time sleepiness type are most common, while parasomnia type is seen less often. The mixed
type is noted when more than one type of sl eep disturbance–related symptom is present and
none predominates. The disturbance must not be better explained by another sleep disorder
(Criterion C). A substance/medication-induced sleep disorder is distinguished from insom-
nia disorder or a disorder associated with excessive daytime sleepines s by considering onset
and course. For drugs of abuse, there must be evidence of intoxication or withdrawal from
the history, physical examination, or laboratory findings. Substance/medication-induced
sleep disorder arises only in association wi th intoxication or di scontinuation/withdrawal
states, whereas other sleep disorders may preced e the onset of substance use or occur during
times of sustained abstinence. As discontinuation/withdrawal states for some substances
can be protracted, onset of th e sleep disturbance can occur 4 weeks after cessation of sub-
stance use, and the disturbance may have feat ures atypical of other sleep disorders (e.g.,
atypical age at onset or course). The diagnosi s is not made if the sleep disturbance occurs
only during a delirium (Criterion D). The symptoms must cause clinically significant dis-
tress or impairment in social, occupational, or other important areas of functioning (Crite-
rion E). This diagnosis should be made instea d of a diagnosis of substance intoxication or
substance withdrawal only when the symptoms in Criterion A predominate in the clinical
picture and when the symptoms warrant  independent clinical attention. 
Associated Features Supporting Diagnosis
During periods of substance/medication use, intoxication, or withdrawal, individuals fre-
quently complain of dysphoric mood, includin g depression and anxiety, irritability, cog-
nitive impairment, inability to concentrate, and fatigue.