2. Difficulty maintaining sleep, characterized by frequent awakenings or problems re-
turning to sleep after awakenings. (In children, this may manifest as difficulty return-
ing to sleep without caregiver intervention.)
3. Early-morning awakening with inability to return to sleep.
B. The sleep disturbance causes clinically significant distress or impairment in social, oc-
cupational, educational, academic, behavioral, or other important areas of functioning.
C. The sleep difficulty occurs at least 3 nights per week.
D. The sleep difficulty is present for at least 3 months.
E. The sleep difficulty occurs despite adequate opportunity for sleep.
F. The insomnia is not better explained by and does not occur exclusively during the
course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep dis-
order, a circadian rhythm sleep-wake disorder, a parasomnia).
G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication).
H. Coexisting mental disorders and medical conditions do not adequately explain the pre-
dominant complaint of insomnia.
Specify if:
With non–sleep disorder  mental comorbidity, including substance use disorders
With other medical comorbidity
With other sleep disorder
Coding note: The code 307.42 (F51.01) applies to all three specifiers. Code also the
relevant associated mental disorder, medica l condition, or other sleep disorder imme-
diately after the code for insomnia disorder in order to indicate the association.