Classification of sleep disorders, as developed in the 19th century, used primarily three categories: Insomnia, Hypersomnia and Nightmare. In the 20th century, increasingly in the last half of it, technological discoveries led to rapid advances in the understanding of sleep and recognition of sleep disorders. Major sleep disorders were defined following the development of Electroencephalography (EEG) in 1924 by Hans Berger.
Three systems of classification are in use worldwide:
- the International classification of diseases (ICD) developed by the World Health Organization (WHO) and intended for use by general and more specialized practitioners,
- the Diagnostic and Statistical Manual (DSM) from the American Psychiatric Association (APA) for psychiatrists and general practitioners, and
- the International classification of sleep disorders (ICSD), an advanced system cultured by the American Academy of Sleep Medicine (AASM) for sleep specialists.
The ICD and DSM lump different disorders together while the ICSD tends to split related disorders into multiple discrete categories. There has, over the last 60 years, occurred a slow confluence of the three systems of classification.
Diagnoses of sleep disorders are based on self-assessment questionnaires, clinical interview, physical examination and laboratory procedures. The validity and reliability of various sleep disorders are yet to be proved and need further research within the ever-changing field of "Sleep Medicine". Admittedly, the development of sleep disorder classification remains as much an art as it is a science.
Video Classification of sleep disorders
History
Milestones
The first book on sleep was published in 1830 by Robert MacNish; it described sleeplessness, nightmares, sleepwalking and sleep-talking. Narcolepsy, hypnogogic hallucination, wakefulness and somnolence were mentioned by other authors of the nineteenth century. Westphal in 1877 described first case of narcolepsy, the name coined later by Gelineu in 1880 in association with cataplexy. Lehermitte called it paroxysmal hypersomnia in 1930 to differentiate it from prolonged hypersomnia. Roger in 1932 coined the term parasomnia and classified hypersomnia, insomnia and parasomnia. Kleitman in 1939 recognized types of parasomnias as nightmares, night terrors, somniloquy (sleep-talking), somnambulism (sleepwalking), grinding of teeth, jactatians, enuresis, delirium, nonepileptic convulsions and personality dissociation. Broughton in 1968 developed classification of the arousal disorders as confusional arousals: night terrors and sleep walking. Insomnias were classified as primary and secondary till 1970 when they were recognized as symptoms of other disorders. Sir William Osler in 1906 correlated snoring, obesity and somnolence (sleepiness) to Dicken's description of Joe. Charles Burwell in 1956 recognized obstructive sleep apnea as Pickwickian syndrome. Circadian rhythm sleep disorders were discovered in 1981 by Weitzman as delayed sleep phase syndrome in contrast to advanced sleep phase syndrome in 1979.
Disturbance of sleep first appeared in the 1955 revised edition of ICD-7-R as symptoms of disease. Subsequently, in the 1965 ICD-8 it was expanded into two categories: Specific sleep disorder of sleep and Disturbance of sleep. DSM-II in 1968 included "Disorder of Sleep" as an independent category. In 1979 the American Academy of Sleep Medicine (AASM) published the first major classification of sleep disorders, the "Diagnostic Classification of Sleep and Arousal Disorders" (DCSAD).
Evolution of classifications of sleep disorders
Maps Classification of sleep disorders
The International Classification of Sleep Disorders (ICSD)
The International Classification of Sleep Disorders (ICSD) was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979.
- Disorder of initiating and maintain sleep (DIMS) - Insomnias
- Disorder of Excessive sleep (DOES) - Hypersomnias
- Disorder of sleep wake schedule
- Parasomnias
The International Classification of Sleep Disorders (ICSD) uses a multiaxial system for stating and coding diagnoses both in clinical reports or for data base purposes. The axial system uses International Classification of Diseases (ICD-9- CM) coding wherever possible. Additional codes are included for procedures and physical signs of particular interest to sleep disorders clinicians and researchers. Diagnoses and procedures are listed and coded on three main "axes." The axial system is arranged as follows:
Axis A ICSD Classification of Sleep Disorders
Axis B ICD-9-CM Classification of Procedures
Axis C ICD-9-CM Classification of Diseases (nonsleep diagnoses).
ICSD - I Revised 1997
Dyssomnias
- Intrinsic Sleep Disorders
- Extrinsic Sleep Disorders
- Circadian Rhythm Sleep Disorders
Parasomnias
- Arousal Disorders
- Sleep-Wake Transition Disorders
- Parasomnias Usually Associated with REM Sleep
- Other Parasomnias
Sleep Disorders Associated with Mental, Neurologic, or Other Medical Disorders
- Associated with Mental Disorders
- Associated with Neurologic Disorders
- Associated with Other Medical Disorders
Proposed Sleep Disorders
ICSD 2 and ICSD 3 is tabulated in the main article International Classification of Sleep Disorders
International Classification of Disease (ICD)
ICD-7R 1955
780.7 Disturbance of sleep
ICD-8 1965
306.4 Specific disorder of sleep
780.6 Disturbance of sleep
ICD-9 1975
327 Organic sleep disorders
327.0 Organic disorders of initiating and maintaining sleep [organic insomnia]
- 327.00 Organic insomnia, unspecified
- 327.01 Insomnia due to medical condition classified elsewhere
- 327.02 Insomnia due to mental disorder
- 327.09 Other organic insomnia
327.1 Organic disorder of excessive somnolence [organic hypersomnia]
- 327.10 Organic hypersomnia, unspecified
- 327.11 Idiopathic hypersomnia with long sleep time
- 327.12 Idiopathic hypersomnia without long sleep time
- 327.13 Recurrent hypersomnia
- 327.14 Hypersomnia due to medical condition classified elsewhere
- 327.15 Hypersomnia due to mental disorder
- 327.19 Other organic hypersomnia
327.2 Organic sleep apnea
- 327.20 Organic sleep apnea, unspecified
- 327.21 Primary central sleep apnea
- 327.22 High altitude periodic breathing
- 327.23 Obstructive sleep apnea (adult)(pediatric)
- 327.24 Idiopathic sleep related non-obstructive alveolar hypoventilation
- 327.25 Congenital central alveolar hypoventilation syndrome
- 327.26 Sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere
- 327.27 Central sleep apnea in conditions classified elsewhere
- 327.29 Other organic sleep apnea
327.3 Circadian rhythm sleep disorder
- 327.30 Circadian rhythm sleep disorder, unspecified
- 327.31 Circadian rhythm sleep disorder, delayed sleep phase type
- 327.32 Circadian rhythm sleep disorder, advanced sleep phase type
- 327.33 Circadian rhythm sleep disorder, irregular sleep-wake type
- 327.34 Circadian rhythm sleep disorder, free-running type
- 327.35 Circadian rhythm sleep disorder, jet lag type
- 327.36 Circadian rhythm sleep disorder, shift work type
- 327.37 Circadian rhythm sleep disorder in conditions classified elsewhere
- 327.39 Other circadian rhythm sleep disorder
327.4 Organic parasomnia
- 327.40 Organic parasomnia, unspecified
- 327.41 Confusional arousals
- 327.42 REM sleep behavior disorder
- 327.43 Recurrent isolated sleep paralysis
- 327.44 Parasomnia in conditions classified elsewhere
- 327.49 Other organic parasomnia
- 327.51 Periodic limb movement disorder
- 327.52 Sleep related leg cramps
- 327.53 Sleep related bruxism
- 327.59 Other organic sleep related movement disorders
327.8 Other organic sleep disorders
307.4 Specific disorders of sleep of nonorganic origin
- 307.40 Nonorganic sleep disorder, unspecified
- 307.41 Transient disorder of initiating or maintaining sleep
- 307.42 Persistent disorder of initiating or maintaining sleep
- 307.43 Transient disorder of initiating or maintaining wakefulness
- 307.44 Persistent disorder of initiating or maintaining wakefulness
- 307.45 Circadian rhythm sleep disorder of nonorganic origin
- 307.46 Sleep arousal disorder
- 307.47 Other dysfunctions of sleep stages or arousal from sleep
- 307.48 Repetitive intrusions of sleep
- 307.49 Other specific disorders of sleep of nonorganic origin
780.5 Sleep disturbances
- 780.50 Sleep disturbance, unspecified
- 780.51 Insomnia with sleep apnea, unspecified
- 780.52 Insomnia, unspecified
- 780.53 Hypersomnia with sleep apnea, unspecified
- 780.54 Hypersomnia, unspecified
- 780.55 Disruption of 24 hour sleep wake cycle, unspecified
- 780.56 Dysfunctions associated with sleep stages or arousal from sleep
- 780.57 Unspecified sleep apnea
- 780.58 Sleep related movement disorder, unspecified
- 780.59 Other sleep disturbances
292.85 Drug induced sleep disorders
ICD-NA (1997)
G47 Sleep disorders
- Excl.: nocturnal myoclonus (G25.80), nightmares (F51.5), nonorganic sleep disorders (F51.-), sleep terrors (F51.4), sleepwalking (F51.3)
G47.0 Disorders of initiating and maintaining sleep [insomnias], Excl. altitudinal insomnia (T70.2)
G47.1 Disorders of excessive somnolence [hypersomnias]
G47.2 Disorders of the sleep-wake schedule
- G47.20 Transient sleep wake schedule disorder
- G47.21 Advanced sleep phase disorder
- G47.22 Delayed sleep phase syndromes
- G47.23 Irregular sleep-wake pattern
- G47.24 Non 24 hour sleep wake cycle
- G47.28 Other disorder of sleep wake schedule
G47.3 Sleep apnoea
- Sleep related respiratory failure (ondine)
- Excl. pickwickian syndrome (E66.2), sleep apnoea of newborn (P28.3)
- G47.30 Alveolar hypoventilation syndrome
- G47.31 Central sleep apnoea
- G47.32 Obstructive sleep apnoea
- G47.38 Other sleep apnoea
G47.4 Narcolepsy and cataplexy
- G47.40 Narcolepsy
- G47.41 Cataplexy
- G47.42 Sleep paralysis
- G47.43 Hypnogogic and hypnopompic hallucination
- G47.44 Any combination of narcolepsy, cataplexy, Sleep paralysis, Hypnogogic and hypnopompic hallucination
- G47.48 Other forms of narcolepsy and cataplexy
G47.8 Other sleep disorders
- Excl: Other sudden death, cause unknown (R96-)
- Sleep apnoea (G47.3)
- newborn (R96.-)
- Sudden infent death syndrome (R95)
- G47.80 Other REM sleep related parasomnias
- Excl. nightmares (F51.5), Sleep paralysis (G47.42 )
- G47.800 REM sleep related behavior disorder (phantasmagorias)
- G47.801 Imapired REM sleep related non painful penile eraction
- G47.802 REM sleep related painful penile eraction
- G47.803 REM sleep related cardiac sinus arrest
- G47.804 REM sleep related headache (use additional code if required to indicate type of headache)
- G47.81 Other non REM sleep related parasomnias
- Excl: benign neonatal sleep syndrome (G25.37)
- G47.810 Sleep related bruxism
- G47.811 Sleep related enuresis
- G47.812 Non-REM-sleep related abnormal swallowing syndrome
- G47.813 Nocturnal paroxysmal dystonia
- G47.82 Sleep arousal disorders, confusional arousal, Sleep drunkenness
- G47.83 Sleep-wake transition disorders
- Excl. nocturnal leg cramps (R25.20)
- G47.830 Sleep related rhythmic movement disorder, head-banging (jactatio capitis noctunus)
- G47.831 Sleep starts
- G47.832 Sleepwalking
- G47.84 Kleine-Levin syndrome, Recurrent hypersomnia
- G47.88 Other specified sleep disorders
G47.9 Sleep disorder, unspecified
F51 Nonorganic sleep disorders
- Excl.: sleep disorders (organic) (G47.-)
F51.0 Nonorganic insomnia Excl.: insomnia (organic) (G47.0)
F51.1 Nonorganic hypersomnia Excl.: hypersomnia (organic) (G47.1), narcolepsy (G47.4)
F51.2 Nonorganic disorder of the sleep-wake schedule
- Psychogenic inversion of:
- circadian
- nyctohemeral
- sleep rhythm
- Excl.: disorders of the sleep-wake schedule (organic) (G47.2)
F51.3 Sleepwalking [somnambulism]
F51.4 Sleep terrors [night terrors]
F51.5 Nightmares, Dream anxiety disorder
F51.8 Other nonorganic sleep disorders
F51.9 Nonorganic sleep disorder, unspecified, Emotional sleep disorder NOS
P28.3 Primary sleep apnoea of newborn
- Sleep apnoea of newborn:
- central
- NOS
- obstructive
P28.4 Other apnoea of newborn
- Apnoea (of):
- newborn, obstructive
- prematurity Excl.: obstructive sleep apnoea of newborn (P28.3)
ICD-10-CM 2016
G47 Sleep disorders
G47.0 Insomnia
- G47.00 ...... unspecified
- G47.01 ...... due to medical condition
- G47.09 Other insomnia
G47.1 Hypersomnia
- G47.10 ...... unspecified
- G47.11 Idiopathic hypersomnia with long sleep time
- G47.12 Idiopathic hypersomnia without long sleep time
- G47.13 Recurrent hypersomnia
- G47.14 ...... due to medical condition
- G47.19 Other hypersomnia
G47.2 Circadian rhythm sleep disorders
- G47.20 Circadian rhythm sleep disorder, unspecified type
- G47.21 Circadian rhythm sleep disorder, delayed sleep phase type
- G47.22 Circadian rhythm sleep disorder, advanced sleep phase type
- G47.23 Circadian rhythm sleep disorder, irregular sleep wake type
- G47.24 Circadian rhythm sleep disorder, free running type
- G47.25 Circadian rhythm sleep disorder, jet lag type
- G47.26 Circadian rhythm sleep disorder, shift work type
- G47.27 Circadian rhythm sleep disorder in conditions classified elsewhere
- G47.29 Other circadian rhythm sleep disorder
G47.3 Sleep apnea
- G47.30 ...... unspecified
- G47.31 Primary central sleep apnea
- G47.32 High altitude periodic breathing
- G47.33 Obstructive sleep apnea (adult) (pediatric)
- G47.34 Idiopathic sleep related nonobstructive alveolar hypoventilation
- G47.35 Congenital central alveolar hypoventilation syndrome
- G47.36 Sleep related hypoventilation in conditions classified elsewhere
- G47.37 Central sleep apnea in conditions classified elsewhere
- G47.39 Other sleep apnea
G47.4 Narcolepsy and cataplexy
- G47.41 Narcolepsy
- G47.411 ...... with cataplexy
- G47.419 ...... without cataplexy
- G47.42 Narcolepsy in conditions classified elsewhere
- G47.421 ...... with cataplexy
- G47.429 ...... without cataplexy
G47.5 Parasomnia
- G47.50 ...... unspecified
- G47.51 Confusional arousals
- G47.52 REM sleep behavior disorder
- G47.53 Recurrent isolated sleep paralysis
- G47.54 ...... in conditions classified elsewhere
- G47.59 Other parasomnia
- G47.61 Periodic limb movement disorder
- G47.62 Sleep related leg cramps
- G47.63 Sleep related bruxism
- G47.69 Other sleep related movement disorders
G47.8 Other sleep disorders
G47.9 Sleep disorder, unspecified
F51 Sleep disorders not due to a substance or known physiological condition
F51.0 Insomnia not due to a substance or known physiological condition
- F51.01 Primary insomnia
- F51.02 Adjustment insomnia
- F51.03 Paradoxical insomnia
- F51.04 Psychophysiologic insomnia
- F51.05 Insomnia due to other mental disorder
- F51.09 Other insomnia not due to a substance or known physiological condition
F51.1 Hypersomnia not due to a substance or known physiological condition
- F51.11 Primary hypersomnia
- F51.12 Insufficient sleep syndrome
- F51.13 Hypersomnia due to other mental disorder
- F51.19 Other hypersomnia not due to a substance or known physiological condition
F51.3 Sleepwalking [somnambulism]
F51.4 Sleep terrors [night terrors]
F51.5 Nightmare disorder
F51.8 Other sleep disorders not due to a substance or known physiological condition
F51.9 Sleep disorder not due to a substance or known physiological condition, unspecified
P28.3
Applicable To
- Central sleep apnea of newborn
- Obstructive sleep apnea of newborn
- Sleep apnea of newborn NOS
Approximate Synonyms
- Neonatal primary apnea
- Primary apnea in the newborn
- Sleep apnea, primary, neonatal
ICD-11-Beta - 10 Sleep Wake Disorder 2016
Insomnia disorders
- 8A00 Chronic insomnia
- 8A01 Short-term insomnia
- 8A02 Disorders of initiating and maintaining sleep
- 8A0Y Other specified insomnia disorders
- 8A0Z Insomnia disorders, unspecified
- 8A10 Restless legs syndrome
- 8A11 Secondary restless legs syndrome
- 8A12 Periodic limb movements disorder
- 8A13 Sleep-related bruxism
- 8A14 Sleep-related leg cramps
- 8A15 Sleep-related rhythmic movement disorder
- 8A16 Benign sleep myoclonus of infancy
- 8A1Y Other specified sleep-related movement disorders
- 8A1Z Sleep-related movement disorders, unspecified
8A20 Hypersomnolence disorders
- 8A20.1 Narcolepsy, Type 1
- 8A20.2 Narcolepsy, Type 2
- 8A20.3 Idiopathic hypersomnolence disorder
- 8A20.4 Kleine-Levin syndrome
- 8A20.5 Behaviourally induced hypersomnolence
- 8A20.6 Hypersomnolence due to substances including medications
- 8A20.Y Other specified hypersomnolence disorders
- 8A20.Z Hypersomnolence disorders, unspecified
- 8A30 Central sleep apnoeas
- 8A31 Obstructive sleep apnoea
- 8A32 Sleep-related hypoventilation or hypoxemia disorders
- 8A3Y Other specified sleep-related breathing disorders
- 8A3Z Sleep-related breathing disorders, unspecified
Circadian rhythm sleep-wake disorders
- 8A40 Circadian rhythm sleep-wake disorder, delayed type
- 8A41 Circadian rhythm sleep-wake disorder, advanced type
- 8A42 Circadian rhythm sleep-wake disorder, irregular sleep-wake rhythm type
- 8A43 Circadian rhythm sleep-wake disorder, non-24 hour type
- 8A44 Circadian rhythm sleep-wake disorder, shift work type
- 8A45 Circadian rhythm sleep-wake disorder, jet lag type
- 8A4Y Other specified circadian rhythm sleep-wake disorders
- 8A4Z Circadian rhythm sleep-wake disorders, unspecified
Parasomnia disorders
Disorders of arousal in non-REM sleep
- 8A50 Confusional arousals
- 8A51 Sleepwalking disorder
- 8A52 Sleep terrors
- 8A5Y Other specified disorders of arousal in non-REM sleep
- 8A5Z Disorders of arousal in non-REM sleep, unspecified
- 8A60 Sleep-related eating disorder
8A61 REM sleep behavior disorder
- 8A62 Recurrent isolated sleep paralysis
- 8A63 Nightmare disorder 8A63 Nightmare disorder
- 8A64 Hypnogogic exploding head syndrome
- 8A65 Recurrent isolated sleep-related hallucinations
8A66 Parasomnia disorder due to substances including medications
- 8A6Y Other specified parasomnia disorders
- 8A6Z Parasomnia disorders, unspecified
- 7B60.1 Nocturnal enuresis
- 8A70 Disorders of the sleep-wake schedule
- 8A71 Parasomnia
- 8A72 Sleeptalking
- 8A7Y Other specified sleep-wake disorders
- 8A7Z Sleep-wake disorders, unspecified
- ME21 Dyssomnia
DSM Classification of Sleep Disorders
- Diagnostic and Statistical Manual (DSM) classification of sleep disorder was first introduced in 1968.
DSM II - 1968
- Disorders of Sleep
DSM III - 1980
- Other disorders with physical manifestation
- Sleep walking
- Sleep terror
DSM III-R 1987
Sleep Disorder
Dysomnias (disorders of amount, quality or time of sleep)
- Insomnia
- Hypersomnia
- Sleep wake schedule disorder
Parasomnia (abnormal event during sleep)
- Nightmare disorder
- Sleep terror
- Sleep walking
DSM IV TR Sleep Disorders
DSM-V Sleep Wake Disorders
Major changes from DSM IV
The DSM-5 Sleep-Wake Disorders Work Group worked closely with other nosology systems (e.g., International Classification of Sleep Disorders, third edition [ICSD-3]) to incorporate changes in diagnoses - DSM-5 sleep-wake disorders are now more in sync with other medical disorders and sleep disorders classificatory systems. In DSM-5, the pathological and etiological factors associated with sleep-wake disorders are taken into consideration, as is the increase in awareness and knowledge gained from sleep studies. The aim is to increase uniformity and consistency among health care professionals when they are assessing and treating patients with various sleep disorders.
Growing evidence has shown that sleep disorders coexist with other medical and psychiatric disorders and may not be mutually exacerbating. DSM-5 underscores the need for independent clinical attention of a sleep disorder regardless of mental or other medical problems that may be present. DSM-5 also recognizes that coexisting medical conditions, mental disorders, and sleep disorders are interactive and bidirectional.
Sleep disorders related to another mental disorder, and sleep disorders related to a general medical condition" were deleted. Primary insomnia became insomnia disorder, and narcolepsy is separate from other hypersomnolence. There are now three breathing-related sleep disorders: obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation. Circadian rhythm sleep-wake disorders were expanded to include advanced sleep phase syndrome, irregular sleep-wake type, and non-24-hour sleep-wake type. Jet lag was removed. Rapid eye movement sleep behavior disorder and restless legs syndrome are each a disorder, instead of both being listed under "dyssomnia not otherwise specified" in DSM-IV. Sleep-wake disorders comprise 11 diagnostic groups:"
-
- M00 Insomnia disorder
- M01 Hypersomnolence Disorder
- M02 Narcolepsy/Hypocretin Deficiency
- M03 Obstructive Sleep Apnea Hypopnea Syndrome
- M04 Central Sleep Apnea
- M05 Sleep-Related Hypoventilation
- M06 Circadian Rhythm Sleep-Wake Disorder
- M07 Disorder of Arousal
- M08 Nightmare Disorder
- M09 Rapid Eye Movement Sleep Behavior Disorder
- M10 Restless Legs Syndrome
- M11 Substance-Induced Sleep disorder
- Sleep-Wake Disorders Not Elsewhere Classified
- Insomnia Disorder Not Elsewhere Classified
- Major Somnolence Disorder (Hypersomnia Not Elsewhere Classified) The following specifiers apply to Sleep-Wake Disorders where indicated: Specify if: Episodic, Persistent, Recurrent Specify if: Acute, Subacute, Persistent Specify current severity: Mild, Moderate, Severe
References
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