Box 1. Diagnostic criteria for Circadian Rhythm Sleep-Wake Disorders most common in older adults.
Note that assessment of endogenous circadian rhythmicity (e.g., timing of evening melatonin secretion onset) is not required for diagnosis 4.
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Main criteria for all CRSWDs: • The sleep-wake complaint is chronic • The patient has a problem with sleep (difficulty falling asleep, remaining asleep, or waking too early), difficulty remaining awake (excessive daytime sleepiness), or both • The sleep-wake problem causes clinically significant distress or impairment of one or more areas of daytime functioning |
| Advanced sleep-wake phase disorder, additional criteria:
○ An advance in the timing of sleep relative to the desired or required timing, both by history and as evidenced using actigraphy and/or a daily sleep log for at least one week ○ Symptoms/complaint present for at least three months ○ When allowed to sleep without timing constraints, the patient is able to achieve a sleep episode of good quality and sufficient duration, although the timing is advanced ○ The sleep problem is not explained by any other sleep, medical, neurological, or psychological disorder, by medication, or by substance use/abuse |
| Irregular sleep-wake rhythm disorder, additional criteria: ○ Irregular sleep and wake episodes throughout the 24-hour day, both by history and as evidenced using actigraphy and/or a daily sleep log for at least one week; three or more sleep episodes per 24 hours, difficulty sleeping/remaining asleep at night, difficulty remaining awake during the day ○ Symptoms/complaint present for at least three months ○ The sleep problem is not explained by any other sleep, medical, neurological, or psychological disorder, by medication, or by substance use/abuse |
| Shift-work disorder, additional criteria:
○ When working a particular shift (night shift or day shift with early morning start time), difficulty sleeping and/or excessive sleepiness, with overall reduced sleep duration by history and as evidenced using actigraphy and/or a daily sleep log for at least one week ○ Symptoms/complaint present for at least three months when on the work schedule ○ The sleep problem is not explained by any other sleep, medical, neurological, or psychological disorder, by medication, by substance use/abuse, or by the patient forgoing daytime sleep to work a second job or perform childcare or other activities |
| Jet lag disorder, additional criteria:
○ Difficulty sleeping and/or excessive sleepiness, with overall reduced sleep duration following rapid travel across two or more time zones ○ Impairment of function that appears within a few days of the travel ○ The sleep problem is not explained by any other sleep, medical, neurological, or psychological disorder, by medication, or by substance use/abuse |