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ICSD-2 Classification
I. Insomnia•
Adjustment Insomnia •
Psychophysiological Insomnia •
Paradoxical Insomnia •
Idiopathic Insomnia •
Insomnia Due to
Mental Disorder •
Inadequate Sleep
Hygiene •
Insomnia due to Drug
or Substance •
Insomnia due to
Medical Condition •
Insomnia not due to
substance or known Physiologic Condition, Unspecified •
Physiologic (Organic)
Insomnia, Unspecified
General Criteria for Insomnia
•
Fatigue or malaise •
Attention,
concentration or memory impairment •
Social or vocational
dysfunction or poor school performance •
Mood disturbance or
irritability •
Daytime sleepiness •
Motivation, energy or
initiation reduction •
Proneness for errors
accidents at work or while driving •
Tension, headaches or
GI symptoms in response to sleep loss •
Concerns or worries
about sleep Adjustment Insomnia•
Diagnostic Criteria –
Symptoms meet criteria
for insomnia –
Temporally associated
with stressor –
Sleep disturbance is
expected to resolve when the acute stressor resolves or the patient adapts to
the stressor –
lasts < 3 months •
Prevalence 15-20%,
more common in women and older adults •
Previous history of
insomnia, anxiety or depressive symptoms predispose people to adjustment
insomnia •
If insomnia starts
out as an adjustment insomnia but persists longer than 3 months, should be
classified as one of the chronic insomnias •
PSG findings (from
experimental models) include prolonged sleep latency, increased awakenings,
short TST, decreased sleep efficiency Psychophysiological Insomnia•
Diagnostic Criteria –
Symptoms meet
criteria for insomnia –
Insomnia is present
for At least 1 month –
Patient has conditioned
sleep difficulty and/or heightened arousal in bed as indicated by at least 1: •
Excessive focus and
anxiety about sleep •
Difficulty in falling
asleep when planned but not during monotonous activities •
Sleeps better away
from home •
Mental arousal in bed
characterized by intrusive thoughts or perceived inability to volitionally
cease sleep preventing activity •
Heightened somatic
tension in bed •
1-2% of the general
population •
12-15% of sleep
clinic •
PSG may show
prolonged sleep latency, increased WASO, decreased sleep efficiency,
increased stage 1, decreased SWS •
Patients with
conditioned response to home may have a reverse first-night effect (i.e.
sleep better in the lab) •
Often underestimate
TST, but no to the extent of paradoxical insomnia •
MSLT often normal
(MSL 10-15 min) and appear hyper-aroused •
Actigraphy often overestimates sleep as patients tend to lie
in bed motionless while awake Paradoxical Insomnia•
Diagnostic Criteria –
Symptoms meet
criteria for insomnia –
Insomnia present for
at least 1 month, –
with at least 1 of: •
Chronic pattern of
little or no sleep •
Sleep log with very
shortened average sleep time, often no naps •
Mismatch between PSG
or actigraphy and subjective sleep estimates –
At least 1 of the
following •
Reports constant or
near constant awareness of environment throughout most nights •
Reports conscious
thoughts while laying in bed –
Daytime impairment is
not as severe as expected for reported sleep deprivation •
Accounts for < 5%
of insomnia patients •
PSG is typically
normal –
Estimates of sleep
latency at least 1.5 times objectively measured –
Estimates of TST are
often 50% or less than objectively measured Idiopathic Insomnia•
Diagnostic Criteria –
Symptoms meet
criteria for insomnia –
Insomnia is present
for at least 1 month –
A mental disorder has
been diagnosed according to standard criteria –
The insomnia is
temporally related to the mental disorder, although insomnia may predate the
mental disorder by days to weeks –
The insomnia is more
prominent than typical for the mental disorder •
Initiation insomnia
common with anxiety disorders, whereas maintenance insomnia and early morning
awakening typical with depression •
Most common chronic
insomnia in sleep clinic •
PSG findings of
fragmented sleep same as other insomnias –
In addition, may see
decreased REM latency and increased REM density, particularly with depression Inadequate Sleep Hygiene•
Diagnostic Criteria –
Symptoms meet
criteria for insomnia –
Insomnia is present
for at least 1 month –
Inadequate sleep
hygiene practices (at least 1) •
Improper sleep
scheduling, frequent daytime napping, selecting highly variable bedtime or
rise times or spending excessive amounts of time in bed •
Routine use of
alcohol, nicotine, caffeine prior to bed •
Engagement in
mentally stimulating, physically activating or emotionally upsetting
activities too close to bedtime •
Frequent use of the
bed for activities other than sleep (TV, reading, studying, snacking,
thinking, planning) •
Failure to maintain a
comfortable sleeping environment •
The sleep disruptive effects of poor sleep hygiene are often
obvious to others, but the patients show little insight into this fact. Insomnia due to Drug or Substance•
Prescription
medications –
Certain
antidepressants, anti-hypertensives, lipid lowering
medications, corticosteroids, anti-parkinsonian
drugs, theophylline, anorectic agents,
antiepileptic medications, pseudoephedrine, stimulant use; withdrawal of
sedatives •
Recreational Drugs –
Cocaine, amphetamines –
Alcohol leads to
decreased SOL but fragmented sleep •
Foods –
Caffeine •
Toxins, allergens Insomnia due to Medical Condition•
Timing of insomnia
relates to onset of symptoms from medical condition •
Common conditions –
Pain syndromes –
COPD, asthma –
Neurologic disorders –
Menopause –
Pregnancy
Reference:The International Classification of Sleep Disorders,
Second Edition. The |
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