record “mild [substance] use disorder” before the substance-induced sleep disorder (e.g.,
“mild cocaine use disorder with cocaine-induc ed sleep disorder”). If a moderate or severe
substance use disorder is comorbid with the substance-induced sleep disorder, the 4th po-
sition character is “2,” and the clinician shoul d record “moderate [substance] use disorder”
or “severe [substance] use disorder,” depending on the severity of the comorbid substance
use disorder. If there is no comorbid substance use disorder (e.g., after a one-time heavy
use of the substance), then the 4th position character is “9,” and the clinician should record
only the substance-induced sleep disorder. A m oderate or severe tobacco use disorder is
required in order to code a tobacco-induced sleep disorder; it is not permissible to code a
comorbid mild tobacco use disorder or no tobacco use disorder with a tobacco-induced
sleep disorder.
Specify whether:
Insomnia type:  Characterized by difficulty falling asleep or maintaining sleep, frequent
nocturnal awakenings, or nonrestorative sleep.
Daytime sleepiness type: Characterized by predominant complaint of excessive
sleepiness/fatigue during waking hours or, less commonly, a long sleep period.
Parasomnia type:  Characterized by abnormal behavioral events during sleep.
Mixed type: Characterized by a substance/m edication-induced sleep problem charac-
terized by multiple types of sleep symptoms, but no symptom clearly predominates.
Specify if (see Table 1 in the chapter “Substance-Related and Addictive Disorders” for di-
agnoses associated with substance class):
With onset during intoxication:  This specifier should be used if criteria are met for