DSM 5 and Insomnia Basics

What is Insomnia?

Insomnia is characterized by dissatisfaction with sleep quantity/quality. It is associated with difficulty initiating sleep, maintaining sleep, or early-morning awakenings. These symptoms must occur for at least three nights per week and be present for at least the last three months. Untreated insomnia can cause significant distress or impairment in social, occupational, or other important areas of life.³

DSM 5 Characteristics of Insomnia

The Diagnostic and Statistical Manual of Mental Illnesses (DSM-5) provides clear and highly detailed definitions of mental health and brain related problems.¹ In regard to insomnia, the following list highlights the diagnostic criteria utilized in the guideline:

1. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
   • Difficulty initiating sleep.
     
     1. In children, this may manifest as difficulty initiating sleep without caregiver intervention.
   • Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings.
     
     1. In children, this may manifest as difficulty returning to sleep without caregiver intervention.
   • Early morning awakening with inability to return to sleep.
2. Sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
3. Sleep difficulty occurs at least 3 nights per week.
4. Sleep difficulty is present for at least 3 months.
5. Sleep difficulty occurs despite adequate opportunity for sleep.
6. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, parasomnia).
7. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
8. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.²

Treatment for Insomnia

Treatment for insomnia disorder typically includes cognitive-behavioral therapy (CBT) as the first-line treatment. Pharmacotherapy may be considered when CBT is insufficient or inaccessible.²

References

1. Cleveland Clinic. DSM-5. Published October 14, 2022. https://my.clevelandclinic.org/health/articles/24291-diagnostic-and-statistical-manual-dsm-5
2. Sleep-Wake Disorders. Diagnostic and Statistical Manual of Mental Disorders. March 2025. doi:10.1176/appi.books.9780890425787.x12_Sleep-Wake_Disorders
3. Winkelman JW. Clinical practice. Insomnia disorder. N Engl J Med. (2015) 373(15):1437–44. doi: 10.1056/NEJMcp1412740