Classification of sleep disorders

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Classification of sleep disorders
Specialty Sleep medicine

Classification of sleep disorders comprises systems for classifying medical disorders associated with sleep. Systems have changed, increasingly using technological discoveries to advance the understanding of sleep and recognition of sleep disorders.

Contents

Three systems of classification are in use worldwide: the International Classification of Diseases (ICD), the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Sleep Disorders (ICSD). The ICD and DSM lump different disorders together, while the ICSD tends to split related disorders into multiple discrete categories. There has, over the last 60 years, occurred a slow confluence of the three systems of classification. [1] The validity and reliability of various sleep disorders are yet to be proved and need further research within the ever-changing field of sleep medicine.

Classification systems

Systems for the classification of sleep disorders are used to classify medical disorders related to human sleep patterns. Three systems of classification are in use worldwide: [2]

The ICD and DSM lump different disorders together, while the ICSD tends to split related disorders into multiple discrete categories. There has, over the last 60 years, occurred a slow confluence of the three major classification systems. [1]

History

Milestones

The first book on sleep[ citation needed ] was published in 1830 by Robert MacNish; it described sleeplessness, nightmares, sleepwalking and sleep-talking. Narcolepsy, hypnogogic hallucination, wakefulness and somnolence were mentioned by other authors of the nineteenth century. Westphal, in 1877, described first case of narcolepsy, the name coined later by Gelineu in 1880 in association with cataplexy. Lehermitte called it paroxysmal hypersomnia in 1930 to differentiate it from prolonged hypersomnia. Roger in 1932 coined the term parasomnia and classified hypersomnia, insomnia and parasomnia. [3] Kleitman in 1939 recognized types of parasomnias as nightmares, night terrors, somniloquy (sleep-talking), somnambulism (sleepwalking), grinding of teeth, jactatians, enuresis, delirium, nonepileptic convulsions and personality dissociation. [4] Broughton in 1968 developed classification of the arousal disorders as confusional arousals: night terrors and sleep walking. [5] Insomnias were classified as primary and secondary until 1970 when they were recognized as symptoms of other disorders. Sir William Osler in 1906 correlated snoring, obesity and somnolence (sleepiness) to Dicken's description of Joe. Charles Burwell in 1956 recognized obstructive sleep apnea as Pickwickian syndrome. [6] Circadian rhythm sleep disorders were discovered in 1981 by Weitzman as delayed sleep phase syndrome in contrast to advanced sleep phase syndrome in 1979. [7]

Evolution of classifications of sleep disorders

Classification of sleep disorders, as developed in the 19th century, used primarily three categories: insomnia, hypersomnia and nightmare. In the 20th century, increasingly in the last half of it, technological discoveries led to rapid advances in the understanding of sleep and recognition of sleep disorders. Major sleep disorders were defined following the development of electroencephalography (EEG) in 1924 by Hans Berger.

YearICSDICDDSMDevelopment
1955 ICD-7R [8] Disturbance of sleep was seen as a symptom of other diseases
1965 ICD-8 [9] Recognized as both a disease and a symptom of other diseases
1968DSM-IIDisorder of Sleep as an independent category
1975 ICD-9 [10] Organic sleep disorder, nonorganic sleep disorder and as symptom of other diseases
1979NosologyClinical classification into four major groups: Disorder of initiating and maintaining sleep (DIMS) - Insomnias, Disorder of Excessive sleep (DOES) - Hypersomnias, Disorder of sleep-wake schedule (Circadian rhythm disorders) and Parasomnias
1980 ICD-CM DSM-IIIManifestation of other disorders with physical manifestation, as Sleep walking and Sleep terror
1987DSM-III-RSleep Disorders were classified into dysomnias and parasomnias.
1990ICSDExpanded previous system into Dysomnias, Parasomnias, Symptomatic and Proposed disorder of sleep
1990 ICD-10 [11] Organic sleep disorders included under nervous system disorder, nonorganic under psychiatric disorders and a third category as manifestation of other diseases
1994 DSM-IV Dyssomnias, Parasomnias, Manifestation of mental disorders and Other
1997ICSD-RFirst detailed classification of various sleep disorders
  • Dyssomnias
    1. Intrinsic Sleep Disorders
    2. Extrinsic Sleep Disorders
    3. Circadian Rhythm Sleep Disorders
  • Parasomnias
    1. Arousal Disorders
    2. Sleep-Wake Transition Disorders
    3. Parasomnias Usually Associated with REM Sleep
    4. Other Parasomnias
  • Sleep Disorders Associated with Mental, Neurologic, or Other Medical Disorders
    1. Associated with Mental Disorders
    2. Associated with Neurologic Disorders
    3. Associated with Other Medical Disorders
  • 4. Proposed Sleep Disorders
2000DSM-IV-TR
  • Primary sleep disorders
    • Dyssomnias
      • Insomnias
      • Hypersomnias
        • Recurrent Hypersomnias
        • Narcolepsy
      • Breathing related sleep disorder
      • Circadian rhythm sleep disorders
      • Movement disorder of sleep
    • Parasomnias
  • Secondary sleep disorders associated with other mental disorders and substance use.
2005ICSD-2Most extensive classification of sleep disorders
2010 ICD-10-CM [12] Three major categories, F51 as nonorganic sleep disorders, G47 organic sleep disorders and R- as symptoms of sleep disorders
2013ICSD-3DSM-VLumping and splitting of sleep disorders and concordance of two systems
2015 ICD-11 Beta [13] Proposed beta version yet to be finalized in line with ICDS3 and DSM V

Validity and reliability

Diagnoses of sleep disorders are based on self-assessment questionnaires, clinical interview, physical examination and laboratory procedures. The validity and reliability of various sleep disorders are yet to be proved and need further research within the ever-changing field of sleep medicine. Admittedly, the development of sleep disorder classification remains as much an art as it is a science. [1]

The International Classification of Sleep Disorders (ICSD)

The International Classification of Sleep Disorders (ICSD) was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979. [14] [15]

  1. Disorder of initiating and maintain sleep (DIMS) - Insomnias
  2. Disorder of Excessive sleep (DOES) - Hypersomnias
  3. Disorder of sleep wake schedule
  4. Parasomnias

The International Classification of Sleep Disorders (ICSD) uses a multiaxial system for stating and coding diagnoses both in clinical reports or for data base purposes. The axial system uses International Classification of Diseases (ICD-9- CM) coding wherever possible. Additional codes are included for procedures and physical signs of particular interest to sleep disorders clinicians and researchers. Diagnoses and procedures are listed and coded on three main "axes." The axial system is arranged as follows: [16]

ICSD - I Revised 1997

[16]

Dyssomnias

  1. Intrinsic Sleep Disorders
  2. Extrinsic Sleep Disorders
  3. Circadian Rhythm Sleep Disorders

Parasomnias

  1. Arousal Disorders
  2. Sleep-Wake Transition Disorders
  3. Parasomnias Usually Associated with REM Sleep
  4. Other Parasomnias

Sleep Disorders Associated with Mental, Neurologic, or Other Medical Disorders

  1. Associated with Mental Disorders
  2. Associated with Neurologic Disorders
  3. Associated with Other Medical Disorders

Proposed Sleep Disorders

ICSD 2 is tabulated in the main article International Classification of Sleep Disorders

ICSD - 3

The last edition of ICSD-3 is a unified classification of sleep disorders. It includes seven major categories: insomnia disorders, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, parasomnias, and other sleep disorders. Each of these categories has several subgroups: [17]

1. Insomnia

  1. Chronic insomnia disorder
  2. Short-term insomnia disorder
  3. Other insomnia disorder
  1. Obstructive sleep apnea (OSA) disorders
    1. OSA, adult
    2. OSA, pediatric
  2. Central sleep apnea syndromes
    1. Central sleep apnea with Cheyne-Stokes breathing
    2. Central sleep apnea due to a medical disorder without Cheyne-Stokes breathing
    3. Central sleep apnea due to high altitude periodic breathing
    4. Central sleep apnea due to a medication or substance
    5. Primary central sleep apnea
    6. Primary central sleep apnea of infancy
    7. Primary central sleep apnea of prematurity
    8. Treatment-emergent central sleep apnea
  3. Sleep-related hypoventilation disorders
    1. Obesity hypoventilation syndrome
    2. Congenital central alveolar hypoventilation syndrome
    3. Late-onset central hypoventilation with hypothalamic dysfunction
    4. Idiopathic central alveolar hypoventilation
    5. Sleep-related hypoventilation due to a medication or substance
    6. Sleep-related hypoventilation due to a medical disorder
  4. Sleep-related hypoxemia disorder
  5. Isolated symptoms and normal variants

3. Central disorders of hypersomnolence

  1. Narcolepsy type 1
  2. Narcolepsy type 2
  3. Idiopathic hypersomnia
  4. Kleine-Levin syndrome
  5. Hypersomnia due to a medical disorder
  6. Hypersomnia due to a medication or substance
  7. Hypersomnia associated with a psychiatric disorder
  8. Insufficient sleep syndrome

4. Circadian rhythm sleep-wake disorders

  1. Delayed sleep-wake phase disorder
  2. Advanced sleep-wake phase disorder
  3. Irregular sleep-wake rhythm disorder
  4. Non-24-h sleep-wake rhythm disorder
  5. Shift work disorder
  6. Jet lag disorder
  7. Circadian sleep-wake disorder not otherwise specified
  1. Restless legs syndrome
  2. Periodic limb movement disorder
  3. Sleep-related leg cramps
  4. Sleep-related bruxism
  5. Sleep-related rhythmic movement disorder
  6. Benign sleep myoclonus of infancy
  7. Propriospinal myoclonus at sleep onset
  8. Sleep-related movement disorder due to a medical disorder
  9. Sleep-related movement disorder due to a medication or substance
  10. Sleep-related movement disorder, unspecified
  11. Isolated symptoms and normal variants
    1. Excessive fragmentary myoclonus
    2. Hypnagogic foot tremor and alternating leg muscle activation
    3. Sleep starts (hypnic jerks)

6. Parasomnias

  1. NREM-related parasomnias
    1. Confusional arousals
    2. Sleepwalking
    3. Sleep terrors
    4. Sleep-related eating disorder
  2. REM-related parasomnias
    1. REM sleep behavior disorder
    2. Recurrent isolated sleep paralysis
    3. Nightmare disorder
  3. Other parasomnias
    1. Exploding head syndrome
    2. Sleep-related hallucinations
    3. Sleep enuresis
    4. Parasomnia due to a medical disorder
    5. Parasomnia due to a medication or substance
    6. Parasomnia, unspecified
  4. Isolated symptoms and normal variants
    1. Sleep talking

7. Other sleep disorders

International Classification of Disease (ICD)

ICD-7R 1955

ICD-8 1965

[9]

ICD-9 1975

[10]

327 Organic sleep disorders

327.0 Organic disorders of initiating and maintaining sleep [organic insomnia]
  • 327.00 Organic insomnia, unspecified
  • 327.01 Insomnia due to medical condition classified elsewhere
  • 327.02 Insomnia due to mental disorder
  • 327.09 Other organic insomnia
327.1 Organic disorder of excessive somnolence [organic hypersomnia]
  • 327.10 Organic hypersomnia, unspecified
  • 327.11 Idiopathic hypersomnia with long sleep time
  • 327.12 Idiopathic hypersomnia without long sleep time
  • 327.13 Recurrent hypersomnia
  • 327.14 Hypersomnia due to medical condition classified elsewhere
  • 327.15 Hypersomnia due to mental disorder
  • 327.19 Other organic hypersomnia
327.2 Organic sleep apnea
  • 327.20 Organic sleep apnea, unspecified
  • 327.21 Primary central sleep apnea
  • 327.22 High altitude periodic breathing
  • 327.23 Obstructive sleep apnea (adult)(pediatric)
  • 327.24 Idiopathic sleep related non-obstructive alveolar hypoventilation
  • 327.25 Congenital central alveolar hypoventilation syndrome
  • 327.26 Sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere
  • 327.27 Central sleep apnea in conditions classified elsewhere
  • 327.29 Other organic sleep apnea
327.3 Circadian rhythm sleep disorder
  • 327.30 Circadian rhythm sleep disorder, unspecified
  • 327.31 Circadian rhythm sleep disorder, delayed sleep phase type
  • 327.32 Circadian rhythm sleep disorder, advanced sleep phase type
  • 327.33 Circadian rhythm sleep disorder, irregular sleep-wake type
  • 327.34 Circadian rhythm sleep disorder, free-running type
  • 327.35 Circadian rhythm sleep disorder, jet lag type
  • 327.36 Circadian rhythm sleep disorder, shift work type
  • 327.37 Circadian rhythm sleep disorder in conditions classified elsewhere
  • 327.39 Other circadian rhythm sleep disorder
327.4 Organic parasomnia
  • 327.40 Organic parasomnia, unspecified
  • 327.41 Confusional arousals
  • 327.42 REM sleep behavior disorder
  • 327.43 Recurrent isolated sleep paralysis
  • 327.44 Parasomnia in conditions classified elsewhere
  • 327.49 Other organic parasomnia
  • 327.51 Periodic limb movement disorder
  • 327.52 Sleep related leg cramps
  • 327.53 Sleep related bruxism
  • 327.59 Other organic sleep related movement disorders
327.8 Other organic sleep disorders
307.4 Specific disorders of sleep of nonorganic origin
  • 307.40 Nonorganic sleep disorder, unspecified
  • 307.41 Transient disorder of initiating or maintaining sleep
  • 307.42 Persistent disorder of initiating or maintaining sleep
  • 307.43 Transient disorder of initiating or maintaining wakefulness
  • 307.44 Persistent disorder of initiating or maintaining wakefulness
  • 307.45 Circadian rhythm sleep disorder of nonorganic origin
  • 307.46 Sleep arousal disorder
  • 307.47 Other dysfunctions of sleep stages or arousal from sleep
  • 307.48 Repetitive intrusions of sleep
  • 307.49 Other specific disorders of sleep of nonorganic origin
780.5 Sleep disturbances
  • 780.50 Sleep disturbance, unspecified
  • 780.51 Insomnia with sleep apnea, unspecified
  • 780.52 Insomnia, unspecified
  • 780.53 Hypersomnia with sleep apnea, unspecified
  • 780.54 Hypersomnia, unspecified
  • 780.55 Disruption of 24 hour sleep wake cycle, unspecified
  • 780.56 Dysfunctions associated with sleep stages or arousal from sleep
  • 780.57 Unspecified sleep apnea
  • 780.58 Sleep related movement disorder, unspecified
  • 780.59 Other sleep disturbances
292.85 Drug induced sleep disorders

ICD-NA (1997)

[18]

G47 Sleep disorders

  • Excl.: nocturnal myoclonus (G25.80), nightmares (F51.5), nonorganic sleep disorders (F51.-), sleep terrors (F51.4), sleepwalking (F51.3)
G47.0 Disorders of initiating and maintaining sleep [insomnias], Excl. altitudinal insomnia (T70.2)
G47.1 Disorders of excessive somnolence [hypersomnias]
G47.2 Disorders of the sleep-wake schedule
  • G47.20 Transient sleep wake schedule disorder
  • G47.21 Advanced sleep phase disorder
  • G47.22 Delayed sleep phase syndromes
  • G47.23 Irregular sleep-wake pattern
  • G47.24 Non 24 hour sleep wake cycle
  • G47.28 Other disorder of sleep wake schedule
G47.3 Sleep apnoea
  • Sleep related respiratory failure (ondine)
  • Excl. pickwickian syndrome (E66.2), sleep apnoea of newborn (P28.3)
  • G47.30 Alveolar hypoventilation syndrome
  • G47.31 Central sleep apnoea
  • G47.32 Obstructive sleep apnoea
  • G47.38 Other sleep apnoea
G47.4 Narcolepsy and cataplexy
  • G47.40 Narcolepsy
  • G47.41 Cataplexy
  • G47.42 Sleep paralysis
  • G47.43 Hypnogogic and hypnopompic hallucination
  • G47.44 Any combination of narcolepsy, cataplexy, Sleep paralysis, Hypnogogic and hypnopompic hallucination
  • G47.48 Other forms of narcolepsy and cataplexy
G47.8 Other sleep disorders
  • Excl: Other sudden death, cause unknown (R96-)
  • Sleep apnoea (G47.3)
  • newborn (R96.-)
  • Sudden infant death syndrome (R95)
  • G47.80 Other REM sleep related parasomnias
    • Excl. nightmares (F51.5), Sleep paralysis (G47.42 )
    • G47.800 REM sleep related behavior disorder (phantasmagorias)
    • G47.801 Impaired REM sleep related non painful penile erection
    • G47.802 REM sleep related painful penile erection
    • G47.803 REM sleep related cardiac sinus arrest
    • G47.804 REM sleep related headache (use additional code if required to indicate type of headache)
  • G47.81 Other non REM sleep related parasomnias
    • Excl: benign neonatal sleep syndrome (G25.37)
    • G47.810 Sleep related bruxism
    • G47.811 Sleep related enuresis
    • G47.812 Non-REM-sleep related abnormal swallowing syndrome
    • G47.813 Nocturnal paroxysmal dystonia
  • G47.82 Sleep arousal disorders, confusional arousal, Sleep drunkenness
  • G47.83 Sleep-wake transition disorders
    • Excl. nocturnal leg cramps (R25.20)
    • G47.830 Sleep related rhythmic movement disorder, head-banging (jactatio capitis noctunus)
    • G47.831 Sleep starts
    • G47.832 Sleepwalking
  • G47.84 Kleine-Levin syndrome, Recurrent hypersomnia
  • G47.88 Other specified sleep disorders
G47.9 Sleep disorder, unspecified

F51 Nonorganic sleep disorders

  • Excl.: sleep disorders (organic) (G47.-)
F51.0 Nonorganic insomnia Excl.: insomnia (organic) (G47.0)
F51.1 Nonorganic hypersomnia Excl.: hypersomnia (organic) (G47.1), narcolepsy (G47.4)
F51.2 Nonorganic disorder of the sleep-wake schedule
  • Psychogenic inversion of:
    • circadian
    • nyctohemeral
    • sleep rhythm
  • Excl.: disorders of the sleep-wake schedule (organic) (G47.2)
F51.3 Sleepwalking [somnambulism]
F51.4 Sleep terrors [night terrors]
F51.5 Nightmares, Dream anxiety disorder
F51.8 Other nonorganic sleep disorders
F51.9 Nonorganic sleep disorder, unspecified, Emotional sleep disorder NOS

P28.3 Primary sleep apnoea of newborn

  • Sleep apnoea of newborn:
    • central
    • NOS
    • obstructive

P28.4 Other apnoea of newborn

  • Apnoea (of):
    • newborn, obstructive
    • prematurity Excl.: obstructive sleep apnoea of newborn (P28.3)

ICD-10-CM 2016

[19]

G47 Sleep disorders

G47.0 Insomnia
  • G47.00 ...... unspecified
  • G47.01 ...... due to medical condition
  • G47.09 Other insomnia
G47.1 Hypersomnia
  • G47.10 ...... unspecified
  • G47.11 Idiopathic hypersomnia with long sleep time
  • G47.12 Idiopathic hypersomnia without long sleep time
  • G47.13 Recurrent hypersomnia
  • G47.14 ...... due to medical condition
  • G47.19 Other hypersomnia
G47.2 Circadian rhythm sleep disorders
  • G47.20 Circadian rhythm sleep disorder, unspecified type
  • G47.21 Circadian rhythm sleep disorder, delayed sleep phase type
  • G47.22 Circadian rhythm sleep disorder, advanced sleep phase type
  • G47.23 Circadian rhythm sleep disorder, irregular sleep wake type
  • G47.24 Circadian rhythm sleep disorder, free running type
  • G47.25 Circadian rhythm sleep disorder, jet lag type
  • G47.26 Circadian rhythm sleep disorder, shift work type
  • G47.27 Circadian rhythm sleep disorder in conditions classified elsewhere
  • G47.29 Other circadian rhythm sleep disorder
G47.3 Sleep apnea
  • G47.30 ...... unspecified
  • G47.31 Primary central sleep apnea
  • G47.32 High altitude periodic breathing
  • G47.33 Obstructive sleep apnea (adult) (pediatric)
  • G47.34 Idiopathic sleep related nonobstructive alveolar hypoventilation
  • G47.35 Congenital central alveolar hypoventilation syndrome
  • G47.36 Sleep related hypoventilation in conditions classified elsewhere
  • G47.37 Central sleep apnea in conditions classified elsewhere
  • G47.39 Other sleep apnea
G47.4 Narcolepsy and cataplexy
  • G47.41 Narcolepsy
    • G47.411 ...... with cataplexy
    • G47.419 ...... without cataplexy
  • G47.42 Narcolepsy in conditions classified elsewhere
    • G47.421 ...... with cataplexy
    • G47.429 ...... without cataplexy
G47.5 Parasomnia
  • G47.50 ...... unspecified
  • G47.51 Confusional arousals
  • G47.52 REM sleep behavior disorder
  • G47.53 Recurrent isolated sleep paralysis
  • G47.54 ...... in conditions classified elsewhere
  • G47.59 Other parasomnia
  • G47.61 Periodic limb movement disorder
  • G47.62 Sleep related leg cramps
  • G47.63 Sleep related bruxism
  • G47.69 Other sleep related movement disorders
G47.8 Other sleep disorders
G47.9 Sleep disorder, unspecified

F51 Sleep disorders not due to a substance or known physiological condition

F51.0 Insomnia not due to a substance or known physiological condition
  • F51.01 Primary insomnia
  • F51.02 Adjustment insomnia
  • F51.03 Paradoxical insomnia
  • F51.04 Psychophysiologic insomnia
  • F51.05 Insomnia due to other mental disorder
  • F51.09 Other insomnia not due to a substance or known physiological condition
F51.1 Hypersomnia not due to a substance or known physiological condition
  • F51.11 Primary hypersomnia
  • F51.12 Insufficient sleep syndrome
  • F51.13 Hypersomnia due to other mental disorder
  • F51.19 Other hypersomnia not due to a substance or known physiological condition
F51.3 Sleepwalking [somnambulism]
F51.4 Sleep terrors [night terrors]
F51.5 Nightmare disorder
F51.8 Other sleep disorders not due to a substance or known physiological condition
F51.9 Sleep disorder not due to a substance or known physiological condition, unspecified

P28.3

Applicable To

  • Central sleep apnea of newborn
  • Obstructive sleep apnea of newborn
  • Sleep apnea of newborn NOS

Approximate Synonyms

  • Neonatal primary apnea
  • Primary apnea in the newborn
  • Sleep apnea, primary, neonatal

ICD-11-Beta - 10 Sleep Wake Disorder 2016

[20]

Insomnia disorders

  • 8A00 Chronic insomnia
  • 8A01 Short-term insomnia
  • 8A02 Disorders of initiating and maintaining sleep
  • 8A0Y Other specified insomnia disorders
  • 8A0Z Insomnia disorders, unspecified
  • 8A10 Restless legs syndrome
  • 8A11 Secondary restless legs syndrome
  • 8A12 Periodic limb movements disorder
  • 8A13 Sleep-related bruxism
  • 8A14 Sleep-related leg cramps
  • 8A15 Sleep-related rhythmic movement disorder
  • 8A16 Benign sleep myoclonus of infancy
  • 8A1Y Other specified sleep-related movement disorders
  • 8A1Z Sleep-related movement disorders, unspecified

8A20 Hypersomnolence disorders

  • 8A20.1 Narcolepsy, Type 1
  • 8A20.2 Narcolepsy, Type 2
  • 8A20.3 Idiopathic hypersomnolence disorder
  • 8A20.4 Kleine-Levin syndrome
  • 8A20.5 Behaviourally induced hypersomnolence
  • 8A20.6 Hypersomnolence due to substances including medications
  • 8A20.Y Other specified hypersomnolence disorders
  • 8A20.Z Hypersomnolence disorders, unspecified
  • 8A30 Central sleep apnoeas
  • 8A31 Obstructive sleep apnoea
  • 8A32 Sleep-related hypoventilation or hypoxemia disorders
  • 8A3Y Other specified sleep-related breathing disorders
  • 8A3Z Sleep-related breathing disorders, unspecified

Circadian rhythm sleep-wake disorders

  • 8A40 Circadian rhythm sleep-wake disorder, delayed type
  • 8A41 Circadian rhythm sleep-wake disorder, advanced type
  • 8A42 Circadian rhythm sleep-wake disorder, irregular sleep-wake rhythm type
  • 8A43 Circadian rhythm sleep-wake disorder, non-24 hour type
  • 8A44 Circadian rhythm sleep-wake disorder, shift work type
  • 8A45 Circadian rhythm sleep-wake disorder, jet lag type
  • 8A4Y Other specified circadian rhythm sleep-wake disorders
  • 8A4Z Circadian rhythm sleep-wake disorders, unspecified

Parasomnia disorders

Disorders of arousal in non-REM sleep
  • 8A50 Confusional arousals
  • 8A51 Sleepwalking disorder
  • 8A52 Sleep terrors
  • 8A5Y Other specified disorders of arousal in non-REM sleep
  • 8A5Z Disorders of arousal in non-REM sleep, unspecified
  • 8A60 Sleep-related eating disorder
8A61 REM sleep behavior disorder
  • 8A62 Recurrent isolated sleep paralysis
  • 8A63 Nightmare disorder 8A63 Nightmare disorder
  • 8A64 Hypnogogic exploding head syndrome
  • 8A65 Recurrent isolated sleep-related hallucinations
8A66 Parasomnia disorder due to substances including medications
  • 8A6Y Other specified parasomnia disorders
  • 8A6Z Parasomnia disorders, unspecified
  • 7B60.1 Nocturnal enuresis
  • 8A70 Disorders of the sleep-wake schedule
  • 8A71 Parasomnia
  • 8A72 Sleeptalking
  • 8A7Y Other specified sleep-wake disorders
  • 8A7Z Sleep-wake disorders, unspecified
  • ME21 Dyssomnia

DSM Classification of Sleep Disorders

DSM II - 1968

DSM III - 1980

DSM III-R 1987

Sleep Disorder

Dysomnias (disorders of amount, quality or time of sleep)
Parasomnia (abnormal event during sleep)

DSM IV TR Sleep Disorders

ICD-9 [21] Sleep Disorders
Primary Sleep Disorders

Dyssomnias

307.42
Primary Insomnia
307.44
Primary Hypersomnia Specify if Recurrent
347.00
Narcolepsy
780.59
307.45
Circadian Rhythm Sleep Disorder
327.31Circadian Rhythm Sleep Disorder, Delayed Sleep Phase Type
327.35Circadian Rhythm Sleep Disorder, Jet Lag Type
327.36Circadian Rhythm Sleep Disorder, Shift Work Type
327.30Circadian Rhythm Sleep Disorder, Unspecified Type
307.47Dyssomnia NOS

Parasomnias

307.47Nightmare Disorder
307.46Sleep Terror Disorder
307.46Sleepwalking Disorder
307.47Parasomnia NOS
307.42Insomnia Related to ... [Indicate the Axis I or Axis II Disorder]
307.44Hypersomnia Related to ... [Indicate the Axis I or Axis II Disorder]

Other Sleep disorders

327.14Sleep Disorder Due to ... [Indicate the General Medical Condition], Hypersomnia Type
327.01Sleep Disorder Due to ... [Indicate the General Medical Condition], Insomnia Type
327.8Sleep Disorder Due to ... [Indicate the General Medical Condition], Mixed Type
327.44Sleep Disorder Due to ... [Indicate the General Medical Condition], Parasomnia Type
291.82Alcohol-Induced Sleep Disorder
292.85Amphetamine-Induced Sleep Disorder
292.85Caffeine-Induced Sleep Disorder
292.85Cocaine-Induced Sleep Disorder
292.85Opioid-Induced Sleep Disorder
292.85Other (or Unknown) Substance-Induced Sleep Disorder

DSM-5 Sleep Wake Disorders

Major changes from DSM IV

Sleep-wake disorders comprise 11 diagnostic groups: [22] [ failed verification ][ clarification needed ]

  1. M00 Insomnia disorder
  2. M01 Hypersomnolence Disorder
  3. M02 Narcolepsy/Hypocretin Deficiency
  4. M03 Obstructive Sleep Apnea Hypopnea Syndrome
  5. M04 Central Sleep Apnea
  6. M05 Sleep-Related Hypoventilation
  7. M06 Circadian Rhythm Sleep-Wake Disorder
  8. M07 Disorder of Arousal
  9. M08 Nightmare Disorder
  10. M09 Rapid Eye Movement Sleep Behavior Disorder
  11. M10 Restless Legs Syndrome
  12. M11 Substance-Induced Sleep disorder
  13. Sleep-Wake Disorders Not Elsewhere Classified
  14. Insomnia Disorder Not Elsewhere Classified
  15. Major Somnolence Disorder (Hypersomnia Not Elsewhere Classified) The following specifiers apply to Sleep-Wake Disorders where indicated: Specify if: Episodic, Persistent, Recurrent Specify if: Acute, Subacute, Persistent Specify current severity: Mild, Moderate, Severe
ICD9-CMICD10-CMDSM 5

Insomnia disorder

780.52G47.00Insomnia disorder

Specify if: With non-sleep disorder mental comorbidity. With other Medical comorbidity. With other sleep disorder

780.52G47.09Other specified insomnia disorder
780.52G47.00Unspecified insomnia disorder
780.54G47.10

Hypersomnolence disorder

Specify if: With mental disorder. With medical condition. With another sleep disorder

780.54G47.19Other specified hypersomnolence disorder
780.54G47.10Unspecified hypersomnolence disorder

Narcolepsy

347.00G47.419 Autosomal dominant cerebellar ataxia, deafness, and narcolepsy
347.00G47.419Autosomal dominant narcolepsy, obesity, and type 2 diabetes
347.00G47.419Narcolepsy without cataplexy but with hypocretin deficiency
347.01G47.411Narcolepsy with cataplexy but without hypocretin deficiency
347.10G47.429Narcolepsy secondary to another medical condition
327.23G47.33
Obstructive sleep apnea hypopnea
Central sleep apnea
780.57G47.37Central sleep apnea comorbid with opioid use
327.21G47.31Idiopathic central sleep apnea:
786.04R06.3Cheyne-Stokes breathing
780.57G47.37Central sleep apnea comorbid with opioid use

Note: First code opioid use disorder, if present.

Specify current severity

327.24G47.34Idiopathic hypoventilation
327.25G47.35Congenital central alveolar hypoventilation
327.26G47.36Comorbid sleep-related hypoventilation
Primary Alveolar Hypoventilation

Circadian rhythm sleep-wake disorders

307.45G47.22Circadian rhythm sleep-wake disorders, Advanced sleep phase type
307.45G47.21Circadian rhythm sleep-wake disorders, Delayed sleep phase type
307.45G47.23Circadian rhythm sleep-wake disorders, Irregular sleep-wake type
307.45G47.24Circadian rhythm sleep-wake disorders, Non-24-hour sleep-wake type
307.45G47.26Circadian rhythm sleep-wake disorders, Shift work type
307.45G47.20Circadian rhythm sleep-wake disorders, Unspecified type

Non–rapid eye movement (NREM) sleep arousal disorders

307.46F51.4Non-rapid eye movement sleep arousal disorders, Sleep terror type
307.46F51.3Non-rapid eye movement sleep arousal disorders, Sleepwalking type
Nightmare disorder
307.47F51.5Nightmare disorder
327.42G47.52

Rapid eye movement (REM) sleep behavior disorder

333.94G25.81 Restless legs syndrome

Medication-induced sleep disorder

291.82Alcohol-induced sleep disorder
292.85Amphetamine (or other stimulant)-induced sleep disorder
292.85Caffeine-induced sleep disorder
292.85Cannabis-induced sleep disorder
292.85Cocaine-induced sleep disorder
292.85Opioid-induced sleep disorder
292.85Other (or unknown) substance-induced sleep disorder
292.85Sedative-, hypnotic-, or anxiolytic-induced sleep disorder
292.85Tobacco-induced sleep disorder
780.54G47.19Other Specified Hypersomnolence Disorder
780.54G47.10Unspecified Hypersomnolence Disorder

Disorder of Arousal

Confusional Arousals
Sleepwalking
Sleep terrors
780.59G47.8

Other specified sleep-wake disorder

780.59G47.9

Unspecified sleep-wake disorder

Related Research Articles

<span class="mw-page-title-main">Sleep disorder</span> Medical disorder of the sleep patterns of a person

A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.

Dyssomnias are a broad classification of sleeping disorders involving difficulty getting to sleep, remaining asleep, or of excessive sleepiness.

Somnolence is a state of strong desire for sleep, or sleeping for unusually long periods. It has distinct meanings and causes. It can refer to the usual state preceding falling asleep, the condition of being in a drowsy state due to circadian rhythm disorders, or a symptom of other health problems. It can be accompanied by lethargy, weakness and lack of mental agility.

Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.

Sexsomnia, also known as sleep sex, is a distinct form of parasomnia, or an abnormal activity that occurs while an individual is asleep. Sexsomnia is characterized by an individual engaging in sexual acts while in non-rapid eye movement (NREM) sleep. Sexual behaviors that result from sexsomnia are not to be mistaken with normal nocturnal sexual behaviors, which do not occur during NREM sleep. Sexual behaviors that are viewed as normal during sleep and are accompanied by extensive research and documentation include nocturnal emissions, nocturnal erections, and sleep orgasms.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

Polysomnography (PSG), a type of sleep study, is a multi-parameter study of sleep and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

Periodic limb movement disorder (PLMD) is a sleep disorder where the patient moves limbs involuntarily and periodically during sleep, and has symptoms or problems related to the movement. PLMD should not be confused with restless legs syndrome (RLS), which is characterized by a voluntary response to an urge to move legs due to discomfort. PLMD on the other hand is involuntary, and the patient is often unaware of these movements altogether. Periodic limb movements (PLMs) occurring during daytime period can be found but are considered as a symptom of RLS; only PLMs during sleep can suggest a diagnosis of PLMD.

<span class="mw-page-title-main">Somnology</span> Scientific study of sleep

Somnology is the scientific study of sleep. It includes clinical study and treatment of sleep disorders and irregularities. Sleep medicine is a subset of somnology.

Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, NREM sleep, and REM sleep, and their combinations.

The International Classification of Sleep Disorders (ICSD) is "a primary diagnostic, epidemiological and coding resource for clinicians and researchers in the field of sleep and sleep medicine". The ICSD was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979. A second edition, called ICSD-2, was published by the AASM in 2005. The third edition, ICSD-3, was released by the AASM in 2014. A text revision of the third edition (ICSD-3-TR) was published in 2023 by the AASM.

When we sleep, our breathing changes due to normal biological processes that affect both our respiratory and muscular systems.

<span class="mw-page-title-main">Sleep medicine</span> Medical specialty devoted to the diagnosis and therapy of sleep disturbances and disorders

Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions about, sleep–wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.

<span class="mw-page-title-main">Catathrenia</span> Sleep-related breathing disorder

Catathrenia or nocturnal groaning is a sleep-related breathing disorder, consisting of end-inspiratory apnea and expiratory groaning during sleep. and it describes a rare condition characterized by monotonous, irregular groans while sleeping. Catathrenia begins with a deep inspiration. The person with catathrenia holds her or his breath against a closed glottis, similar to the Valsalva maneuver. Expiration can be slow and accompanied by sound caused by vibration of the vocal cords or a simple rapid exhalation. Despite a slower breathing rate, no oxygen desaturation usually occurs. The moaning sound is usually not noticed by the person producing the sound, but it can be extremely disturbing to sleep partners. It appears more often during expiration REM sleep than in NREM sleep.

<span class="mw-page-title-main">Sleep study</span> Sleep Medicine

A sleep study is a test that records the activity of the body during sleep. There are five main types of sleep studies that use different methods to test for different sleep characteristics and disorders. These include simple sleep studies, polysomnography, multiple sleep latency tests (MSLTs), maintenance of wakefulness tests (MWTs), and home sleep tests (HSTs). In medicine, sleep studies have been useful in identifying and ruling out various sleep disorders. Sleep studies have also been valuable to psychology, in which they have provided insight into brain activity and the other physiological factors of both sleep disorders and normal sleep. This has allowed further research to be done on the relationship between sleep and behavioral and psychological factors.

<span class="mw-page-title-main">Narcolepsy</span> Human sleep disorder that involves an excessive urge to sleep and other neurological features

Narcolepsy is a chronic neurological disorder that involves a decreased ability to regulate sleep–wake cycles. Symptoms often include periods of excessive daytime sleepiness and brief involuntary sleep episodes. Narcolepsy paired with cataplexy is evidenced to be an autoimmune disorder. These experiences of cataplexy can be brought on by strong emotions. Less commonly, there may be vivid hallucinations or an inability to move while falling asleep or waking up. People with narcolepsy tend to sleep about the same number of hours per day as people without, but the quality of sleep tends to be lessened.

Idiopathic hypersomnia(IH) is a neurological disorder which is characterized primarily by excessive sleep and excessive daytime sleepiness (EDS). The condition typically becomes evident in early adulthood and most patients diagnosed with IH will have had the disorder for many years prior to their diagnosis. As of August 2021, an FDA-approved medication exists for IH called Xywav, which is oral solution of calcium, magnesium, potassium, and sodium oxybates; in addition to several off-label treatments (primarily FDA-approved narcolepsy medications).

Sleep disorder is a common repercussion of traumatic brain injury (TBI). It occurs in 30%-70% of patients with TBI. TBI can be distinguished into two categories, primary and secondary damage. Primary damage includes injuries of white matter, focal contusion, cerebral edema and hematomas, mostly occurring at the moment of the trauma. Secondary damage involves the damage of neurotransmitter release, inflammatory responses, mitochondrial dysfunctions and gene activation, occurring minutes to days following the trauma. Patients with sleeping disorders following TBI specifically develop insomnia, sleep apnea, narcolepsy, periodic limb movement disorder and hypersomnia. Furthermore, circadian sleep-wake disorders can occur after TBI.

Confusional arousals are classified as “partial awakenings in which the state of consciousness remains impaired for several minutes without any accompanying major behavioural disorders or severe autonomic responses”. Complete or partial amnesia of the episodes may be present.

<span class="mw-page-title-main">Behavioral sleep medicine</span>

Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.

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