Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Substance/Medication-Induced Sleep Disorder


Differential Diagnosis

  • Delirium
  • Other sleep disorders
  • Sleep disorder due to another medical condition
  • Substance intoxication or substance withdrawal

Medical Codes

ICD-9-CM:
291.82 - Alcohol-Induced Mental Disorders, Other Specified; Alcohol Induced Sleep Disorders; Alcohol Induced Circadian Rhythm Sleep Disorders; Alcohol Induced Hypersomnia; Alcohol Induced Insomnia; Alcohol Induced Parasomnia
292.85 - Drug-induced Mental Disorders, Other Specified; Drug Induced Sleep Disorders; Drug Induced Circadian Rhythm Sleep Disorder; Drug Induced Hypersomnia; Drug Induced Insomnia; Drug Induced Parasomnia

Overview

Substance/medication-induced sleep disorder is 1 of 10 identified sleep-wake disorders. There is a high degree of comorbidity with other psychiatric disorders; please refer to the particular psychiatric disorder for more information.

Note: This topic follows the approach to substance-induced disorders established by the DSM-IV-TR and the DSM-5. For the approach to substance dependence/abuse established by DSM-IV-TR, and the approach to substance use established by DSM-5, please refer to specific topics including Alcohol and Drug Detoxification and Rehabilitation; Alcohol Intoxication, Acute; Alcoholism; and Cannabis Use Disorder.

Incidence and Prevalence: The prevalence of substance/medication-induced sleep disorder varies according to the substance or medication; in one survey, 96% of individuals with active alcohol, narcotic, or polysubstance abuse reported experiencing sleep disorders (Mahfoud).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Substance/medication-induced sleep disorder ensues only in association with intoxication or discontinuation/withdrawal states.

Intoxication with or withdrawal from the following classes of substances can be associated with prominent and severe sleep disturbances: alcohol; caffeine; cannabis; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamines and cocaine); tobacco; and other (or unknown) substances.

Medications associated with sleep disturbances include adrenergic, cholinergic, serotonergic, and dopamine agonists and antagonists; antihistamines; and corticosteroids.

Source: Medical Disability Advisor



Diagnosis

History: According the DSM-5, individuals with substance/medication-induced sleep disorder must have a prominent and severe disturbance in sleep in order to make the diagnosis. The history reveals that the disturbance in sleep developed during the course of, or shortly after (within 30 days, DSM-IV-TR), substance intoxication, or after withdrawal from or exposure to a medication. The involved substance/medication must be able to produce a prominent and severe disturbance in sleep.

The disturbance is not better accounted for by a sleep disorder that is not substance/medication-induced. Evidence of an independent sleep disorder may include appearance of the symptoms before the onset of the substance/medication use; persistence of the symptoms for approximately 1 month after acute withdrawal from the substance/medication use, or symptoms that exceed those normally produced by the substance/medication use — as well as a history of recurrent non-substance/medication-related episodes.

The sleep disorder does not occur exclusively during the course of a delirium. The sleep disorder causes clinically significant distress or impairment in social, occupational, or other areas of functioning. This diagnosis should be made instead of a diagnosis of substance/medication intoxication or withdrawal only when the prominent and severe disturbance in sleep predominates in the clinical picture and when its severity warrants independent clinical attention.

It is necessary to specify the type based on the predominant sleep disturbance: insomnia type (difficulty falling asleep or maintaining sleep, frequent nocturnal awakenings, or nonrestorative sleep); daytime sleepiness/hypersomnia type (predominant complaint of excessive sleepiness/fatigue during waking hours or, less commonly, a long sleep period); parasomnia type (abnormal behavioral events during sleep); or mixed type (multiple types of sleep symptoms, but without a clear predominance of any one symptom).

According both to the DSM-5 and DSM-IV-TR, coding of substance-induced sleep disorder includes specifying the offending substance: alcohol; caffeine; cannabis; opioid; sedative, hypnotic, or anxiolytic; amphetamine (or other stimulant); cocaine; tobacco; or other (or unknown) substance. In the DSM-5 coding includes "with use disorder, mild," "with use disorder, moderate or severe," or "without use disorder" for each substance based on the ICD-10-CM. Finally, it is also necessary to specify if the onset occurred during intoxication, or during discontinuation/withdrawal.

Physical exam: Please refer to the physical exam for the particular sleep disorder, and for dependence on/abuse of the particular substance/medication.

Tests: Please refer to the tests for the particular sleep disorder, and for dependence on/abuse of the particular substance/medication.

Source: Medical Disability Advisor



References

Cited

Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Association, 2013.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Mahfoud, Y. , et al. "Sleep disorders in substance abusers: how common are they?" Psychiatry (Edgmont) 6 9 (2009): 38-42.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.