Which diagnosis best fits duration, episodicity, and exclusions?
A
Insomnia disorder
Predominant complaint of dissatisfaction with sleep quantity/quality: ≥1 of: difficulty initiating sleep; difficulty maintaining sleep (frequent awakenings); early morning awakening with inability to return to sleep
Urge to move the legs, usually accompanied by uncomfortable sensations in the legs, that begins or worsens during rest/inactivity, is partially or totally relieved by movement, and occurs primarily in the evening or night
AA. Predominant complaint of dissatisfaction with sleep quantity/quality: ≥1 of: difficulty initiating sleep; difficulty maintaining sleep (frequent awakenings); early morning awakening with inability to return to sleep B. Causes clinically significant distress or impairment in social, occupational, educational, academic, behavioural, or other important areas of functioning C. Sleep difficulty occurs ≥3 nights/week
BA. Urge to move the legs, usually accompanied by uncomfortable sensations in the legs, that begins or worsens during rest/inactivity, is partially or totally relieved by movement, and occurs primarily in the evening or night B. Criterion A symptoms occur ≥3 times/week and have persisted for ≥3 months C. Criterion A symptoms are accompanied by significant distress or impairment
Common specifiers
AEpisodic; Persistent; Recurrent
BWith sleep disturbance; Mild; Moderate; Severe
Differential flags
AShort-term insomnia (< 3 months - do not diagnose insomnia disorder); Circadian rhythm sleep-wake disorder (sleep timing problem, not sleep maintenance); Restless legs syndrome (urge to move legs at rest)
BAkathisia (medication-induced; no sensory component; not limited to rest; no circadian pattern); Peripheral neuropathy (constant sensations; not relieved by movement); Leg cramps (painful involuntary muscle contractions; brief; focal)