Depending on the substance, one of four types of sleep disturbances occur:
- Insomnia Type
- Daytime Sleepiness Type
- Parasomnia Type
- Mixed Type

Insomnia type and daytime sleepiness type are most common.

It is also necessary to note whether onset occurs during intoxication, during withdrawal, or after medication use.

Specifiers for Substance/Medication-Induced Sleep Disorder

During periods of substance/medication use, intoxication, or withdrawal, individuals with substance/medication-induced sleep disorder can often experience symptoms, such as:
- Dysphoric mood (i.e. depression, anxiety)
- Irritability
- Cognitive Impairment
- Inability to concentrate
- Fatigue

Associated Features of Substance/Medication-Induced Sleep Disorder

Classes of substances and medications that invoke severe sleep disturbances and can occur in association with intoxication and withdrawal include:
- Alcohol
- Caffeine
- Cannabis
- Opioids
- Sedatives, hypnotics, or anxiolytics
- Stimulants (i.e. cocaine)
- Tobacco (only with substance withdrawal, not intoxication)
- Unknown (any substance/medication not listed above that likely affects the central or autonomic nervous systems)

Substances and Medications Related to Substance/Medication-Induced Sleep Disorder

The use of recreational substances (e.g. cannabis, ecstasy) is prevalent in adolescence and early adulthood. Because older individuals are likely to take more medications, they are at higher risk for developing a substance/medication-induced sleep disorder, which may be interpreted as normal aging. Children can also experience observable sleep disturbances when beginning a medication.

Development of Substance/Medication-Induced Sleep Disorder

Substance/medication-induced sleep disorders are characterized by a severe sleep disturbance that occurs during or soon after substance intoxication, medication exposure, or substance/medicine withdrawal.

University of California, Berkeley

The DSM-5-TR separates Sleep-Wake Disorders into the following specific disorders and groups:
-	Insomnia Disorder
-	Hypersomnolence Disorder
-	Narcolepsy
-	Breathing Related Sleep-Disorders*
-	Circadian Rhythm Sleep-Wake Disorders*
-	Parasomnias*
-	Restless Leg Syndrome
-	Substance / Medication-Induced Sleep Disorder
-	Other Specified Insomnia Disorder
-	Unspecified Insomnia Disorder
-	Other Specified Hypersomnolence Disorder
-	Unspecified Hypersomnolence Disorder
-	Other Specified Sleep-Wake Disorder
-	Unspecified Sleep-Wake Disorder

Note: * Groups that separate into further specific disorders

[DSM-5-TR] List of Sleep-Wake Disorders

American Psychiatric Association Publishing. (2022). Non–Rapid Eye Movement Sleep Arousal Disorders. In Diagnostic and statistical manual of mental disorders, fifth edition text revision: DSM-5-TR (5th ed., pp. 469–475). section.

Substance/Medication-Induced Sleep Disorder from the DSM-V

Non-Rapid Eye Movement Sleep Arousal (NREM) Disorders are characterized by repeated episodes incomplete awakenings during sleep that usually last about 1-10 minutes but can also last as long as 1 hour without any recollection. Little to no dream imagery is recalled. 

NREM Sleep Arousal Disorders


Narcolepsy is a sleep disorder characterized by an uncontrollable urge to fall asleep at inopportune times. These sleep episodes are frequently accompanied by cataplexy, a sudden loss of muscle tone. Narcoleptic attacks often exhibit features characteristic of REM sleep; for instance, about a third of those with the disorder report experiencing vivid, dream-like hallucinations during an episode.

Narcolepsy

Sleep apnea is a disorder characterized by episodes in which a person's breathing stops during sleep. These cessations can last for 10-20 seconds or longer and often result in brief arousals. Although individuals with sleep apnea may be unaware of these repeated sleep disruptions, they frequently experience significant daytime fatigue. The condition is commonly associated with loud snoring and is more prevalent in overweight people.

Sleep Apnea

A sleep disorder that consists of not getting enough sleep.

Insomnia

A sleep disorder in which someone physically acts out their dream. This disorder typically presents after age 50, is more common in men than women, and usually followed by Parkinson’s and/or dementia symptoms, suggesting it’s the start of widespread neurodegeneration. Usually controlled by anti-anxiety drugs like benzodiazepines at night. 

REM Behavior Disorder

Somnambulism, or sleepwalking, is a condition more common in childhood that can persist into adulthood. It involves episodes of complex behaviors, lasting from seconds to minutes, which are often not remembered. While these episodes most frequently occur during stage 3 slow-wave sleep (SWS), they can happen at any time during a sleep period. Sleepwalkers are not acting out their dreams.

Somnambulism

Insomnia is a common health concern that causes significant distress and disruption in daily life, due to difficulty with and lack of sleep. Insomnia tends to be associated with an increased risk of developing physical health problems, anxiety, and depression.

Insomnia 

Substance/Medication-Induced Sleep Disorder

* Obstructive Sleep Apnea Separate Specific Disorder
* Central Sleep Apnea
* Sleep-Related Hypoventilation


Specific Breathing Sleep-Related Disorders

Circadian rhythm sleep-wake disorders happen when constant patterns of sleep disturbances occur. These disturbances can be caused by a new circadian rhythm or discrepancies between the person’s circadian rhythm and the sleep-wake schedule that is demanded by the person’s social life, occupation, or environment.

Circadian Rhythm Sleep-Wake Disorders

Hypersomnolence disorder consists of sleeping for too many hours at night, trouble staying completely awake after being woken up, or frequent episodes of sleep throughout the day. 

Hypersomnolence Disorder

Reference for Sleep-Wake Disorders

Insomnia, the most prevalent sleep disorder, is characterized by a persistent difficulty in initiating or maintaining sleep. Individuals with this condition often experience significant delays before falling asleep and may wake up frequently during the night, struggling to resume sleep. According to diagnostic criteria, these sleep disturbances must occur at least three nights a week for a minimum of one month.

REM behavior disorder (RBD), sleepwalking, restless leg syndrome, and night terrors are examples of parasomnias, which involve unwanted motor behaviors or experiences during the sleep cycle.

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