Precedence of Diagnosis Sleep Disorders

Diagnostic dilemmas arise when clients have symptoms consistent with more than one diagnosis. The diagnoses may belong to the same diagnostic group (e.g., Sleep Disorders) or different groups (e.g., Mood Disorders and Sleep Disorders). When these conflicts occur, they are often resolved using the rules of diagnostic precedence that are included in the criteria for many diagnoses. However, these rules require clinical judgment. For example, the diagnosis of Primary Insomnia cannot usually be made if the insomnia occurs exclusively during the course of Major Depressive Disorder. However, if the insomnia is of sufficient severity to require independent treatment beyond the treatment of the depression, the client can be given a diagnosis of Insomnia Related to Major Depressive Disorder. Therefore, the rules of diagnostic precedence, rather than taken as hard and firm, should be seen as guidelines. They suggest other diagnoses that should be considered before a specific diagnosis is made and they indicate the circumstances under which the diagnosis in question may be excluded if the client fulfills the criteria for other diagnoses. The table below should be used as a reminder of those diagnoses that must be considered and excluded before a specific Sleep Disorder diagnosis can be made.

Sleep Disorder Disorders taking precedence

Primary Insomnia Does not occur exclusively during Circadian Rhythm Sleep Disorder, Narcolcpsy, Breathing-Related Sleep Disorder, Para-somnia, or another mental disorder Not due to effects of a substance or general medical condition

Primary Hypersomnia Does not occur exclusively during another sleep disorder or mental disorder Not better accounted for by Insomnia or inadequate amount of sleep Not due to effects of a substance or general medical condition Narcolepsy Not due to effects of a substance or general medical condition

Breathing-Related Sleep Disorder Not better accounted for by another mental disorder Not due to effects of a substance or general medical condition

Circadian Rhythm Sleep Disorder Does not occur exclusively during another sleep disorder or mental disorder Not due to effects of a substance or general medical condition

Nightmare Disorder Does not occur exclusively during another mental disorder Not due to effects of a substance or general medical condition Sleep Terror Disorder Not due to effects of a substance or Sleepwalking Disorder general medical condition

Insomnia Related to Another Not better accounted for by another Mental Disorder Sleep Disorder or inadequate amount Hypersomnia Related to Another of sleep Mental Disorder Not due to effects of a substance or general medical condition