Diagnostic criteria for
Circadian Rhythm Sleep Disorder (Code 307.45 before 10.01.2005)
( cautionary statement )
Persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia, that is due to a mis-matching between the sleep/wake schedule required by a person's environment and their circadian sleep-wake pattern. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The disturbance does not occur exclusively during the course of another Sleep Disorder or other mental disorder and the disturbance is not due to the direct physiological effects of a substance. General characteristics are:
A. A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep-wake schedule required by a person's environment and his or her circadian sleep-wake pattern. B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The disturbance does not occur exclusively during the course of another Sleep Disorder or other mental disorder .
D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Specify type (code):
Delayed Sleep Phase Type (327.31 after 10.01.2005): a persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time
Jet Lag Type (327.35 after 10.01.2005): sleepiness and alertness that occur at an inappropriate time of day relative to local time, occurring after repeated travel across more than one time zone
Shift Work Type (327.36 after 10.01.2005): insomnia during the major sleep period or excessive sleepiness during the major awake period associated with night shift work or frequently changing shift work
Unspecified Type (327.30 after 10.01.2005)
Associated Features:
Learning Problem.
Depressed Mood.
Hyperactivity.
Addiction.
Dramatic or Erratic or Antisocial Personality.
Differential Diagnosis :
Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which one needs to be ruled out to establish a precise diagnosis.
Oppositional Defiant Disorder.
Attention-Deficit/Hyperactivity Disorder.
Manic Episode.
Adjustment Disorder.
Child or Adolescent Antisocial Behavior.
Antisocial Personality Disorder.
Cause:
Circadian Rhythm Sleep Disorder causes periods of insomnia, sleepiness, or both, depending on the time of day and how much time the person has to make up for the insomnia. Only in severe cases of disruption would a person with this type of difficulty seek treatment. The relative normalcy of this disorder is indicated by its subtypes, which include "shift work type" and "jet lag type," along with "delayed sleep phase" and "unspecified" types. Difficulties with adapting to changing work shifts and jet trips are so universal that they hardly deserve to be called disorders, and are so classified only if they cause significant distress or impairment, as with all disorders.
Treatment:
Treatment is varied depending upon the cause of the disorder. This may involve behavioral therapies and drug treatment |