What are the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) makes no distinction between primary and comorbid insomnia. This previous distinction had been of questionable relevance in clinical practice and a diagnosis of insomnia is made if an individual meets the diagnostic criteria, despite any coexisting conditions. The International Classification of Sleep Disorders, Third Edition (ICSD-3) criteria are consistent with the changes to the DSM-5.

The DSM-5 defines insomnia as dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: [11]

  • Difficulty initiating sleep

  • Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings

  • Early-morning awakening with inability to return to sleep

Other criteria include the following:

  • The sleep disturbance causes clinically significant distress or impairments in social, occupational, educational, academic, behavioral, or other important areas of functioning

  • The sleep difficulty occurs at least 3 nights per week

  • The sleep difficulty is present for at least 3 months

  • The sleep difficulty occurs despite adequate opportunity for sleep

  • The insomnia cannot be explained by and does not occur exclusively during the course of another sleep-wake disorder

  • The insomnia is not attributable to the physiological effects of a drug of abuse or medication.

  • Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia

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