Information for Patients
What is sleep?
Sleep is a complex biological process. While you are sleeping, you are unconscious, but your brain and body functions are still active. They are doing a number of important jobs that help you stay healthy and function at your best. So when you don't get enough quality sleep, it does more than just make you feel tired. It can affect your physical and mental health, thinking, and daily functioning.
What are sleep disorders?
Sleep disorders are conditions that disturb your normal sleep patterns. There are more than 80 different sleep disorders. Some major types include:
- Insomnia - being unable to fall asleep and stay asleep. This is the most common sleep disorder.
- Sleep apnea - a breathing disorder in which you stop breathing for 10 seconds or more during sleep
- Restless leg syndrome (RLS) - a tingling or prickly sensation in your legs, along with a powerful urge to move them
- Hypersomnia - being unable to stay awake during the day. This includes narcolepsy, which causes extreme daytime sleepiness.
- Circadian rhythm disorders - problems with the sleep-wake cycle. They make you unable to sleep and wake at the right times.
- Parasomnia - acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating
Some people who feel tired during the day have a true sleep disorder. But for others, the real problem is not allowing enough time for sleep. It's important to get enough sleep every night. The amount of sleep you need depends on several factors, including your age, lifestyle, health, and whether you have been getting enough sleep recently. Most adults need about 7-8 hours each night.
What causes sleep disorders?
There are different causes for different sleep disorders, including:
- Other conditions, such as heart disease, lung disease, nerve disorders, and pain
- Mental illnesses, including depression and anxiety
Sometimes the cause is unknown.
There are also some factors that can contribute to sleep problems, including:
- Caffeine and alcohol
- An irregular schedule, such as working the night shift
- Aging. As people age, they often get less sleep or spend less time in the deep, restful stage of sleep. They are also more easily awakened.
What are the symptoms of sleep disorders?
The symptoms of sleep disorders depend on the specific disorder. Some signs that you may have a sleep disorder include that:
- You regularly take more than 30 minutes each night to fall asleep
- You regularly wake up several times each night and then have trouble falling back to sleep, or you wake up too early in the morning
- You often feel sleepy during the day, take frequent naps, or fall asleep at the wrong times during the day
- Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods
- You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall asleep
- Your bed partner notices that your legs or arms jerk often during sleep
- You have vivid, dreamlike experiences while falling asleep or dozing
- You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh
- You feel as though you cannot move when you first wake up
How are sleep disorders diagnosed?
To make a diagnosis, your health care provider will use your medical history, your sleep history, and a physical exam. You may also have a sleep study (polysomnogram). The most common types of sleep studies monitor and record data about your body during a full night of sleep. The data includes:
- Brain wave changes
- Eye movements
- Breathing rate
- Blood pressure
- Heart rate and electrical activity of the heart and other muscles
Other types of sleep studies may check how quickly you fall asleep during daytime naps or whether you are able to stay awake and alert during the day.
What are the treatments for sleep disorders?
Treatments for sleep disorders depend on which disorder you have. They may include:
- Good sleep habits and other lifestyle changes, such as a healthy diet and exercise
- Cognitive behavioral therapy or relaxation techniques to reduce anxiety about getting enough sleep
- CPAP (continuous positive airway pressure) machine for sleep apnea
- Bright light therapy (in the morning)
- Medicines, including sleeping pills. Usually, providers recommend that you use sleeping pills for a short period of time.
- Natural products, such as melatonin. These products may help some people but are generally for short-term use. Make sure to check with your health care provider before you take any of them.
General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.
Index of Diseases and Injuries Definitions
- And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
- Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
- Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
- Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
- Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
- Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
- NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
- See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
- See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
- 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
- With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.