Adding in the "excessive sleep" definition – frequency of at least three times per week for at least 3 months, despite normal sleep duration – dropped the hypersomnia disorder prevalence to 4.7% of the sample. Adding in "significant distress or impairment in cognitive, social, occupational, or other important areas of functioning" further dropped the prevalence to 2.6%, and the differential "hypersomnia is not better accounted for or does not occur exclusively during the course of another sleep disorder" gave a final prevalence of 1.5% (Arch. Gen. Psychiatry 2012;69:71-9).
"This is a threshold for significant daytime distress/impairment that warrants diagnosis. This kind of empirical basis is something we’ve pursued throughout DSM-5 in order to make it less dependent on expert opinion and be more data driven," Dr. Reynolds commented.
Insomnia Disorder 307.42
According to the Sleep-Wake Disorders Work Group, the following is the proposed wording of the new criteria:
A. The predominant complaint is a global sleep dissatisfaction with one or more of the following symptoms:
1. Difficulty initiating sleep (in children: without caregiver intervention).
2. Difficulty maintaining sleep (e.g., frequent or prolonged awakenings with difficulty returning to sleep) (in children: without caregiver intervention).
3. Early morning awakening (e.g., premature awakening with inability to return to sleep).
4. Nonrestorative sleep (adults).
5. Resistance to going to bed (children).
B. The sleep complaint is accompanied by significant distress or impairment in social, occupational, or other important areas of functioning as indicated by the presence of at least one of the following:
1. Fatigue or low energy.
2. Daytime sleepiness.
3. Cognitive impairments (e.g., attention, concentration, memory).
4. Mood disturbance (e.g., irritability, dysphoria).
5. Behavioral problems in children (hyperactivity, impulsivity, aggression).
6. Impaired occupational function.
7. Impaired interpersonal/social function.
8. Impaired academic function (children).
9. Negative impact on caregiver or family function (children).
C. The sleep difficulty is present for at least 3 months (empirical basis to address severity of the complaint).
D. The sleep difficulty occurs despite adequate age-appropriate circumstances and opportunity for sleep. Clinically comorbid Conditions, (may warrant individual work-up/attention):
1. Mental/psychiatric disorder (specify).
2. Medical disorder (specify).
3. Another disorder (specify).
E. The sleep difficulty occurs at least 3 nights per week.
Dr. Reynolds disclosed that he has received funding from the National Institute of Mental Health; the National Institute on Aging; the National Center on Minority Health and Health Disparities; the National Heart, Lung, and Blood Institute; the John A. Hartford Foundation; the American Foundation for Suicide Prevention; the Commonwealth of Pennsylvania; and the UPMC Endowment in Geriatric Psychiatry. Forest Laboratories, Pfizer, Lilly, and Bristol-Myers Squibb have provided pharmaceuticals for his National Institutes of Health–sponsored research.