely dysphoric, well-remembered dreams during the second half of major sleep episode
- on awakening from dysporic dreams, the person rapidly becomes oriented and alert
- causes significant distress in other important areas of functioning
- rule out: physiogical effect of substance, coexisting mental or medical disorders
c. Rapid Eye Movement Sleep Behavior Disorder
- arousal during sleep associated with vocalization and complex motor behaviors
- arise during rapid eye movement sleep, occurs more than 90 minutes after sleep onset, uncommonly occur during daytime nap
- upon awakening, the person is completely awake, alert not confused and disoriented
- REM sleep without atonia
- causes significant distress in other important areas of functioning
- rule out: physiological effects of substance, coexisting mental or medical disorders
d. Restless Legs Syndrome
- an urge to move the legs, accompanied by or in response to uncomfortable and unpleasant sensations in legs
- occurs 3x per week, persisted for atleast 3 months
- significant distress in other important areas of functioning
- rule out: other mental or medical condition, physiological effects of substance
e. Substance/Medication-Induced Sleep Disorder
- severe disturbance in sleep
- evidence from history, physical examination or laboratory findings
- rule out: other sleep disorders that is not substance induced, delirium
- causes significant distress in other important areas of functioning
- specified whether; Insomnia Type, Daytime Sleepiness Type, Parasomnia Type, Mixed Type
6) Other Specified and Unspecified Sleep-Wake Disorders
a. Other Specified Insomnia Disorder
- causes significant distress but do not meet the full criteria
a1. Brief Insomnia Disorder - less than 3 months
a2. Restricted to nonrestorative Type
b. Unspecified Insomnia Disorder
c. Other Specified Hypersomnolence Disorder
- causes significant distress but do not meet the full criteria
d. Unspecified Hypersomnolence Disorder
e. Other Specified Sleep-Wake Disorder
f. Unspecified Sleep-Wake Disorder
