Evaluation of Insomnia
|Sleep-onset insomnia||Difficulty falling asleep|
|Frequent or sustained awakenings|
|Sleep offset insomnia||Early morning awakenings|
|Nonrestorative sleep duration||Persistent sleepiness despite sleep of adequate
|Transient||Insomnia complaint lasting one to
several nights within a single episode (eg,
acute illness, jet lag, shift changes)
|Short-term||Insomnia lasting from a few days to
3 weeks (eg, associated with a longer
duration of stress such as grief, stress,
|Long-term or chronic||Insomnia lasting for months or years,
often waxing and waning (eg, due to
medical or psychiatric diseases, chronic stress, bereavement, primary sleep disorders)
Adapted from: Czeisler CA, et al, Sleep Disorders. In: Kasper DL et al. Harrison's Textbook of Internal Medicine 16th ed. New York, NY; McGraw-Hill Professional: 2004;153–162.
|MAJOR CATEGORIES OF SLEEP DISORDERS|
|PRIMARY SLEEP DISORDERS|
|Sleep disorders thought to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors.||Dyssomnias—characterized by abnormalities in the amount, quality, or timing of sleep.|
|Parasomnias—characterized by abnormal behavior
or physiologic events occurring
in association with sleep.
|MENTAL DISORDER-RELATED SLEEP DISORDER|
|Presence of either insomnia or
hypersomnia thought to be related to another mental disorder (eg, major depressive disorder, dysthymic disorder, mood disorder, generalized anxiety disorder, panic disorder, schizophrenia and other psychotic disorders, adjustment disorders, somatoform disorders, personality disorders).
|Diagnosis of insomnia or hypersomnia due to another mental disorder should be made only when symptoms are severe and are an independent focus of clinical attention; the sleep disturbance may be one of the earliest symptoms in persons who subsequently develop an associated mental disorder.|
|GENERAL MEDICAL CONDITION RELATED SLEEP DISORDER|
|Prominent disturbance in sleep due to a general medical condition and severe enough to warrant independent clinical attention.||History, physical exam, and lab findings suggest that the sleep disturbance is the direct physiologic consequence of a medical condition; the disturbance is not due to another medical disorder (eg, an adjustment disorder) and does not occur only during a delirium; breathing related sleep disorder or narcolepsy can be ruled out.|
|SUBSTANCE-INDUCED SLEEP DISORDER|
|Prominent disturbance in sleep, thought to be due to direct physiologic effects of a substance (eg, drugs of abuse, medication, a toxin) or withdrawal from such a substance.||One of the 4 types of sleep disturbance seen: insomnia, hypersomnia, parasomnia, mixed-type insomnia.|
Adapted from: American Psychiatric Assn. Diagnosis and Statistical Manual of Mental Disorders, 4th ed, Text Revision. Washington DC; Amer Psych Assn; 2000; 597–607.