to the healthcare system in the United States.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
This category of coding is focused on psychiatric and mental health issues. It is currently referred to the DSM‐5 and was published in May of 2013 [4]. The ICSD‐3 was used as a guide for the incorporation of diagnostic coding in this publication. The primary focus has been and is on insomnia; however, in the DSM‐5 attention was given to other sleep disorders under the broad category of sleep–wake disorders. This included 10 diagnostic groups that included other sleep disorders such as sleep apnea, narcolepsy, rapid eye movement (REM) behavior disorders, and circadian rhythm disorder to name a few. The overall importance of this is based on the growing evidence that sleep disorders may coexist with a variety of medical and psychiatric conditions and these may interact and impact one another.
The International Classification of Sleep Disorders (ICSD)
In 1990, the ICSD was first published as a joint effort between the ASDA, European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society [6]. It was developed mainly for diagnostic, epidemiologic, and research purposes. It was intended to enhance communication relative to sleep disorder research for the international community.
Since the pathophysiology of many of these sleep disorders was not well understood at that time, the ICSD was based on the most common or major symptoms. These consisted primarily of insomnia, excessive sleepiness, and parasomnias (abnormal events that would take place while sleeping).
In 2005, the second edition of the ICSD was published and this made minor changes and updates to the original ICSD. As more research on the various sleep disorders was being published, the need to further revise and update the classifications to be more relevant became evident. In 2011, the need to have a classification system that was based as much as possible on the most current evidence available was initiated that resulted in the third edition. The third edition was basically similar in structure to the second edition as it relates to various clinical categories. In addition an effort was made to coordinate the ICD‐10‐CM codes where possible. This was not always practical because there was no total agreement between the ICD coding and the coding of sleep disorders based on the criteria established in the third edition.
The third edition of the ICSD has a large number of sleep disorders that are of little to no consequence to the practicing dentist. The intent therefore is to be aware of the various categories of those disorders, and attention will be given to those that are most important and are most relevant. If there is interest in reviewing all of the sleep disorders in more detail, it is advisable that the ICSD‐3 be obtained from the AASM. This would provide more detail(s) regarding all of the sleep disorders and in addition would be educational. Each of the sleep disorders is accompanied by discussion as well as a bibliography of evidence that supports the diagnosis as being clinically relevant. The third edition was the outcome of a task force that oversaw the development of this project, and in addition there were specific workgroups made up of experts related to the respective categories.
General Categories
The ICSD‐3 contains six general categories of sleep disorders, and under each of these are more detailed and descriptive disorders. In each of these categories there is a description of alternate names that may apply or may be used as well the specific diagnostic criteria that need to be met to make each diagnosis. In most instances the essential features of the disorder are reviewed. In addition to the six general categories there are three additional categories: Other Sleep Disorder, Appendix A, and Appendix B. The presence of the ICD‐10‐CM code in association with each disorder, when present, is specific to that disorder based on the relevant criteria.
The six general categories of sleep disorders are as follows:
Insomnia
Sleep‐related breathing disorders
Central disorders of hypersomnolence
Circadian rhythm sleep–wake disorders
Parasomnias
Sleep‐related movement disorders
Insomnia
Under this category insomnia has a number of disorders:
Chronic insomnia disorderICD‐10‐CM code: F51.01
Short‐term insomnia disorderICD‐10‐CM code: F51.02
These are the ones most relevant to the dentist. There is a subcategory that is entitled isolated symptoms and normal variants and the focus is on excessive time in bed and short sleepers.
Sleep‐Related Breathing Disorders (SRBDs)
This is the category that is most important to the practicing dentist involved in oral appliance therapy. Specifically, attention should be given to obstructive sleep apnea, sleep‐related hypoxemia and isolated symptoms and normal variants. There are five specific disorders:
Obstructive sleep apnea disordersICD‐10‐CM code: G47.33Applies to both adult and pediatric
Central sleep apnea syndromes
The dentist is not likely to encounter central sleep apnea. The one to consider might possibly be central sleep apnea due to a medication or substance. This may be associated with the use of opioids, or when using some other respiratory depressant medication.
Sleep‐related hypoventilation disorders
Sleep‐related hypoxemia disorder ICD‐10‐CM code: G47.36
The dentist is not likely to encounter this specifically. If the patient's blood oxygen is equal to or less than 88% for greater than five minutes, then this may be present and should be further evaluated by a physician as hypoxia has implications that are outside the scope of the dentist.
Isolated symptoms and normal variants
The most commonly encountered condition here is snoring. Despite the fact that an ICD code exists for snoring (R06.83), this is typically not a billable or reimbursable service. The presence of snoring indicates the potential risk for sleep apnea and if present should be evaluated further.
Central Disorders of Hypersomnolence
In this category there are a number of disorders that patients may be at risk for that the dentist may recognize.
Narcolepsy Type 1ICD‐10‐CM code: G47.411
Narcolepsy may have many of the same symptoms as sleep apnea, especially daytime sleepiness. Oftentimes it is difficult to make a distinction and if suspected it is advisable to refer the patient to a sleep medicine specialist. This form of narcolepsy
