Range and Classification of Sleep Disorders
2.3 Classification Systems Currently in Use
groups—dyssomnias and parasomnias. The remaining two categories were sleep disorders associated with mental, neurological or other medical disorders and pro- posed sleep disorders.
Published in 2005, the 2nd edition of the ICSD (ICSD-2) (American Academy of Sleep Medicine 2005) reflected the science and opinions of the sleep specialist com- munity and was prepared for use by specialists in sleep medicine. The ICSD-2 included 81 highly specific sleep disorders and 8 major categories as summarized in Table 2.1.
The eight categories were insomnia, sleep-related breathing disorders, hypersomnias of central origin, circadian rhythm sleep disorders, the parasomnias, sleep-related movement disorders, isolated symptoms that are apparently normal variants and unre- solved issues and other sleep disorders. Interestingly, the second edition was a return to a classification system based on phenomenology resembling the 1979 system.
2.3.1.1 Sleep Disorders G47
• G47.0 Disorders of initiating and maintaining sleep (insomnias)
• G47.1 Disorders of excessive somnolence (hypersomnias)
• G47.2 Disruptions in circadian rhythm (including jet lag)
• G47.3 Sleep apnoea
• G47.4 Narcolepsy and cataplexy
• G47.5 Parasomnias
• G47.6 Sleep-related movement disorders
2.3.2 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) 2013
As with DSM-IV, the approach taken to the classification of sleep-wake disorders in DSM-5 can be understood within the context of grouping similar disorders, so- called lumping or clustering, versus the more expansive list based on specialist cri- teria or “splitting” (American Psychiatric Association 2013). In the DSM-5, sleep-wake disorders are classified under ten disorders, or disorder groups, as sum- marized in Table 2.3.
2.3.3 International Classification of Sleep Disorders, 3rd Edition (ICSD-3) 2014
The third edition of the ICSD follows the same general structure as the second edi- tion so that the major clinical divisions remain unchanged (American Academy of Sleep Medicine 2014). In this edition, 64 highly specific sleep disorders are described under six categories. A further six sleep-related disorders are listed in an appendix category of “sleep-related medical and neurological disorders”; these include fatal familial insomnia, sleep-related epilepsy, headache, laryngospasm, gastro-oesophageal reflux and myocardial ischaemia.
Table 2.4 shows the ICSD-3 classification of sleep disorders by categories and subtypes including the numeric ICD-9-CM and alphanumeric ICD-10-CM codes.
The most notable change is the collapse of all previous chronic insomnia diagnoses
Table 2.2 The ICD-10 Chapter V (F) nonorganic sleep disorders
Classification of mental and behavioural disorders including the classification of nonorganic sleep disorders (F51) (World Health Organization)
F51.0 Nonorganic insomnia F51.1 Nonorganic hypersomnia
F51.2 Nonorganic disorder of the sleep-wake schedule F51.3 Sleepwalking [somnambulism]
F51.4 Sleep terrors [night terrors]
F51.5 Nightmares
F51.8 Other nonorganic sleep disorders F51.9 Nonorganic sleep disorder, unspecified
Table 2.3 The DSM-5 Classification of Sleep-Wake Disorders Insomnia disorder
780.52 G47.00
Difficulty initiating sleep, maintaining sleep or early morning awakening. Causes significant distress. Occurs at least 3 nights per week despite adequate opportunity to sleep. Present for at least 3 months; acute and short term if present for less than 3 months Specify if: With non-sleep disorder mental comorbidity, with other comorbidity or other sleep disorder
Specify if: Episodic (>1 < 3 months), persistent (3 months +) or recurrent (2+ episodes in 1 year)
Hypersomnolence disorder
780.54 G47.10
Specify if: With non-sleep disorder mental comorbidity (including substance abuse), with medical condition or with other sleep disorder
Specify if: Acute, subacute or persistent Specify current severity: Mild, moderate, severe Narcolepsy
347.00 G47.419 347.01 G47.411 347.00 G47.419 347.00 G47.419 347.10 G47.429
Specify current severity: Mild, moderate, severe
Narcolepsy without cataplexy but with hypocretin deficiency Narcolepsy with cataplexy but without hypocretin deficiency Autosomal dominant cerebella ataxia, deafness and narcolepsy Autosomal dominant narcolepsy, obesity and type 2 diabetes Narcolepsy secondary to another medical condition Breathing-related sleep disorders
327.21 G47.33
327.21 G47.31 786.04 R06.3 780.57 G47.37 327.24 G47.34 327.25 G47.35 327.26 G47.36
Obstructive sleep apnoea-hypopnea (current severity: Mild, moderate, severe)
Central sleep apnoea:
Idiopathic central sleep apnoea Cheyne-Stokes breathing
Complex sleep apnoea comorbid with opioid use Sleep-related hypoventilation:
Idiopathic hypoventilation
Congenital central alveolar hypoventilation Comorbid sleep-related hypoventilation
Circadian rhythm sleep-wake disorders specify if: Episodic, persistent or recurrent 307.45 G47.21
307.45 G47.22 307.45 G47.23 307.45 G47.24 307.45 G47.26 307.45 G47.20
Delayed sleep phase type Advanced sleep phase type Irregular sleep-wake type Non-24 h sleep-wake type Shift work type
Unspecified type Parasomnias
307.46 F51.3 307.46 F51.4 307.47 F51.5 327.42 G47.52
Non-rapid eye movement arousal disorders
Sleepwalking type. Specify if: With sleep-related eating, sexsomnia
Sleep terror type
Nightmare disorder. Specify if: With associated non-sleep disorder, with other medical condition or with other sleep disorder
Rapid eye movement sleep behaviour disorder 333.94 G25.81 Restless Legs Syndrome (RLS)
Substance−/medication- induced sleep disorder
Alcohol, caffeine, cannabis, opioid, sedatives/hypnotics/anxiolytics, amphetamines, cocaine, tobacco or other (unknown) substances
(continued)
Table 2.3 (continued)
780.52 G47.09 Other specified insomnia disorder, e.g. brief insomnia disorder, nonrestorative sleep
780.52 G47.00 Unspecified insomnia disorder
780.54 G47.19 Other specified hypersomnolence disorder 780.54 G47.10 Unspecified hypersomnolence disorder 780.59 G47.8 Other specified sleep-wake disorder 780.59 G47.9 Unspecified sleep-wake disorder
Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) Classification of Sleep Disorders 2013
Table 2.4 The ICSD-3: Classification of sleep disorders by categories and sub-types including the numeric ICD-9-CM and alphanumeric ICD-10-CM codes in brackets (ICD-9-CM;
ICD-10-CM)
Insomnia 1. Chronic insomnia disorder (307.42; F51.01) 2. Short-term insomnia disorder (307.41; F51.02) 3. Other insomnia disorder (307.49; F51.09) 4. Isolated symptoms and normal variants:
Excessive time in bed Short sleeper Sleep-related
breathing disorders
1. Obstructive sleep apnoea disorders:
(a) obstructive sleep apnoea, adults (327.23; G47.33) (b) obstructive sleep apnoea, paediatrics (327.23; G47.33) 2. Central sleep apnoea syndromes:
(a) central sleep apnoea with Cheyne-Stokes breathing (786.04;
R06.3)
(b) central sleep apnoea due to a medical disorder without Cheyne- Stokes breathing (327.27; G47.37)
(c) central sleep apnoea due to high-altitude periodic breathing (327.22; G47.32)
(d) central sleep apnoea due to medication or substance (327.29;
G47.39)
(e) primary central sleep apnoea (327.21; G47.31) (f) primary central sleep apnoea of infancy (770.81; P28.3) (g) primary central sleep apnoea of prematurity (770.82; P28.4) (h) treatment emergent central sleep apnoea (327.29; G47.39) 3. Sleep-related hypoventilation:
(a) obesity hypoventilation syndrome (278.03; E66.2)
(b) congenital central alveolar hypoventilation syndrome (327.25;
G47.35)
(c) late-onset central hypoventilation with hypothalamic dysfunction (327.26; G47.36)
(d) idiopathic central alveolar hypoventilation (327.24; G47.34) (e) sleep-related hypoventilation due to a medication or substance
(327.26; G47.36)
(f) sleep-related hypoventilation due to a medical disorder (327.26;
G47.36)
4. Sleep-related hypoxemia disorder:
Sleep-related hypoxemia (327.26; G47.36) 5. Isolated symptoms and normal variants:
(a) snoring (786.09; R06.83) (b) Catathrenia
Table 2.4 (continued) Central disorders of hypersomnia
1. Narcolepsy type 1 with cataplexy (347.01; G47.411) 2. Narcolepsy type 2 without cataplexy (347.00; G47.419) 3. Idiopathic hypersomnia (327.11; G47.11)
4. Kleine-Levin syndrome (327.13; G47.13)
5. Hypersomnia due to a medical disorder (327.14; G47.14) 6. Hypersomnia due to medication or substance
7. Hypersomnia associated with psychiatric disorder (327.15; F51.13) 8. Insufficient sleep syndrome (307.44; F51.12)
9. Isolated symptoms and normal variants: Long sleeper Circadian rhythm
sleep-wake disorders
1. Delayed sleep-wake phase disorder (327.31; G47.21) 2. Advanced sleep-wake phase disorder (327.32; G47.22) 3. Irregular sleep-wake rhythm disorder (327.33; G47.23) 4. Non-24-hour sleep-wake rhythm disorder (327.34; G47.24) 5. Shift work disorder (327.36; G47.26)
6. Jet lag disorder (327.35; G47.25)
7. Circadian sleep-wake disorder not otherwise specified (327.30; G47.20) Parasomnias 1. NREM-related parasomnias: Disorders of arousals (from NREM
sleep)
(a) Confusional arousals (327.41; G47.51) (b) sleepwalking (307.23; F51.3) (c) sleep terrors (307.23; F51.4)
(d) sleep-related eating disorders (327.40; G47.59) 2. REM-related parasomnias:
(a) REM sleep behavioural disorder (327.42; G47.52) (b) recurrent isolated sleep paralysis (327.43; G47.51) (c) nightmare disorder (307.47; F51.5)
3. Other parasomnias:
(a) exploding head syndrome (327.49; G47.59) (b) sleep-related hallucinations (368.16; H53.16) (c) sleep enuresis (788.36; N39.44)
(d) Parasomnias due to a medical disorder (327.44; G47.54) (e) Parasomnias due to a medication or substance
(f) Parasomnias, unspecified (327.40; G47.50)
4. Isolated symptoms and normal variants: Sleep talking Sleep-related
movement disorders
1. Restless legs syndrome (333.94; G25.81) 2. Periodic leg movement disorder (327.51; G47.61) 3. Sleep-related leg cramps (327.52; G47.62) 4. Sleep-related bruxism (327.53; G47.63)
5. Sleep-related rhythmic movement disorder (327.59; G47.69) 6. Benign myoclonus of infancy (327.59; G47.69)
7. Propriospinal myoclonus at sleep onset (327.59; G47.69) 8. Sleep-related movement disorders due to a medical disorder
(327.59; G47.69)
9. Sleep-related movement disorder due to medication or substance 10. Sleep-related movement disorder, unspecified (327.59; G47.69) 11. Isolated symptoms and normal variants:
(a) excessive fragmentary myoclonus
(b) hypnagogic foot tremor and alternating leg muscle activation (c) sleep starts
Other sleep disorder
Adapted from the American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual (3rd ed)
into a single chronic insomnia disorder category. Within the central disorders of hypersomnolence, the nomenclature for narcolepsy has been changed to narcolepsy type 1 (with cataplexy) and type 2 (without cataplexy). The expansion of disorders listed within the sleep-related breathing disorders category reflects the increased awareness and research, as well as technological and therapeutic advances, in this area of sleep medicine.
2.4 Technical Publications and Specifications for Recording