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Diagnostic criteria for chronic insomnia disorder (ICSD-3-TR)

Diagnostic criteria for chronic insomnia disorder (ICSD-3-TR)
Criteria A through F must be met:
A The patient reports, or the patient's parent or caregiver observes, one or more of the following:
  • Difficulty initiating sleep*
  • Difficulty maintaining sleep*
  • Final awakening earlier than desired
  • Resistance to going to bed on an appropriate schedule
  • Difficulty sleeping without parent or caregiver presence or intervention
B The patient reports, or the patient's parent or caregiver observes, one or more of the following related to the nighttime sleep difficulty:
  • Fatigue/malaise
  • Impaired attention, concentration, or memory
  • Impaired social, family, occupational, or academic performance
  • Mood disturbance/irritability
  • Subjective daytime sleepiness
  • Behavioral problems (eg, hyperactivity, impulsivity, aggression)
  • Reduced motivation/energy/initiative
  • Proneness for errors/accidents
  • Concerns about or dissatisfaction with sleep
C The reported sleep-wake complaints cannot be explained purely by inadequate opportunity (ie, time allotted for sleep) or inadequate circumstances (ie, safety, darkness, quiet, and comfort) for sleep.
D The sleep disturbance and associated daytime symptoms occur at least three times per week.
E The sleep disturbance and associated daytime symptoms have been present for at least three months.
F The sleep disturbance and associated daytime symptoms are not solely due to another current sleep disorder, medical disorder, mental disorder, or medication/substance use.

* In general, among adults, delays in sleep onset and periods of awakening in the middle of the night >30 minutes connote clinical significance. Thresholds in infants and children are less well established and are age-dependent. Among very young children, clinical significance also depends on the level of caregiver involvement needed for the child to sleep.

¶ In general, among adults, early morning awakening entails the termination of sleep >30 minutes before the desired rising time and a concomitant reduction in total sleep time compared with the usual premorbid sleep pattern.
Reproduced with permission from: International Classification of Sleep Disorders, 3rd ed, text revision, American Academy of Sleep Medicine 2023. Copyright © 2023 American Academy of Sleep Medicine.
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