Up until now non-restorative sleep (NRS) has been one of the cardinal symptoms of insomnia. However, it has come to my knowledge that in the new editions of ICSD and DSM-V this criteria has been exluded from diagnosis. Unfortunately have I missed the discusson that led to this. Do anyone know any studies discussing the symptom NRS in relation to insomnia diagnostic criteria?
It still has the criteria of dissatisfaction with sleep quantity or quality in it. The new theme is not to use secondary insomnia as it is so comorbid in nature
I agree: the aim of the new classification system is to consider insomnia a disorder, indipendently from other disturbances. The criteria of "dissatisfaction with sleep quantity or quality in it" tries to simplify the distincton in ICSD between different types of primary insomnia (see "pshycophysiological insomnia", wich has numorous elements of NRS). DSM 5 add a "frequency criterion" too of dissatisfctory sleep.
See : http://www.dsm5.org/Documents/Sleep-wake%20Disorders%20Fact%20Sheet.pdf
An interesting reference: Wilkinson K, Shapiro C. Nonrestorative sleep: symptom or unique diagnostic entity? Sleep Med. 2012 Jun;13(6):561-9
In my opinion, DSM 5 reinforced the clinical significance of NRS (focusing on sleep quality) as a sign of insomnia disorder but as sign of other sleep disturbances too (narcolepsy).
It is important to make sure that there is no other sleep disorder present before diagnosing insomnia. Many clinicians are not familiar with OSA and RLS, which could certainly cause "non restorative" sleep.
It is a very important concept to patients. The article below describes a patients assessment of the concept.
Article Development and Evaluation of a Measure to Assess Restorative Sleep
Thank you Robert. It was a very interesting article on the subject.
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