DSM 5 and Insomnia Basics

DSM 5 and Insomnia Basics

Viral Patel
Viral Patel

Galt Pharmaceuticals Medical Affairs Fellow, 2024-2025

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

 

 

 

 

The Importance of Proper Sleep Hygiene

The Importance of Proper Sleep Hygiene: How to Improve Your Sleep

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

Sleep is a crucial part of our health and well-being, yet many of us struggle to get enough of it. Busy schedules, stress, and lifestyle habits can all interfere with our ability to rest properly. Good sleep hygiene involves practicing behaviors that help optimize the quality and duration of sleep, improving both physical and mental health.

1. Maintain a Consistent Sleep Schedule

One of the most effective ways to improve sleep hygiene is to go to bed and wake up at the same time every day, even on weekends. This consistency helps regulate your body’s internal clock, known as the circadian rhythm. Studies show that irregular sleep schedules can lead to poor sleep quality and daytime fatigue.

Tip: Try setting a consistent bedtime routine, including a wind-down period before bed to signal to your body that it’s time to sleep.

2. Create a Relaxing Bedtime Routine

Engaging in relaxing activities before bed can help you unwind and prepare for restful sleep. This might include reading a book, meditating, or taking a warm bath. Avoid stimulating activities such as using electronic devices, which emit blue light that can interfere with melatonin production, the hormone responsible for sleep.

Tip: Consider using dim lighting and staying away from screens at least 30 minutes before bed.

3. Optimize Your Sleep Environment

Your bedroom environment plays a crucial role in sleep quality. A cool, quiet, and dark environment is ideal for promoting restful sleep. Using blackout curtains or a sleep mask can help block out light, while earplugs or white noise machines can minimize noise distractions.

Tip: Make sure your mattress and pillows are comfortable and supportive to prevent waking up with aches or pains.

4. Be Mindful of Your Diet

What you eat and drink can have a significant impact on your sleep. It’s best to avoid large meals, caffeine, and alcohol close to bedtime. Caffeine is a stimulant that can interfere with your ability to fall asleep, while alcohol might make you feel sleepy initially but can disrupt your sleep later in the night.

Tip: Consider having a light snack before bed if you’re hungry, such as a banana or a small bowl of oatmeal, which can promote sleep by increasing serotonin levels.

5. Get Regular Exercise

Regular physical activity can enhance sleep quality, reduce the time it takes to fall asleep, and even increase the amount of deep sleep you get. However, exercising too close to bedtime can be stimulating and interfere with sleep.

Tip: Aim to finish vigorous exercise at least three hours before bedtime to allow your body to wind down.

6. Limit Naps During the Day

While short naps can be refreshing, longer naps during the day, especially in the afternoon, can make it harder to fall asleep at night. If you need to nap, try to keep it to 20-30 minutes.

Tip: If you feel the need for a nap, consider doing it earlier in the day to avoid interfering with nighttime sleep.

7. Manage Stress and Anxiety

Stress and anxiety are common causes of sleep difficulties. Incorporating relaxation techniques into your daily routine, such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation, can help ease your mind and promote better sleep.

Tip: Journaling before bed can help clear your mind by writing down any worries or thoughts that might keep you awake.

Conclusion

Improving sleep hygiene is a process that involves making small, consistent changes to your daily habits. By following these strategies, you can create a sleep-friendly environment and develop routines that help you get the restful sleep your body needs. Proper sleep doesn’t just improve how you feel today, it contributes to long-term health and well-being.

References:

  1. Harvard Health Publishing. (2019). Blue light has a dark side. Retrieved from https://www.health.harvard.edu
  2. National Sleep Foundation. (2021). The connection between sleep and physical activity. Retrieved from https://www.sleepfoundation.org
  3. Centers for Disease Control and Prevention. (2020). Sleep Hygiene Tips. Retrieved from https://www.cdc.gov
  4. American Sleep Association. (2021). The effects of alcohol on sleep. Retrieved from https://www.sleepassociation.org
  5. Mayo Clinic. (2022). Sleep tips: 6 steps to better sleep. Retrieved from https://www.mayoclinic.org