How to Report Circadian Rhythm Sleep Disorder

Hello and Welcome to our Podcast Series. My name is Meghann Drella and I am a Senior Solutions manager here Outsource Strategies International. Today I will be discussing how to report Circadian Rhythm Sleep Disorder (CRSD).

Circadian Rhythm Sleep Disorder or referred to as CRSD refers to sleep problems in which a person’s internal sleep-wake cycle does not line up with the times in their schedule when they need to be asleep or awake. Your body runs on an internal clock that causes you to feel sleepier during the night and more awake and alert during the day time. This natural sleep rhythm is known as the circadian rhythm.  When this rhythm is disrupted, it can cause symptoms that range from daytime sleepiness to depression. One of the key features associated with CRSD is a continuous or occasional disruption of sleep patterns. The disruption results from either a malfunction in the “internal body clock” or a mismatch between the “internal body clock” and the external environment regarding the timing and duration of sleep. As a result of the circadian mismatch, individuals with these disorders usually complain of insomnia at certain times and excessive sleepiness at other times of the day, resulting in work, school, or social impairment. Taking adequate steps to get on a more regular sleep schedule can help alleviate these symptoms in the long run. When compared to other sleep problems, CRSDs do not affect the quality of your sleep, but may rather make you sleepy – especially at times when they need to be awake and make you awake when you need to sleep. Treatment for this condition involves a combination of medications and behavioral support.

There are different factors that cause circadian rhythm sleep disorders. Conditions that normally influence sleep include – light, levels of physical activities, levels of melatonin, a sleep hormone and social activities. Disruptions of one or more of these factors can lead to this sleep disorder. Persons suffering from certain medical conditions like congestive heart failure or chronic obstructive pulmonary disease are more likely to experience a circadian sleep condition. Additional risk factors related to medical conditions include – chronic pain syndromes, dementia, hyperthyroidism and intellectual disability. In addition, consuming certain medications, people who travel overseas and shift workers can also have higher chances of suffering from CRSD.

Circadian rhythm sleep disorders are of different types. In fact, many classifications are based on when a person typically goes to sleep. There is Advanced sleep phase disorder (ASP), Delayed sleep phase syndrome (DSPS), Irregular sleep-wake disorder (ISWD), a Non-24-hour sleep-wake disorder, Jet-lag disorder and Shift work disorder.

A circadian rhythm sleep disorder can impact many aspects of your life. Each disorder type has unique symptoms. Most people with these sleep disorders have one or more of these symptoms. Some of the most common symptoms include – difficulty going to sleep, difficulty staying asleep and not feeling refreshed after sleeping. If left undiagnosed and untreated at the right time, this condition can lead to insomnia, depression, impaired work performance, stressed relationships and disrupted social schedules.

Generally, diagnosis of circadian rhythm sleep disorder is done by a sleep medicine specialist. The sleep specialist as part of the diagnosis will ask patients to maintain a sleep journal where they can note down the details of their sleep patterns like what time they went to sleep and the time they woke up from their sleep. People who have difficulties keeping an accurate sleep journal may opt for actigraphy. This technique uses a wrist monitor to measure periods of being awake and asleep. In addition, the sleep specialist may also recommend a sleep study which involves sleeping under observation. A patient may wear a heart monitor, a breathing monitor, or both during the sleep study. This helps a sleep medicine specialist to rule out heart- or breathing-related sleep disruptions.

Treatment for this condition may focus on addressing light and melatonin – the two main factors that affect sleep. Incorporating a series of changes to promote better sleep can help sufferers find relief. Treatment modalities for this condition involve a combination of medications and behavioral therapy. Medications like – Benzodiazepines, Estazolam, Flurazepam, Quazepam (Doral), Temazepam (Restoril) and Triazolam (Halcion) help regulate sleep wake cycles over-the-counter to enhance sleep. Non -benzodiazepine hypnotics are another class of medications that are prescribed to treat circadian rhythm sleep disorders. Apart from medications, behavioral therapy activities like – maintaining regular sleep times, avoiding naps, getting regular exercise, adjusting exposure to day light, performing quiet activities (like reading before going to sleep) and avoiding bright lights at night can help manage the symptoms of this condition. Bright light therapy is used to help advance or delay sleep through the use of a high intensity light box. This therapy helps in calibrating the circadian rhythm by having the user sit in front of the bright light box at appropriate times of the day (depending on the disorder being treated) for a varied amount of time (depending on doctor recommendations).

Sleep medicine specialists or other physicians who diagnose, screen and treat CRSD must carefully document the diagnostic tests and other procedures using the correct medical codes. Those codes can be found in the article attached.

People with circadian rhythm sleep disorders need to maintain a normal sleep schedule to get enough sleep. However, for those who do not sleep enough, complications such as depression, disrupted social schedule, insomnia, and difficulty in concentrating at work can occur. In addition, people who make adequate changes to their sleep routines and light exposure are more likely to resume a more normal sleep schedule.

I hope this helps, but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursements for the procedures performed.

Thank you for joining me and stay tuned for my next podcast.