<p> Quick Guide Sleep Disorders</p><p>The Sleep Disorders chapter of the DSM-IV-TR has four major sections. These sections are organized according to the presumed cause (etiology) of the Sleep Disorder, and are similar to the classification system used by the American Sleep Disorders Association </p><p>I. Primary Sleep Disorders (p. 598) are all sleep disorders in this chapter, except those under II, III, and IV listed below.</p><p>Subdivisions of Primary Sleep Disorder: A. Dyssomnias (6 Disorders). Client sleeps too little, too much, or at the wrong time. The problem is with the amount (quantity) or timing of sleep. Sleep itself (when client gets it) is pretty normal. 1. Insomnia - Sleeps too little 2. Hypersomnia - Sleeps too much B. Parasomnias (4 Disorders) Something abnormal occurs during sleep itself or during the times when the client is fall asleep or waking up (e.g., bad dreams). The quality, quantity, and timing of sleep are essentially normal</p><p>II. Sleep Disorder Related to Another Mental Disorder (p. 650) 1II. Sleep Disorder Due to a General Medical Condition (p. 654) IV. Substance-Induced Sleep Disorder (p. 660)</p><p>I. Primary Sleep Disorders</p><p>A. Dyssomnias</p><p>1. 307.42 Primary Insomnia (Criteria, p.604) Characteristics a. Difficulty initiating or maintaining sleep (sleeping too little). b. Persists for 1 month or longer c. Rarely is this diagnosis independent of an Axis I or II disorder, a GMC, or substance use. Cause a. Often due to Major Depressive Episodes, Manic Episodes, or Anxiety Disorders b. Misused substances, as well as some prescription medicines. c. Breathing-related problems d. Sometimes cause is difficult to identify Treatment a. Vigorous daytime exercise, but not exercising before sleep b. Sexual intercourse, if pleasurable c. Metronome or ticking clock- slow, 60 beats per minute or slower, beat of human heart d. Relaxation exercises, practiced regularly but condensed to 5 </p><p>111 minutes e. Decrease stimulation and increase soothing environment, such as use of ear plugs or calm reading f. Practice good sleep habits (see attachment)</p><p>2. 307.44 Primary Hypersomnia (Criteria, p. 609) Characteristics (a) Excessive sleepiness (b) Persists for 1 month or longer (c) Rarely is this diagnosis independent of an Axis I or II disorder, a GMC, or substance use. Cause (a) Major Depressive Episode, Dysthymic Disorder with atypical features (b) Use of substances is less likely to produce hypersomnia than insomnia, but substance use can have an effect (e.g., sleeping pills overdose) (c) Sometimes cause cannot be identified. Treatment (a) Exercise when becoming sleepy XXX</p><p>3. 347.00 Narcolepsy (Criteria, p.615) Characteristics (1) Sleep intrudes into wakefulness, causing clients to fall asleep almost instantly. (2) Sleep is brief but refreshing. (3) May also have sleep paralysis, sudden loss of strength, and hallucinations as they fall asleep or awaken. d. 780.59 Breathing-Related Sleep Disorder (Criteria, 622) Characteristics: (1) Sleep disruption (excessive sleepiness or insomnia) (2) Due to sleep-related breathing condition (e.g., Obstructive sleep apnea syndrome) e. 327.3x Circadian Rhythm Sleep Disorder (Criteria, p. 629) Characteristics: (1) Persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia. (2) Due to mismatch between sleep-wake schedule required by a person's environment and his/her circadian sleep-wake pattern (e.g., shift work, jet lag). f. 307.47 Dyssomnia NOS (Criteria on p. 629)</p><p>Parasomnias </p><p>112 g. 307.47 Nightmare Disorder (Criteria, p. 634) Characteristics: (1) Repeated awakenings from bad dreams (2) When awakened client becomes oriented and alert h. 307.46 Sleep Terror Disorder (Criteria, p. 630587) Characteristics: (1) Abrupt awakening from sleep (2) Intense fear and signs of autonomic arousal (3) Unresponsive to efforts from other to calm client (4) No detailed dream recalled (5) Amnesia for episode i. 307.46 SleepwalkingDisorder (Criteria, p. 644) Characteristics: (1) Rising from bed during sleep and walking about. (2) Usually occurs early in the night. (3) On awakening, the person has amnesia for episode j. 307.47 Parasomnia NOS (Criteria, 644)</p><p>II. Sleep Disorders Related to Another Mental Disorder a. 327.02 Insomnia Related to... (Indicate the Axis I or Axis II disorder) (Criteria, p. 650) Characteristics: (1) Difficulty in initiating or maintaining sleep (2) Persists for at least 1 month. b. 327.15 Hypersomnia Related to... (Indicate the Axis I or Axis H disorder) (Criteria, p. 650) Characteristics: (1) Excessive sleepiness (2) Persists for at least 1 month</p><p>III. Sleep Disorder Due to a General Medical Condition</p><p>327.xx Sleep Disorder Due to...(Indicate the General Medical Condition) (Criteria, p. 654) Characteristics: (1) Prominent disturbance in sleep that is sufficiently severe to warrant independent clinical attention. (2) Has to be evidence that sleep disturbance is direct physiological consequence of a general medical condition. Type: (1) .01 Insomnia Type (2) .14 Hypersomnia Type</p><p>113</p><p>2 (3) .44 Parasomnia Type (4) .8 Mixed Type</p><p>IV. Substance-Induced Sleep Disorder (Indicate Code & Identify Substance) (Criteria, p. 660) Characteristics a. Substance use that produces a sleep disorder severe enough to warrant independent clinical attention b. Has to be evidence that sleep disturbance is direct physiological consequence of substance use. Code: 291.82 Alcohol; 292.85 Amphetamine; 292.85 Caffeine; 292.85 Cocaine; 292.85 Opioid; 292.85 Sedative, Hypnotic, or Anxiolytic; 292.85 Other (or unknown) Substance</p><p>Specify Types: Insomnia Type Hypersomnia Type Parasomnia Type Mixed Type</p><p>Specify if: With Onset During Intoxication With Onset During Withdrawal</p><p>114</p>