SSD3377 - SECTION 14: INFORMATION THAT INDICATES SUBSTANCE/MEDICATION-INDUCED SLEEP DISORDER
Section 14: Information that Indicates Substance/Medication-Induced Sleep Disorder
DSM-5-TR Code: F10.182, .282, .982 Alcohol
DSM-5-TR Code: F15.982 Caffeine (without use disorder)
DSM-5-TR Code: F12.182, .282, .982 Cannabis
DSM-5-TR Code: F11.182, .282, .982 Opioid
DSM-5-TR Code: F13.182, .282, .982 Sedative, hypnotic, anxiolytic
DSM-5-TR Code: F15.182, .282, .982 Amphetamine, stimulant
DSM-5-TR Code: F14.182, .282, .982 Cocaine
DSM-5-TR Code: F17.282 Tobacco (without use disorder)
DSM-5-TR Code: F19.182, .282, .982 Other or unknown substance
Common Specifiers:
- Insomnia type
- Daytime sleepiness type
- Parasomnia type
- Mixed type
Common Specifiers:
- With onset during intoxication
- With onset during discontinuation/withdrawal
Prevalence: While there is no absolute prevalence information, studies suggest that 25-96% of persons who abuse substances or are withdrawing from substances have problems with sleep that may approach or reach the status of a sleep disorder.
Can this disorder legitimately be diagnosed by a Master’s level Clinician? Yes, with great caution under limited circumstances. If signs and symptoms suggest that the sleep disorder may be attributable to other factors, a referral to a sleep specialist is indicated in order to rule out other diagnoses.
As has been noted in earlier sections of this course, there are a number of medications and psychoactive substances that can contribute to, or be responsible for, sleep disturbances. The difficult part of the diagnostic process with regard to establishing this diagnosis is determining whether the medication/substance use 1) is the primary reason for the sleep disturbance, 2) creates another diagnosis comorbid with the sleep disturbance, or 3) is just concurrent with the sleep disturbance with no contribution to the development of a sleep disturbance.
In attempting to establish whether the sleep disorder exists comorbidly with a substance use disorder, it is important to establish that the factors related to the substance usage meet the criteria for a diagnosis the person of substance use disorder. Not everyone who uses a psychoactive substance will, in fact, meet the criteria. In such instances, it would be inappropriate to specify that there is a sleep disorder comorbid with a substance use disorder.
Likewise, not every person who takes a medication or uses a substance that may create sleep disturbances will necessarily develop a sleep disorder as a result of that substance or medication. There are variable responses to the use of any substance. If a client had a sleep disturbance prior to the administration of a new medication, and the sleep disturbance remains substantially the same, then it is difficult to ascribe the persistence of the sleep disturbance to the addition of the new medication.
Likewise, not every client who uses a psychoactive substance will experience sleep disturbances due to the use of that substance. Again, it is important to gather history concerning the existence of a sleep disturbance prior to the use of the psychoactive substance. A sizeable number of people attempt to use psychoactive substances in order to medicate themselves in a sometimes ill-informed attempt to improve their sleep.
In such circumstances a little further assessment work may be indicated. Complex psychoactive substances, like alcohol or barbiturates, may have some effects that make it easier for some people to relax and fall asleep, but which may contribute to other kinds of sleep problems over time. Diagnosis of this sleep disorder must be made by a thorough assessment of the substance’s effects in the context of the client’s full experience over time.
Where the assessment process does not reveal a sufficient degree of clarity, it may be more appropriate to apply the specifiers “Rule out” or “Provisional” to the use of this diagnosis. This would allow the opportunity to engage in an ongoing assessment process, including an exchange of information with other health care providers, i.e., any physician responsible for supervision of medications the client may be taking.