Substance/Medication-Induced Sleep Disorder 419
Diagnostic Markers
Each of the substance/medica tion-induced sleep disorders produces electroencephalo-
graphic sleep patterns that are as sociated with, but cannot be considered diagnostic of, other
disorders. The electroencephalo graphic sleep profile for each substance is related to the
stage of use, whether intake/intoxication, chronic use, or wi thdrawal following discontinu-
ation of the substance. All-night polysomnography can help define the severity of insomnia
complaints, while the multiple sleep latency test provides information about the severity of
daytime sleepiness. Monitoring of nocturnal respiration and periodic limb movements with
polysomnography may verify a substance’s im pact on nocturnal breathing and motor be-
havior. Sleep diaries for 2 weeks and actigraphy  are considered helpful in confirming the
presence of substance/medication-induced sleep disorder. Dr ug screening ca n be of use
when the individual is not aware or unwilling to relate information about substance intake.
Functional Consequences of 
Substance/Medication-I nduced Sleep Disorder
While there are many functional consequences  associated with sleep disorders, the only
unique consequence for substa nce/medication-induced sleep disorder is increased risk
for relapse. The degree of sleep disturbance during alcohol withdrawal (e.g., REM sleep
rebound predicts risk of relapse of drinking ). Monitoring of sleep quality and daytime
sleepiness during and after withdrawal may provide clinically meaningful information on
whether an individual is at increased risk for relapse.
Differential Diagnosis
Substance intoxication or substance withdrawal. Sleep disturbances are commonly en-
countered in the context of substance intoxi cation or substance discontinuation/with-
drawal. A diagnosis of substance/medication-induced sleep disorder should be made