Diagnostic criteria and codes - sleep wake disorders

16 important questions on Diagnostic criteria and codes - sleep wake disorders

What sleep wake disorders are there?

- sleep-wake disorders
  • insomnia disorder
  • hypersomnolence disorder
  • narcolepsy
- breathing related sleep disorders
  • obstructive sleep apnea hypopnea
  • central sleep apnea
  • sleep related hypoventilation
  • circadian rhythm sleep wake disorder
- Parasomnias
  • non-rapid eye movement sleep arousal disorder
  • nightmare disorder
  • rapid eye movement sleep behaviour disorder
  • restless legs syndrome
  • S/M-I sleep disorder

  • other specified sleep disorder
  • unspecified sleep disorder

What is criteria A for insomnia disorder?

Complaint of dissatisfaction with sleep quantity or quality. One or more of:
  • Difficulty initiating sleep
  • Difficulty maintaining sleep
  • Early-morning awakening

Specifiers for insomnia disorder?

Specify if:
  • With non–sleep disorder mental comorbidity, including substance use disorders
  • With other medical comorbidity
  • With other sleep disorder

Specify if:
  • Episodic: Symptoms last at least 1 month but less than 3 months.
  • Persistent: Symptoms last 3 months or longer.
  • Recurrent: Two (or more) episodes within the space of 1 year.
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What is criteria A for narcolepsy?

Periods of an irrepressible need for sleep, lapsing into sleep, napping.

What is criteria B for narcolepsy?

At least one of:
  • Episodes of cataplexy (weakness of muscle preceded by laughter) or just laughter within 6 months of onset
  • Hypocretin deficiency (informative available through testing)
  • Nocturnal sleep polysomnography showing REM sleep latency less than or equal to 15 minute

What is criteria A for obstructive sleep apnea hypopnea?

Either 5 obstructive apneas or hypopneas per hour of sleep with at least one of:
  • Nocturnal breathing disturbances (snoring, gasping, breathing pauses)
  • Daytime sleepiness.

Or 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless accompanying symptoms.

Specifiers for obstructive sleep apnea hyponea?

Specify current severity: (based on apnea hypopnea index)
  • Mild < 15.
  • Moderate 15-30,
  • severe > 30 

Specifiers for central sleep apnea?

Specify whether:
  • Idiopathic central sleep apnea: apnea caused by respiratory effort but no airway obstruction
  • Cheyne-stokes breathing: periodic crescendo-decrescendo variation in tidal volume that results in central apneas.
  • Central sleep apnea comorbid with opioid use.  

What is criteria A for sleep related hypoventilation?

Episodes of decreased respiration associated with elevated CO2 levels.

Specifiers for sleep related hypoventilation?

Specify whether:
  • Idiopathic hypoventilation
  • Congenital central alveolar hypoventilation
  • Comorbid sleep-related hypoventilation

What is criteria A for circadian sleep wake rhythm disorder?

Pattern of sleep disruption that is primarily due to an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual’s schedule. (unable to sleep and wake at the times required for normal work, school, and social needs, quality of their sleep is usually normal. )

What is criteria B for circadian sleep wake rhythm disorder?

leads to excessive sleepiness, insomnia, or both

What is criteria A for Non-rapid eye movement sleep arousal disorders?

Episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode
  • Sleepwalking
  • Sleep terrors: abrupt terror arousals from sleep, usually beginning with a panicky scream. 

Specifiers for Non-rapid eye movement sleep arousal disorders?

Specify whether:
  • Sleepwalking type

Specify if:
  • With sleep-related eating With sleep-related sexual behavior (sexsomnia)
  • Sleep terror type - Nightmare disorder 

What is criteria A for Restless legs syndrome (RLS)?

An urge to move legs. Due through uncomfortable and unpleasant sensations in legs.
  • The urge begins or worsens during periods of inactivity
  • The urge is partially or totally relieved by movement
  • The urge is worse in the evening or at night or occurs only at night

Specifiers for S/M-I sleep disorder?

Specify whether:
  • Insomnia type: Characterized by difficulty falling asleep or maintaining sleep, frequent nocturnal awakenings, or nonrestorative sleep.
  • Daytime sleepiness type: Characterized by predominant complaint of excessive sleepiness/fatigue during waking hours or, less commonly, a long sleep period.
  • Parasomnia type: Characterized by abnormal behavioral events during sleep.
  • Mixed type: Characterized by a substance/medication-induced sleep problem characterized by multiple types of sleep symptoms, but no symptom clearly predominant

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