Criteria

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Aanpak van slaapklachten en insomnie (slapeloosheid) bij volwassenen in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2018Prise en charge des problèmes de sommeil et de l’insomnie chez l’adulte en première lignePublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2018

Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR)[1]

Major criteria for a diagnosis of insomnia disorder include:

  • Difficulty initiating or maintaining sleep or early-morning awakening that leads to dissatisfaction with sleep quantity or quality.

  • Resulting sleep disturbance leads to significant distress and/or impairment in social, occupational, educational, academic, behavioural, or other important areas of functioning.

  • Patients experience this even with adequate opportunity to sleep, at least 3 nights per week and for at least 3 months.

  • Insomnia is not explained by the presence of mental disorders, substance use, or medical conditions and is not associated with another sleep-wake disorder.

The main characteristic of insomnia related to another mental disorder is the presence of insomnia that is judged to be temporally or causally related to another mental disorder. When insomnia that is sufficient to warrant independent attention is judged by onset or course to be related to intoxication or substance withdrawal, or if medication use is aetiologically related to the sleep disturbance, criteria for a substance-induced sleep disorder may be met.

International Classification of Sleep Disorders 3rd edition, Text Revision (ICSD-3-TR)[2]​

Chronic insomnia disorder

Criteria A-F must be met.

  1. The patient reports, or the patient's carer observes, one or more of the following:

    1. difficulty initiating sleep

    2. difficulty maintaining sleep

    3. final awakening earlier than desired

    4. resistance to going to bed on an appropriate schedule

    5. difficulty sleeping without parent or carer presence or intervention.

  2. The patient reports, or the patient's carer observes, one or more of the following related to the night-time sleep difficulty:

    1. fatigue/malaise

    2. impaired attention, concentration, or memory

    3. impaired social, family, occupational, or academic performance

    4. mood disturbance or irritability

    5. subjective daytime sleepiness

    6. behavioural problems (e.g., hyperactivity, impulsivity, aggression)

    7. reduced motivation/energy/initiative

    8. proneness for errors/accidents

    9. concerns about or dissatisfaction with sleep.

  3. The reported sleep/wake complaints cannot be explained purely by inadequate opportunity (e.g., time allotted for sleep) or inadequate circumstances (e.g., safety, darkness, quiet, comfort) for sleep.

  4. The sleep disturbance and associated daytime symptoms occur at least 3 times per week.

  5. The sleep disturbance and associated daytime symptoms have been present for at least 3 months.

  6. The sleep disturbance and associated daytime symptoms are not solely due to another current sleep disorder, medical disorder, mental disorder, or medication/substance use.

Short-term insomnia disorder

Criteria A-E must be met.

  1. The patient reports, or the patient's carer observes, one or more of the following:

    1. difficulty initiating sleep

    2. difficulty maintaining sleep

    3. final awakening earlier than desired

    4. resistance to going to bed on an appropriate schedule

    5. difficulty sleeping without parent or carer presence or intervention.

  2. The patient reports, or the patient's carer observes, one or more of the following related to the night-time sleep difficulty:

    1. fatigue/malaise

    2. impaired attention, concentration, or memory

    3. impaired social, family, occupational, or academic performance

    4. mood disturbance or irritability

    5. subjective daytime sleepiness

    6. behavioural problems (e.g., hyperactivity, impulsivity, aggression)

    7. reduced motivation/energy/initiative

    8. proneness for errors/accidents

    9. concerns about or dissatisfaction with sleep.

  3. The reported sleep/wake complaints cannot be explained purely by inadequate opportunity (e.g., time allotted for sleep) or inadequate circumstances (e.g., safety, darkness, quiet, comfort) for sleep.

  4. The sleep disturbance and associated daytime symptoms have been present for less than 3 months.

  5. The sleep disturbance and associated daytime symptoms are not solely due to another current sleep disorder, medical disorder, mental disorder, or medication/substance use.

Note that neither the ICSD-3-TR nor the DSM-5-TR have quantitative severity criteria for insomnia disorder; it is up to the clinician to judge what is severe enough to treat.[7]​

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