DSM-5 work group proposes updated sleep disorders

PHILADELPHIA — Researchers have suggested changes to sleep disorder criteria in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, here at the 2012 American Psychological Association Annual Meeting.

Charles Reynolds, MD, chair of the APA work group assigned to oversee proposed changes in sleep disorder criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), said sleep disorders presented a significant challenge to the inclusion of new criteria in the DSM-5.

“Our fundamental challenge has been take the scientific advances that have occurred in sleep disorders medicine,” Reynolds said, “particularly over the last dozen years or so, since DSM-IV, and to make them user friendly, to make them clinically useful for the general mental health clinician and the general medical or pediatric clinician who is not necessarily an expert in sleep disorders.”

Some of the new proposed changes to the sleep disorder criteria in the DSM-5 include:

Dropping the diagnosis of “primary insomnia” in favor of “insomnia disorder,” with concurrent specification of clinically comorbid conditions (medical and psychiatric).

Dropping “sleep disorder related to another mental disorder” and “sleep disorder related to a general medical condition” in favor of “insomnia disorder” or “hypersomnia disorder” with concurrent specification of clinically comorbid conditions.

These changes, according to Reynolds, emphasize that the patient has a sleep disorder requiring independent clinical attention, as well as having psychiatric and medical disorders present. He said the changes acknowledge “bidirectional or interactive effects between sleep disorders and coexisting medical-psychiatric conditions.”

Other major changes to the diagnostic criteria include the distinction between narcolepsy and hypocretin deficiency from other forms of hypersomnia disorder. To inform better treatment planning, a subtype of breathing-related sleep disorders was created with “obstructive” vs. “central” categories, Reynolds said.

The work group also proposed to “elevate REM sleep behavior disorder and restless legs syndrome into full-fledged diagnostic status,” and add sleep phase syndrome to the subtype circadian rhythm sleep disorder.

Reynolds reminded clinicians that complaints of sleep/wake disturbance can pose significant risks in the new onset of mental or substance abuse disorders.

“If you think, for example, about the patient you may be treating for depression,” Reynolds said, “if she continues to have complaints of insomnia after you treat her for depression, it’s very clear that her long-term course may be a stormy one. She is at heightened risk for a relapsing-recurring course of depressive illness. There is a very deep, intrinsic relationship between sleep/wake complaints and whole variety of common mental disorders that have both diagnostic and also treatment and prognostic implications for us.”

For more proposed changes to the DSM-5, visit http://www.dsm5.org.

For More Information:
DSM-5. Symposium S044-2. Presented at: the 2012 American Psychiatric Association Annual Meeting; May 5-9, 2012; Philadelphia.

Disclosure: The presenters report no relevant financial disclosures.