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Cited by 56Sleep and related disordersObstructive Sleep Apnea ResearchMental Health and Psychiatry

The DSM-V Sleep-Wake Disorders Nosology: An Update and an Invitation to the Sleep Community

Open access
Reynolds, Charles F., Redline, Susan·2010·Sleep
DOI 10.1093/sleep/33.1.10PMC PMC2802237
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Abstract

DURING THE PERIOD OF JANUARY 18-MARCH 18, 2010 (APPROXIMATELY), THE AMERICAN PSYCHIATRIC ASSOCIATION IS PLANNING TO POST ON ITS website updates of the DSM-V sleep-wake disorders nosology. The updates will include draft diagnostic criteria, research and clinically based rationales for changes, and proposed dimensional measures of severity. We would like to invite the readers of SLEEP to comment, to offer a rationale and supporting evidence to argue for or against the changes proposed by the DSM-V sleep-wake disorders workgroup, and to propose additional revisions to the criteria. The workgroup's recommended changes will be posted on the website (DSM5.org) on or about January 18, 2010. The overriding goal of the revision has been to enhance the clinical utility, reliability, and validity of the DSM sleep-wake disorders nosology. The primary users of DSM are mental health and general medical clinicians, not sleep disorder specialists. Mindful of these users, the workgroup has sought to simplify the classification of sleep-wake disorders in clinically meaningful ways, to facilitate identification of sleep disorders, and to offer useful dimensional measures of severity. In refining the diagnostic criteria and expanding the accompanying text, the DSM-V workgroup has also strived to incorporate information that reflects major advances in the basic physiology and genetics of sleep conditions, information about lifespan issues, and evidence-based research in treatment outcomes that have occurred in the years since DSM-IV. In this context, we have an abundance of biomarker data (polysomnographic and neurobiologic) generally lacking in other areas of psychiatric diagnosis. Thus, we have an opportunity to model for other areas of psychiatric classification the incorporation of quantitative, physiologic measures into the diagnostic classification system, dimensional measures of severity, and the accompanying text. An important goal of DSM-V sleep nosology will be to improve recognition of sleep disorders by mental health and general medical clinicians, to improve appropriate referrals to a sleep specialist, and to improve the approach to treatment of sleep disorders that are comorbid with other health conditions. The major changes under consideration include: (1) eliminating the diagnosis of “primary insomnia” in favor of “insomnia disorder,” with concurrent specification of clinically comorbid conditions (both medical and psychiatric). Making this change will allow us also to (2) eliminate “sleep disorder related to another mental disorder” and “sleep disorder due to a general medical condition,” in favor of “insomnia disorder” (or “hypersomnia disorder”) with concurrent specification of clinically comorbid conditions. These changes move away from the causal attribution inherent in DSM-IV and simply specify clinically relevant comorbidities. As such they are consistent with the data and recommendations of the 2005 NIH State of the Science position on classification of insomnia disorders. The criteria underscore that the patient has a sleep disorder (either insomnia or hypersomnia) that warrants independent clinical attention, in addition to mental/psychiatric or medical disorders also present. The workgroup will also propose (3) aggregating hypersomnia disorder and narcolepsy without cataplexy, which will be distinguished from narcolepy/cataplexy/hypocretin-1 deficiency disorder. We will also propose (4) breaking up the unitary DSM-IV “breathing-related sleep disorder” into distinct syndromes of obstructive versus central forms of sleep apnea in order to better inform treatment planning. Similar to other workgroups in DSM-V, we will (5) decrease the use of “not otherwise specified” (NOS) as a diagnostic category. This change will encompass elevation of REM sleep behavior disorder and restless legs syndrome to full-fledged diagnostic status (from their current classification in DSM-IV as “not otherwise specified”). We will argue for (6) aggregation of NREM parasomnias under “confusional arousal disorders” (to include confusional arousal disorder, sleep walking, and sleep terrors). Finally, we will propose (7) further elaboration of a greater number of distinct types of circadian rhythm disorders, such as advanced sleep phase syndrome, which were not in DSM-IV. The secondary analyses performed by the workgroup and our reviews of the literature published since DSM-IV are leading to greater and more specific quantification of some criteria, as well as elaboration of epidemiologic, genetic, neurobiological, and treatment response data in the accompanying text. These data serve as concurrent and prognostic validators of the proposed diagnostic categories. We will continue to provide linkages to ICSD nosology in the text, while recognizing that DSM-V diagnoses are often broader in scope than those in ICSD. “Insomnia disorder” is a good example of this. Finally, we anticipate engaging in field trials to assess the clinical uti

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Authors
Reynolds, C. F., & Redline, S.
Affiliations
  • University of Pittsburgh (US)
  • Case Western Reserve University (US)
Corresponding author
Reynolds, Charles F.
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2010-01
Volume
33
Issue
1
Pages
10-11
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.1093/sleep/33.1.10
PMC
PMC2802237
OpenAlex
W1597837278
Cited by
55
References
0
Citations by year
2025: 1 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 4 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 5 · 2014: 6 · 2013: 13 · 2012: 1
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords
DSM-V, sleep-wake disorders, diagnostic criteria, insomnia, comorbidities, psychiatric classification, sleep genetics, sleep physiology
MeSH terms
Humans, Terminology as Topic, Referral and Consultation, Sleep Wake Disorders, United States, Diagnostic and Statistical Manual of Mental Disorders

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