Insomnia diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Overview
The diagnostic study of choice for insomnia is sleep history. Polysomnography must be performed when there is either a suspicion of an underlying sleep disorder, unusual nocturnal activity, or severe difficulty sleeping without an explanation. Multiple sleep latency test must be performed when there is a suspicion of narcolepsy. Actigraphy must be performed when there is a suspicion of circadian rhythm sleep disorder and the patient cannot provide the history of sleep pattern, or for the patients with insomnia that is unresponsive to treatment.
Diagnostic Study of Choice
Study of Choice
The diagnostic study of choice for insomnia is sleep history. While the history of the patients' symptoms might reveal the underlying comorbid disorder, a detailed sleep history is also important for sleep disorders such as circadian rhythm sleep disorder and obstructive sleep apnea.[1]
Sequence of Diagnostic Studies
- Polysomnography might be performed when there is either a suspicion of an underlying sleep disorder, unusual nocturnal activity, or severe difficulty sleeping without an explanation.[1]
- Multiple sleep latency test might be performed when there is a suspicion of narcolepsy.
- Actigraphy might be performed when there is a suspicion of circadian rhythm sleep disorder and the patient cannot provide the history of sleep pattern, or for the patients with insomnia that is unresponsive to treatment.
DSM-V Diagnostic Criteria for Insomnia Disorder[2]
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Specify if:
Specify if:
Note:Acute and short-term insomnia (i.e., symptoms lasting less than 3 months but otherwise meeting all criteria with regard to frequency, intensity, distress, and/or impairment)should be coded as an other specified insomnia disorder. |
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Insomnia versus poor sleep quality
Poor sleep quality can occur as a result of sleep apnea or major depression. Poor sleep quality is caused by the individual not reaching stage 4 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 4 sleep due to brain damage who still lead perfectly normal lives.
- Sleep apnea is a condition that occurs when a sleeping person's breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper's respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember awakening or having difficulty breathing, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the central nervous system, and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.
Major depression leads to alterations in the function of the hypothalamus and pituitary causing excessive release of cortisol which can lead to poor sleep quality.
Nocturnal polyuria or excessive nighttime urination can be very disturbing to sleep.[3] Nocturnal polyuria can be nephrogenic (related to kidney disease) or it may be due to prostate enlargement or hormonal influences. Deficiencies in vasopressin, which is either caused by a pituitary problem or by insensitivity of the kidney to the effects of vasopressin, can lead to nocturnal polyuria. Excessive thirst or the use of diuretics can also cause these symptoms.
References
- ↑ 1.0 1.1 Sutton EL (March 2021). "Insomnia". Ann Intern Med. 174 (3): ITC33–ITC48. doi:10.7326/AITC202103160. PMID 33683929 Check
|pmid=value (help). - ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Sleep issues in Parkinson’s disease. Neurology. 2005. pp. 64, S12–20. Unknown parameter
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