404 Sleep-Wake Disorders
Relationship to Internat ional Classification of 
Sleep Disorders
The International Classificat ion of Sleep Disorders,  2nd Edition, includes “confusional
arousal” as a NREM sleep arousal disorder.
Nightmare Disorder
Diagnostic Criteria 307.47 (F51.5)
A. Repeated occurrences of extended, extremely dysphoric, and well-remembered
dreams that usually involve efforts to avoid threats to survival, security, or physical in-
tegrity and that generally occur during the second half of the major sleep episode.
B. On awakening from the dysphoric dreams, the individual rapidly becomes oriented and
alert.
C. The sleep disturbance causes clinically significant distress or impairment in social, oc-
cupational, or other important areas of functioning.
D. The nightmare symptoms are not attributable to the physiological effects of a sub-
stance (e.g., a drug of abuse, a medication).
E. Coexisting mental and medical disorders do not adequately explain the predominant
complaint of dysphoric dreams.
Specify if:
During sleep onset
Specify if:
With associated non–sleep disorder, including substance use disorders
With associated othe r medical condition
With associated ot her sleep disorder
Coding note:  The code 307.47 (F51.5) applies to all three specifiers. Code also the
relevant associated mental disorder, medical condition, or other sleep disorder imme-
diately after the code for nightmare disorder in order to indicate the association.
Specify if:
Acute:  Duration of period of nightmares is 1 month or less.
Subacute:  Duration of period of nightmares is greater than 1 month but less than
6 months.
Persistent:  Duration of period of nightmares is 6 months or greater.
Specify current severity: