Classification systems used to classify sleep disorders:
- ICD-10 (International Statistical Classification of Diseases and Related Health Problems/International statistical classification of diseases and related health problems).
- DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, 2000)DSM-V (2013).
- ICSD (International Classification of Sleep Disorders, 1990), ISCD-R (1997), ICSD-3 (2014).
ICD-10
According to the ICD-10, sleep disorders are classified according to their presumed etiology (cause):
- F51: nonorganic sleep disorders (mental and behavioral disorders chapter) or
- G47: (organic) sleep disorders (chapter Diseases of the nervous system).
Non-organic insomnia is a condition of inadequate duration and quality of sleep that persists for a considerable period of time (at least three times a week for a period of at least one month) and includes difficulty falling asleep, difficulty sleeping through the night, and early morning awakenings. Insomnia is a common symptom of many mental and somatic disorders and should therefore be classified additionally only when it dominates the clinical picture (F51.0). It causes significant distress and/or has a disruptive effect on daily functioning (daytime sleepiness):
- Nonorganic insomnia (F51.0): main features are difficulty falling asleep, difficulty sleeping through the night, and early morning awakenings, as well as insufficient duration and quality of sleep (poor sleep quality; nonrestorative sleep). [about 10% of all insomnia.]
- Non-organic hypersomnia: Hypersomnia is defined either as a state of excessive sleepiness during the day and sleep attacks (not explained by inadequate sleep duration) or by prolonged transition times to wakefulness after awakening. In the absence of an organic cause for hypersomnia, this condition is usually associated with other mental disorders (F51.1).
- Non-organic sleep-wake rhythm disorders (F51.2): the sleep-wake pattern deviates from the desired sleep-wake rhythm, i.e., there is a lack of synchronicity between the individual sleep-wake rhythm and the desired sleep-wake rhythm of the environment. This leads to complaints of insomnia during the main sleep period and hypersomnia during the waking period.
Non-organic parasomnias are abnormal episodes that occur during sleep (disturbances of awakening (arousal), partial awakening, or sleep stage change):
- Sleepwalking (somnambulism; F51.3): sleepwalking is a state of altered consciousness in which phenomena of sleep and wakefulness are combined. During a somnambulic episode, the individual leaves the bed, often during the first third of the night’s sleep, walks around, exhibits lowered consciousness, decreased reactivity, and dexterity. Upon awakening, there is usually no memory of sleepwalking.
- Night terrors (Pavor nocturnus, night terrors; F51.4): nocturnal episodes of extreme fear and panic with violent crying, movements, and strong autonomic arousal. The affected person sits up or stands up with a panic cry, usually during the first third of night sleep. She often rushes to the door as if to escape, but usually without leaving the room. After awakening, memory of the event is absent or limited to one or two fragmentary pictorial ideas. Efforts by others to influence the person during the episode are unsuccessful or result in disorientation and perseverative movements. An episode lasts up to 10 minutes.
- Nightmares (nightmare; anxiety dreams (F51.5. ): dream experience full of anxiety or fear, with very detailed memory of the dream content. This dream experience is very vivid; themes include threats to life, safety, or self-esteem. There is often a repetition of the same or similar frightening nightmare themes. During a typical episode, there is autonomic stimulation, but no perceptible crying or body movements. Upon awakening, the patient quickly becomes lively and oriented.
Organic sleep disorders are referred to as:
- Sleep onset and sleep maintenance disorders (G47.0).
- Hyposomia
- Insomnia
- Pathologically increased need for sleep (G47.1).
- Hypersomnia (idiopathic).
- Sleep-wake rhythm disorders (G47.2).
- Delayed sleep phase syndrome
- Irregular sleep-wake rhythm
- Sleep apnea (G47.3):
- Central sleep apnea syndrome (47.30): repeated respiratory arrests due to lack of activation of respiratory muscles
- Obstructive sleep apnea syndrome (OSAS) (G47.32): cessations of breathing during sleep caused by obstruction of the airway, often occurring several hundred times per night
- Sleep-related hypoventilation syndrome (G47.32):
- Congenital central-alveolar hypoventilation syndrome.
- Sleep-related idiopathic nonobstructive alveolar hypoventilation.
- Narcolepsy and cataplexy (G47.4): narcolepsy (frequency: < 0.05%) includes the following in its symptomatology:
- Disturbances of wakefulness (attacks of falling asleep and automatic behavior),
- Non-REM sleep disorders (sleep fragmentation).
- Disturbances of REM sleep (RBD).
- Disorders of motor function during sleep (PLM, talking during sleep and also cataplexies).
- Other sleep disorders (G47.8)
- Kleine-Levin syndrome: periodically increased need for sleep (hypersomnia), perceptual and behavioral disturbances; genetic cause is assumed – mode of inheritance of unclear
DSM-IV
The DSM-IV, unlike the ICD-10, does not divide sleep disorders into nonorganic (psychogenic) and organic causes, but according to whether the sleep disorder is primary or the result of another factor secondary, for example, due to another mental illness, a medical disease factor, or substance use. Primary sleep disorders are thereby divided into dyssomnias and parasomnias:
- Dyssomnias include primary insomnia (insomnia), respiratory sleep disorder (unless due to another medical condition or substance use), and sleep disorder due to circadian rhythm disturbance.
- Parasomnias (disorders of awakening (arousal), partial awakening, or sleep stage change; frequency peak: childhood) include sleep disorder with:
- Sleepwalking (somnambulism).
- Nightmares (anxiety rooms) and
- Pavor nocturnus (night terrors).
Further subdivided into:
- Sleep disorders occurring in association with another mental disorder: those occurring due to a medical disease process, and.
- Sleep disorders that are related to the use of a psychotropic substance such as alcohol, amphetamine, caffeine, cocaine, opiate, or medication (substance-induced sleep disorder).
Diagnostic criteria of insomnia disorder (“insomnia disorder”) according to DSM-5 A.
| A |
A foreground complaint of dissatisfaction with sleep quality or quantity, associated with one (or more) of the following symptoms:
|
| B | The sleep disorder results in clinically significant suffering or limitations in social, educational, occupational, or other important areas of functioning. |
| C | Sleep disturbance occurs at least 3 nights per week. |
| D | Sleep disturbance persists for at least 3 months. |
| E | Sleep disturbance occurs despite adequate opportunity for sleep. |
| F | Insomnia is not better explained and does not occur exclusively in the context of another sleep-wake rhythm disorder. |
| G | Insomnia is not attributable to the physiological effects of a substance (e.g., a drug or medication). |
| H | Coexisting mental and physical illnesses do not explain the occurrence of insomnia. |
Specify:
- With a non-sleep disorder-related mental comorbidity (concomitant disorder).
- With another medical comorbidity
- With another sleep disorder
Classification of sleep disorders in ICSD-3 and ICD-10
| Main group according to ICDS-3 | Corresponding designations according to ICD-10 |
| Insomnia |
|
| Sleep-related breathing disorders (SBAS). |
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| Central nervous disorders with daytime sleepiness |
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| Circadian sleep-wake rhythm disturbances |
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| Parasomnias (behavioral abnormalities occurring predominantly from sleep). |
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| Sleep-related movement disorders |
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| Other sleep disorders |
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