Chronic insomnia disorder

Source: Repatriation Medical Authority Statements of Principles as held by the Veterans Health Centre. SoPs are amended and replaced regularly; always confirm the current instrument at rma.gov.au before relying on it.

RH No. 37 of 2019 · BoP No. 38 of 201958 factors

Meaning of chronic insomnia disorder: For the purposes of this Statement of Principles, chronic insomnia disorder means a persistent disorder of sleep that meets the following diagnostic criteria (derived from DSM-5): A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: (i) difficulty initiating sleep; (ii) difficulty maintaining sleep, characterised by frequent awakenings or problems returning to sleep after awakenings; or (iii) early-morning awakening with inability to return to sleep. B. The sleep difficulty causes clinically significant distress or impairment in social, occupational, educational, academic, behavioural or other important areas of functioning. C. The sleep difficulty occurs at least three nights per week. D. The sleep difficulty is present for at least three months. E. The sleep difficulty occurs despite adequate opportunity for sleep and cannot be explained by inadequate circumstances for sleep. F. The sleep difficulty is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (for example, narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake diso

Reasonable Hypothesis (RH) — Statement of Principles No. 37 of 2019

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting chronic insomnia disorder or death from chronic insomnia disorder with the circumstances of a person's relevant service:

(1)
having a clinically significant disorder of mental health as specified within the one year before the clinical onset of chronic insomnia disorder;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(2)
experiencing a category 1A stressor within the one year before the clinical onset of chronic insomnia disorder;
Note: category 1A stressor is defined in the Schedule 1 - Dictionary.
(3)
experiencing a category 1B stressor within the one year before the clinical onset of chronic insomnia disorder;
Note: category 1B stressor is defined in the Schedule 1 - Dictionary.
(4)
experiencing a category 2 stressor within the one year before the clinical onset of chronic insomnia disorder;
Note: category 2 stressor is defined in the Schedule 1 - Dictionary.
(5)
experiencing severe childhood abuse before the clinical onset of chronic insomnia disorder;
Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.
(6)
having a medical illness or injury, which is life-threatening or which results in serious physical or cognitive disability, within the one year before the clinical onset of chronic insomnia disorder;
(7)
having a severe, chronic medical condition within the one year before the clinical onset of chronic insomnia disorder;
Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.
(8)
having persistent pain for at least the three months before the clinical onset of chronic insomnia disorder;
Note: persistent pain is defined in the Schedule 1 - Dictionary.
(9)
having tinnitus for at least the three months before the clinical onset of chronic insomnia disorder;
(10)
having concussion or moderate to severe traumatic brain injury within the one year before the clinical onset of chronic insomnia disorder;
(11)
being in the menopausal transition within the five years before the clinical onset of chronic insomnia disorder;
Note: menopausal transition is defined in the Schedule 1 - Dictionary.
(12)
being pregnant at the time of the clinical onset of chronic insomnia disorder;
(13)
inability to undertake any physical activity greater than three METs for at least the one year before the clinical onset of chronic insomnia disorder;
Note: MET is defined in the Schedule 1 - Dictionary.
(14)
being treated with a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least seven days before the clinical onset of chronic insomnia disorder, where the last dose of the drug was received within the 30 days before the clinical onset of chronic insomnia disorder;
Note: specified list of drugs is defined in the Schedule 1 - Dictionary.
(15)
being treated with a drug for a continuous period of at least seven days before the clinical onset of chronic insomnia disorder, where: (a) the involved drug is capable of producing a prominent and severe disturbance in sleep; and (b) the drug is associated in the individual with the development of insomnia symptoms during drug therapy; and (c) the last dose was received within the 30 days before the clinical onset of chronic insomnia disorder;
(16)
being treated with mefloquine within the two months before the clinical onset of chronic insomnia disorder;
(17)
having a clinically significant disorder of mental health as specified within the one year before the clinical worsening of chronic insomnia disorder;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(18)
experiencing a category 1A stressor within the one year before the clinical worsening of chronic insomnia disorder;
Note: category 1A stressor is defined in the Schedule 1 - Dictionary.
(19)
experiencing a category 1B stressor within the one year before the clinical worsening of chronic insomnia disorder;
Note: category 1B stressor is defined in the Schedule 1 - Dictionary.
(20)
experiencing a category 2 stressor within the one year before the clinical worsening of chronic insomnia disorder;
Note: category 2 stressor is defined in the Schedule 1 - Dictionary.
(21)
having a medical illness or injury, which is life-threatening or which results in serious physical or cognitive disability, within the one year before the clinical worsening of chronic insomnia disorder;
(22)
having a severe, chronic medical condition within the one year before the clinical worsening of chronic insomnia disorder;
Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.
(23)
having persistent pain for at least the three months before the clinical worsening of chronic insomnia disorder;
Note: persistent pain is defined in the Schedule 1 - Dictionary.
(24)
having tinnitus for at least the three months before the clinical worsening of chronic insomnia disorder;
(25)
having concussion or moderate to severe traumatic brain injury within the one year before the clinical worsening of chronic insomnia disorder;
(26)
being in the menopausal transition within the five years before the clinical worsening of chronic insomnia disorder;
Note: menopausal transition is defined in the Schedule 1 - Dictionary.
(27)
being pregnant at the time of the clinical worsening of chronic insomnia disorder;
(28)
inability to undertake any physical activity greater than three METs for at least the one year before the clinical worsening of chronic insomnia disorder;
Note: MET is defined in the Schedule 1 - Dictionary.
(29)
being treated with a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least seven days before the clinical worsening of chronic insomnia disorder, where the last dose of the drug was received within the 30 days before the clinical worsening of chronic insomnia disorder;
Note: specified list of drugs is defined in the Schedule 1 - Dictionary.
(30)
being treated with a drug for a continuous period of at least seven days before the clinical worsening of chronic insomnia disorder, where: (a) the involved drug is capable of producing a prominent and severe disturbance in sleep; and (b) the drug is associated in the individual with the worsening of insomnia symptoms during drug therapy; and (c) the last dose was received within the 30 days before the clinical worsening of chronic insomnia disorder;
(31)
being treated with mefloquine within the two months before the clinical worsening of chronic insomnia disorder;
(32)
inability to obtain appropriate clinical management for chronic insomnia disorder;

Aggravation-only factors: the factors in subsections 8(17) to 8(32) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

Balance of Probabilities (BoP) — Statement of Principles No. 38 of 2019

26 factors

At least one of the following factors must exist before it can be said that, on the balance of probabilities, chronic insomnia disorder or death from chronic insomnia disorder is connected with the circumstances of a person's relevant service:

(1)
having a clinically significant disorder of mental health as specified within the one year before the clinical onset of chronic insomnia disorder;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(2)
experiencing a category 1A stressor within the one year before the clinical onset of chronic insomnia disorder;
Note: category 1A stressor is defined in the Schedule 1 - Dictionary.
(3)
experiencing a category 1B stressor within the one year before the clinical onset of chronic insomnia disorder;
Note: category 1B stressor is defined in the Schedule 1 - Dictionary.
(4)
experiencing a category 2 stressor within the one year before the clinical onset of chronic insomnia disorder;
Note: category 2 stressor is defined in the Schedule 1 - Dictionary.
(5)
experiencing severe childhood abuse before the clinical onset of chronic insomnia disorder;
Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.
(6)
having a medical illness or injury, which is life-threatening or which results in serious physical or cognitive disability, within the one year before the clinical onset of chronic insomnia disorder;
(7)
having a severe, chronic medical condition within the one year before the clinical onset of chronic insomnia disorder;
Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.
(8)
having persistent pain for at least the three months before the clinical onset of chronic insomnia disorder;
Note: persistent pain is defined in the Schedule 1 - Dictionary.
(9)
having tinnitus for at least the three months before the clinical onset of chronic insomnia disorder;
(10)
being pregnant at the time of the clinical onset of chronic insomnia disorder;
(11)
being treated with a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least seven days before the clinical onset of chronic insomnia disorder, where the last dose of the drug was received within the 30 days before the clinical onset of chronic insomnia disorder;
Note: specified list of drugs is defined in the Schedule 1 - Dictionary.
(12)
being treated with a drug for a continuous period of at least seven days before the clinical onset of chronic insomnia disorder, where: (a) the involved drug is capable of producing a prominent and severe disturbance in sleep; and (b) the drug is associated in the individual with the development of insomnia symptoms during drug therapy; and (c) the last dose was received within the 30 days before the clinical onset of chronic insomnia disorder;
(13)
being treated with mefloquine within the two months before the clinical onset of chronic insomnia disorder;
(14)
having a clinically significant disorder of mental health as specified within the one year before the clinical worsening of chronic insomnia disorder;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(15)
experiencing a category 1A stressor within the one year before the clinical worsening of chronic insomnia disorder;
Note: category 1A stressor is defined in the Schedule 1 - Dictionary.
(16)
experiencing a category 1B stressor within the one year before the clinical worsening of chronic insomnia disorder;
Note: category 1B stressor is defined in the Schedule 1 - Dictionary.
(17)
experiencing a category 2 stressor within the one year before the clinical worsening of chronic insomnia disorder;
Note: category 2 stressor is defined in the Schedule 1 - Dictionary.
(18)
having a medical illness or injury, which is life-threatening or which results in serious physical or cognitive disability, within the one year before the clinical worsening of chronic insomnia disorder;
(19)
having a severe, chronic medical condition within the one year before the clinical worsening of chronic insomnia disorder;
Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.
(20)
having persistent pain for at least the three months before the clinical worsening of chronic insomnia disorder;
Note: persistent pain is defined in the Schedule 1 - Dictionary.
(21)
having tinnitus for at least the three months before the clinical worsening of chronic insomnia disorder;
(22)
being pregnant at the time of the clinical worsening of chronic insomnia disorder;
(23)
being treated with a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least seven days before the clinical worsening of chronic insomnia disorder, where the last dose of the drug was received within the 30 days before the clinical worsening of chronic insomnia disorder;
Note: specified list of drugs is defined in the Schedule 1 - Dictionary.
(24)
being treated with a drug for a continuous period of at least seven days before the clinical worsening of chronic insomnia disorder, where: (a) the involved drug is capable of producing a prominent and severe disturbance in sleep; and (b) the drug is associated in the individual with the worsening of insomnia symptoms during drug therapy; and (c) the last dose was received within the 30 days before the clinical worsening of chronic insomnia disorder;
(25)
being treated with mefloquine within the two months before the clinical worsening of chronic insomnia disorder;
(26)
inability to obtain appropriate clinical management for chronic insomnia disorder;

Aggravation-only factors: the factors in subsections 8(14) to 8(26) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

Chronic insomnia disorder — DVA SoP factors