Cognitive Behavioral Therapy for Insomnia (CBT-I)

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Topics: Psychotherapy

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Insomnia in DSM-5
According to Dr. Morin, DSM-5 will move away from the distinction between “primary” and “secondary” insomnia that is present in DSM-IV, and instead identify all insomnia as “insomnia disorder.” While the condition description will include a list of comorbid conditions, clinicians won’t have to make a causal attribution of what is primary and what is secondary insomnia, mainly because this is sometimes impossible to do. This is reflected by the removal of the DSM-IV criteria for primary sleep disorder specifying that 1) the sleep disturbance does not occur exclusively during the course of another mental disorder, including conditions like parasomnias and narcolepsy, and 2) the sleep disturbance is not due to the direct physiological effects of a substance (a drug of abuse, a medication), or a general medical condition.

Distinctions would be made based on duration, with acute insomnia presenting for one month or less, sub-acute insomnia lasting one to three months, and persistent insomnia lasting greater than three months.

The diagnosis of persistent insomnia would be made on a primary complaint of dissatisfaction with sleep quality or quantity, occurring at least three nights a week for at least three months (a change from the one-month rule in DSM-IV), plus one or more of the following symptoms (in adults):

  • 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
  • Nonrestorative sleep

These sleep problems must cause distress or impairment, indicated by any of the following symptoms:

  • Fatigue or low energy
  • Daytime sleepiness
  • Cognitive impairments (eg, attention, concentration, memory)
  • Mood disturbance (eg, irritability, dysphoria)
  • Behavioral problems (eg, hyperactivity, impulsivity, aggression)
  • Impaired occupational or academic function
  • Impaired interpersonal/social function
  • Negative impact on caregiver or family functioning (eg, fatigue, sleepiness)

Source: DSM-5 Development, Proposed Revision, M00 Insomnia Disorder.