DSM-IV

Disorders

  1. Insomnia Related to Another Mental Disorder
  2. Hypersomnia Related to Another Mental Disorder

Recording Procedures

The name of the diagnosis begins with the type of sleep disturbance (i.e., insomnia or hypersomnia) followed by the name of the specific disorder that it is related to (e.g., Insomnia Related to Major Depressive Disorder). The specific related mental disorder should also be recorded as appropriate.

Differential Diagnosis

Insomnia or Hypersomnia Related to Another Mental Disorder should not be diagnosed in every individual with a mental disorder who also has sleep-related symptoms. A diagnosis of Insomnia or Hypersomnia Related to Another Mental Disorder should be made only when sleep symptoms are severe and are an independent focus of clinical attention.

Major Depressive Disorder

No independent sleep disorder diagnosis is warranted for most individuals with Major Depressive Disorder who report difficulties falling or staying asleep in the middle of the night. However, if the individual primarily complains of sleep disturbance or if the insomnia is out of proportion to other symptoms, then an additional diagnosis of Insomnia Related to Another Mental Disorder may be warranted.

Primary Insomnia and Primary Hypersomnia

Distinguishing Primary Insomnia or Primary Hypersomnia from Insomnia or Hypersomnia Related to Another Mental Disorder can be especially difficult in individuals who present with both clinically significant sleep disturbance and other symptoms of a mental disorder. The diagnosis of Insomnia or Hypersomnia Related to Another Mental Disorder is based on three judgments. First, the insomnia or hypersomnia must be judged to be attributable to the mental disorder (e.g., the insomnia or hypersomnia occurs exclusively during the mental disorder). Second, the insomnia or hypersomnia must be the predominant complaint and must be sufficiently severe to warrant independent clinical attention. Third, the symptom presentation should meet the full criteria for another mental disorder. A diagnosis of Primary Insomnia or Primary Hypersomnia is appropriate when (as is often the case) the insomnia or hypersomnia is accompanied by symptoms (e.g., anxiety, depressed mood) that do not meet criteria for a specific mental disorder. A diagnosis of Primary Insomnia is also appropriate for individuals with chronic insomnia who later develop a Mood or Anxiety Disorder. If symptoms of insomnia or hypersomnia persist long after the other symptoms of the related mental disorder have remitted completely, the diagnosis would be changed from Insomnia or Hypersomnia Related to Another Mental Disorder to Primary Insomnia or Primary Hypersomnia.

Another Sleep Disorder

Insomnia or Hypersomnia Related to Another Mental Disorder is not distinguished if the presentation is better accounted for by another Sleep Disorder (e.g., Narcolepsy, Breathing-Related Sleep Disorder, or a Parasomnia).

Sleep Disorder Due to a General Medical Condition and Substance-Induced Sleep Disorder

Insomnia or Hypersomnia Related to Another Mental Disorder must be distinguished from a Sleep Disorder Due to a General Medical Condition. The diagnosis is Sleep Disorder Due to a General Medical Condition when the sleep disturbance is judged to be a direct physiological consequence of a specific general medical condition (e.g., pheochromocytoma, hyperthyroidism). This determination is based on history, laboratory findings, and physical examination. A Substance-Induced Sleep Disorder is distinguished from Insomnia or Hypersomnia Related to Another Mental Disorder by the fact that a substance (i.e., a drug of abuse, a medication) is judged to be etiologically related to the sleep disturbance. For example, insomnia that occurs only in the context of heavy coffee consumption would be diagnosed as Caffeine-Induced Sleep Disorder, Insomnia Type.

Normal sleep patterns

Sleep Disorders Related to Another Mental Disorder must be differentiated from normal sleep patterns, as well as from other Sleep Disorders. Although complaints of occasional insomnia or hypersomnia are common in the general population, they are not usually accompanied by the other signs and symptoms of a mental disorder. Transient sleep disturbances are common reactions to stressful life events and generally do not warrant a diagnosis. A separate diagnosis of Insomnia or Hypersomnia Related to Adjustment Disorder should be considered only when the sleep disturbance is particularly severe and prolonged.

DSM-5

See Insomnia Disorder and Hypersomnolence Disorder

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