DSM-IV-TR Diagnostic Criteria for Primary Insomnia

DSM is short for Diagnostic and Statistical Manual of Mental Disorders. It is published by the American Psychiatric Association and privides a common language and standard criteria for the classification of mental disorders. It is used in the United States and in varying degrees around the world. DSM-IV-TR is the "test revision" of its fifth edition.

Primary insomnia is defined as follows in DSM-IV-TR.

A. The predominant complaint is difficulty initiating or maintaining sleep, or nonrestorative sleep, for at least 1 month.
A1.1. The predominant complaint is difficulty initiating sleep
SL1 = 3-7 (problems getting to sleep ≥3 and ≤7 nights a week) AND
SL3 ≥ 30 minutes (it takes 30 or more minutes to get to sleep those nights)
OR
A1.2. The predominant complaint is difficulty maintaining sleep
A1.2a. Waking multiple times (waking 3 or more times at night)
SL4 = 3-7 (problems staying asleep ≥3 and ≤7 nights a week) AND EITHER
[(SL6 ≥ 3: waking 3 or more times)
OR
A1.2b. Taking a long time to get back to sleep after awakening at night (30 or more minutes awake)
SL4 = 3-7 (problems staying asleep ≥3 and ≤7 nights a week) AND EITHER
[(SL5.1 ≥ 30 minutes awake at night) OR (SL7: Number of minutes it takes to get back to sleep) x (SL6: Number of awakenings) ≥ 30 minutes]
OR
A1.2c. Waking too early in the AM (30 or more minutes early)
SL8 = 3-7 (problems waking too early in the morning ≥3 and ≤7 days a week) AND
SL10 ≥ 30 minutes (R wakes 30 or more minutes early those mornings)
OR
A1.3. The predominant complaint is nonrestorative sleep
SL11 = 3-7 (problems feeling unrefreshed in the morning ≥3 and ≤7 days a week) AND
SL13 = 2-4 (the severity of the problem waking up feeling nonrefreshed is either moderate, severe, or very severe) AND
SS5+SS6 >= 7 hours (R has adequate opportunity for sleep) AND
A1.1 = No and A1.2a= No and A1.2b=No and A1.2c=No (R doesn’t have any other sleep problem)
AND
A2. The complaint has lasted at least one month
SL21 ≥ 30 days (For how many weeks, months, or years have you had at least one of these problems?)
B. The sleep disturbance (or associated daytime fatigue) causes clinically significant
distress or impairment in social, occupational, or other important areas of
functioning.
We created a count of responses to all the daytime impairment items to operationalize this criterion.
SUM the number of responses in the SL28-34 series that were coded 3-4 plus whether or not SL35 was coded 4 plus whether or not 36A was coded 3-4 plus whether or not SL36B was coded 4-5 (you only get 1 point if either 36A or 36B was in the range) plus the sum of the SL41-44 series that were coded 7-10.
Impairment is initialized to zero.
28. reduced motivation mod/sev - If SL28=3 or 4 then impairment=impairment + 1
29. reduced performance at work, school, or social activities mod/sev - IF SL29=3 or 4 then impairment = impairment + 1
30. errors or accidents mod/sev - If SL30=3 or 4 then impairment=impairment + 1
31. irritability, nerves, mood disturbance mod/sev - If SL31=3 or 4 then impairment=impairment + 1
32. daytime attention, concentration, or memory problems mod/sev - If SL32=3 or 4 then impairment=impairment + 1
33. daytime fatigue mod/sev - If SL33=3 or 4 then impairment=impairment + 1
34. daytime sleepiness mod/sev - If SL34=3 or 4 then impairment=impairment + 1
35. tension headaches or digestive problems SEVERE (NOT MOD/SEV) - If SL35=4 then impairment=impairment + 1
36A. concerns or worries about your sleep mod/sev
36B. worried or distressed about sleep problems much/very much – If SL36a OR SL36b=3 or 4 then impairment=impairment+1
41. sleep probs interfered with home management 7-10/0-10 - If SL41 ≥ 7 then impairment=impairment +1
42. sleep probs interfered with ability to work 7-10/0-10 - If SL42 ≥ 7 then impairment=impairment +1
43. sleep probs interfered with social life 7-10/0-10 - If SL43 ≥ 7 then impairment=impairment +1
44. sleep probs interfered with close relationships 7-10/0-10 - If SL44 ≥ 7 then impairment=impairment +1
We say that Criterion B is met if impairment ≥ 2.
C. The sleep disturbance does not occur exclusively during the course of narcolepsy,
breathing-related sleep disorder, circadian rhythm sleep disorder, or parasomnia.
NOT OPERATIONALIZED
D. The disturbance does not occur exclusively during the course of another mental
disorder (e.g., major depressive disorder, generalized anxiety disorder, a delirium).
NOT OPERATIONALIZED
E. The disturbance is not due to the direct physiological effects of a substance.
NOT OPERATIONALIZED