We will explain the criteria in ICD 11 in simple terms so that all understand them. In the ICD 11, insomnia is a diagnosis under a “Sleep-Wake disorders F07” classification.
Sleep-wake disorders are a group of disorders that include insomnia, hypersomnolence disorders (where excessive sleep is an issue), sleep-related breathing disorders, disorders of the circadian rhythm (the circadian rhythm is the 24-hour biological clock in the body), sleep-related movement disorders, and parasomnia disorders (these are disorders where abnormal physical and behavioural changes occur).
Insomnia disorders are the technical term for sleep reduction disorders or disorders of sleeplessness. These are defined in ICD 11 as symptoms of difficulty in getting to sleep initially leading to people staying awake in bed for several hours or changes in sleep duration (sometimes people keep waking up in between the night and also wake up earlier than usual). Sleeplessness also refers to poor sleep quality (quality is the nature and depth of sleep. So even if a person sleeps 8 hours, they may feel tired due to poor sleep quality).
ICD 11 also requires criteria that this kind of reduced quantity and quality of sleep needed to diagnose Insomnia must not be due to a lack of opportunity to rest, such as no time to sleep for shift workers or people caring for children.
Additional diagnosis criteria require that it cause daytime impairments such as irritability, tiredness despite rest, low mood, general uneasiness, discomfort, and impairment in thinking such as forgetfulness, lack of concentration, and brain fog.
Please note that if there are no difficulties in the daytime, then it is not a disorder of insomnia, as per ICD 11.
So, sleep duration and quality must be affected, daytime functioning must be affected, and this sleep disorder must occur despite having a good opportunity to sleep. According to ICD 11, these are the three main requirements for diagnosing someone with Insomnia.
There are two main subtypes of Insomnia under ICD 11.
Chronic insomnia and Short-term insomnia. There is another subcategory within ICD 11 known as unspecified insomnia.
Chronic means long-standing or longer duration. Chronic insomnia is diagnosed when all the symptoms mentioned above for insomnia and sleep disturbance occur over more than three months, including daytime functioning impairment. Some people who struggle with chronic insomnia may suffer from these sorts of disturbances lasting for several weeks or years together. If the insomnia is due to some other sleep-related disorder, mental disorder, medical condition, or a substance or medication, chronic insomnia is diagnosed if the sleep disturbance causes a separate and significant problem.
Short-term insomnia is another subtype within ICD 11. As the name implies, it is a condition of shorter duration and lasts less than three months. The main symptoms include difficulty falling asleep and staying asleep. However, the main difference between short-term and chronic insomnia criteria is the duration of symptoms, which is less than three months. Even if the opportunity to sleep is present, these difficulties must be present. These are the primary criteria for diagnosing short-term insomnia as a clinical disorder.
Additionally, it must affect a person’s functioning during the daytime. Symptoms include tiredness despite resting, depressed mood or irritability, general fatigue and muscle pain, and brain fog-like symptoms. Some people report sleep-related symptoms but no daytime impairments. Such people will not be diagnosed as having insomnia.
Suppose insomnia is due to some other sleep-wake disorder, a mental disorder, a physical illness, or the use of substances like alcohol or medication. In that case, short-term insomnia should only be diagnosed if it is a separate problem causing impairment to daytime activities.
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