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1. Insomnia
or disorders of initiating and maintaining
sleep:
A. The predominant complaint is difficulty initiating or
maintaining sleep, or nonrestorative sleep, for at least 1
month.
B. The sleep disturbance (or associated daytime fatigue)
causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
C. The sleep disturbance does not occur exclusively during
the course of narcolepsy, breathing-related sleep disorder,
circadian rhythm sleep disorder, or a parasomnia.
D. The disturbance does not occur exclusively during the
course of another mental disorder (eg, major depressive
disorder, generalized anxiety disorder, a delirium).
2.
Hypersomnia or disorders of excessive daytime sleepiness:
A. The predominant complaint is excessive sleepiness for at
least 1 month (or less if recurrent) as evidenced by either
prolonged sleep episodes or daytime sleep episodes that occur
almost daily.
B. The excessive sleepiness causes clinically significant
distress or impairment in social, occupational, or other
important areas of functioning.
C. The excessive sleepiness is not better accounted for by
insomnia and does not occur exclusively during the course of
another sleep disorder and cannot be accounted for by an
inadequate amount of sleep.
D. The disturbance does not occur exclusively during the
course of another mental disorder.
E. The disturbance is not due to the direct physiological
effects of a substance or a general medical condition.
A. Irresistible attacks of refreshing sleep that occur daily
for at least 3 months.
B. The presence of one or both of the following:
(1) cataplexy (ie, brief episodes of sudden bilateral loss of
muscle tone, most often in association with intense emotion)
(2) recurrent intrusions of elements of rapid eye movement
sleep into the transition between sleep and wakefulness, as
manifested by either hypnopompic or hypnagogic hallucinations or
sleep paralysis at the beginning or end of sleep episodes
C. The disturbance is not due to the direct physiological
effects of a substance or another general medical condition.
A. Sleep disruption, leading to excessive sleepiness or
insomnia, that is judged to be due to a sleep- related breathing
condition (eg, obstructive or central sleep apnea syndrome or
central alveolar hypoventilation syndrome).
B. The disturbance is not better accounted for by another
mental disorder and is not due to the direct physiological
effects of a substance or another general medical condition
(other than a breathing-related disorder).
3.
Parasomnias:
A. Repeated awakenings from the major sleep period or naps
with detailed recall of extended and extremely frightening
dreams, usually involving threats to survival, security, or
self-esteem. The awakenings generally occur during the second
half of the sleep period.
B. On awakening from the frightening dreams, the person
rapidly becomes oriented and alert (in contrast to the confusion
and disorientation seen in sleep terror disorder and some forms
of epilepsy).
C. The dream experience, or the sleep disturbance resulting
from the awakening, causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
D. The nightmares do not occur exclusively during the course
of another mental disorder and are not due to the direct
physiological effect of a substance or a general medical
condition.
A. Recurrent episodes of abrupt awakening from sleep, usually
occurring during the first third of the major sleep episode and
beginning with a panicky scream.
B. Intense fear and signs of autonomic arousal, such as
tachycardia, rapid breathing, and sweating, during each episode.
C. Relative unresponsiveness to efforts of others to comfort
the person during the episode.
D. No detailed dream is recalled, and there is amnesia for
the episode.
E. The episodes cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
F. The disturbance is not due to the direct physiological
effect of a substance or a general medical condition.
A. Repeated episodes of rising from bed during sleep and
walking about, usually occurring during the first third of the
major sleep episode.
B. While sleepwalking, the person has a blank, staring face,
is relatively unresponsive to the efforts of others to
communicate with him or her, and can be awakened only with great
difficulty.
C. On awakening (either from the sleepwalking episode or the
next morning), the person has amnesia for the episode.
D. Within several minutes after awakening from the
sleepwalking episode, there is no impairment of mental activity
or behavior (although there may initially be a short period of
confusion or disorientation).
E. The sleepwalking causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
F. The disturbance is not due to the direct physiological
effect of a substance or a general medical condition.
4. Circadian rhythm disorders:
A. A persistent or recurrent pattern of sleep disruption
leading to excessive sleepiness or insomnia that is due to a
mismatch between the sleep-wake schedule required by a person's
environment and his or her circadian sleep-wake pattern.
B. The sleep disturbance causes clinically significant
distress or impairment in social, occupational, or other
important areas of functioning.
C. The disturbance does not occur exclusively during the
course of another sleep disorder or other mental disorder.
D. The disturbance is not due to the direct physiological
effect of a substance or a general medical condition.
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