The DSM-5 Sleep Disorders workgroup has been especially busy. They are calling for a nearly complete overhaul of the sleep disorders category in the Diagnostic and Statistical Manual of Mental Disorders (“DSM”).
According to a presentation at the annual meeting of the American Psychiatric Association in May, Charles Reynolds, MD, suggested that the reworking of this category will make sleep problems easier for professionals to diagnose and discriminate between different sleep disorders.
He stated that the current DSM-IV puts too much emphasis on presumed causes of symptoms, something that the rest of the DSM-IV does not do. Bringing the sleep disorder section more in line with the other sections in the DSM should make it less confusing.
Primary and commonly diagnosed sleep disorders are being organized in the DSM-5 into three major categories: insomnia, hypersomnia and arousal disorder. The new DSM will allow professionals to choose amongst sub-types in each category, as can be done with many other major disorders in the manual.
Here’s a summary of some of the proposed additions and changes in the sleep disorders category for the DSM-5, slated for publication in May 2013.
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What about narcolepsy and other cental hypersomnias?
“Kleine Levin Syndrome: This syndrome is characterized by a person who experiences recurrent episodes of excessive sleep (more than 11 hours/day). These episodes occur at least once a year, and are between 2 days and 4 weeks in duration.”
So if I am excessively tired for two days a year and cannot seem to function well during these two days, then I am suffering from a disorder?
To be perfectly honest, half of the diagnoses there sound like adolescence, and the other half like old age. My circadian rhythm is totally out of sync with the rest of the world, but at least I am sleeping nowadays… So, I really don’t mean to say that a person suffering from these symptoms for an extended period of time was not suffering*, but to the layman that I am, the list above seems to imply that sleeping per se warrants a diagnosis, now.
I’m thinking these diagnoses are beginning to cross-the-line into medical issues, areas in which a patient requires primary medical testing and intervention by qualfied personnel.
Seems like dangerous territory here…
I seriously recommend guidance to encourage users of DSM to initially R/O possible medical conditions prior to slapping-on a purely psychiatric dx.
Just an opinion here.
Psychiatrists are MDs so they are trained to do “medical” diagnoses. All psychiatric diagnoses are “medical” diagnoses.
I am surprised by the exclusion of hypersomnias on this list unless Dr. Grohol forgot them.
My thoughts when reading some of this have to do with these disorders being more medical than mental health related. The DSM is a diagnostic manual, not a treatment manual, but it seems that if a manual for use by mental health professionals includes these disorders, then mental health professionals will also need some guidelines for treating these disorders. Some will require referral to medical providers.
I am always interested in the circadian rhythm disorders, because I definitely meet those criteria. Here I am at 3:30 AM wide awake and wondering if I will be able to be awake at the proper times during the day – I’m seriously challenged in the morning, as that’s my best sleeping time. I have read research that draws connections between circadian rhythm and mood disorders, and see evidence of that in myself. I’m particularly interested in how the Sleep Disorders Workgroup, or anyone else, would suggest treating this. None of the therapists I have gone to have cared about circadian rhythm. They tend to dismiss it.
One thing that I have learned is that it isn’t helpful generally to identify problems without also identifying solutions.
I agree with Rapunzel’s comment that identifying problems with offering solutions isn’t helpful. I have friends and family who suffer from Central sleep apnea. The most common central sleep apnea solutions involve using one or more of a range of options including: treating any rudimentary disease, medication to enhance breathing, and machines that force air into the respiratory passages during sleep.
Great information! Since sleep is so vital to one’s health it is vitally important to have this information available to the public. Thanks!
Great post John, I have also written about sleep disorders in my blog, however I take a slightly more homeopathic direction with it. Very complementary to yours
I have had a few sleepwalkers in my family history. It is a creepy experience when you come face to face with the person sleepwalking: sometimes you ask them questions, like “Where are you going?’ the person answers but the answer doesn’t make sense; the person can look right at you but her don’t really see you.; you stand in his way and he push you aside.
A good night of quality sleep is key to memory and learning.Have a relaxing bedtime routine to get your body ready for sleep disorders fall into different types like: difficulty falling asleep, problems with staying asleep or easily wakes up, inappropriate sleeping hours, sleeping hours too long or too short and abnormal behaviors manifested while asleep like teeth grinding or sleep walking.
hypnosis for sleep
Complicating matters is the increasing incidence of pediatric sleep disorders that prevent children from getting a full night’s rest. These disorders include insomnia, snoring, sleep apnea (associated with an increase in childhood obesity), nightmares and night terrors.
During these sleep studies, monitors record a patient’s snoring, pulse, breathing patterns, sleep stages, oxygenation and exhaled carbon dioxide. These recordings are evaluated the following day by a sleep medicine specialist at Children’s. The specialist can then develop a comprehensive treatment program that incorporates lifestyle changes and medical therapy.
John, you said,
“”As with all mental disorders, sleep disorders must cause a significant impact or distress in the person’s normal, everyday functioning in their life — work, at home, and at play. All of the sleep disorders listed above are proposed to generally not be diagnosed if directly caused by a known medical condition, disease, or impairment in the person’s health.”"
As someone with sleep apnea, I am totally perplexed by these comments as this is caused by a medical condition that frankly, in my opinion, has no business being in the DSM. How a disorder that is due to stopping breathing during sleep ended up in the DSM is beyond me.
I guess if this compelled psychiatrists to routinely order sleep studies before subjecting people to needless drugs who have sleep apnea, it would be more tolerable. But that isn’t what is happening and is a disgrace.
By the way John, as I am sure you are well aware, many people with apnea had no clue how impaired they were. It was only when they were fully treated with a cpap machine, did they realize how wrong they were. So if a medical professional be it a psychiatrist or doctor is making a diagnosis based on someone’s perception of how impaired they are regarding their sleep, that would be a huge mistake that could result in a horrific tragedy.
I am very perplexed by the overt omission of parasomnias, not only as a valid and recognized term, but of the condition known as sexsomnia.
Sexsomnia aka Sleep Sex and Sexual Behavior Sleep is a parasomnia (sleep disorder) that causes a person to engage in sexual relations while asleep with no memory of the event.
Evidently, my aspirations and faith in the APA to formerly recognize sexsomnia are misguided to say the least.
Sexsomnia is a truly terrifying condition to those truly afflicted by this disorder. An ailment that they no more asked for than a person requests cancer.
To this end, I will continue onward as an advocate for Sexsomnia Awareness. Until the day Sexsomnia is recognized as a legitimate disorder by the APA and DSM, taken seriously for extensively funded research to effect positive and healthy treatment for those suffering from sexsomnia.
Based upon this article and my research into the DSM V, launching Sexsomniacs Journey (http://sexsomniacsjourney.com/about/) for Sexsomniacs, those who love us, and the curious as a path to understanding and healing was needed to bring forth further dialogue of and universal enlightenment of this very little known and extremely misunderstood parasomnia, Sexsomnia.
Let us keep up the good fight for ensuring all valid conditions, not only sexsomnia, are formerly registered with the APA for inclusion into the DSM.
Take care and be well.
Respectfully,
Concerned Sexsomniac