Metabolic Intelligence · Anatomy of One Decision

How a clinical judgment becomes community intelligence

Worked example · Chronic Insomnia, ICD-11 Code 7A00 · WHO 2024-01

CASE STUDY 7A00
Chronic Insomnia
Sleep–Wake Disorders
© Deepleap.ai · Companion to Paper III
i.Source · WHO Definition
Natural Prose
ICD-11 · 7A00 · Sleep–Wake Disorders

Chronic Insomnia (7A00)

"Chronic insomnia is characterised by persistent difficulty initiating or maintaining sleep, or early morning awakening, despite adequate opportunity for sleep, resulting in some form of daytime impairment. The sleep difficulty occurs at least 3 nights per week and has been present for at least 3 months."
icd.who.int/browse/2024-01/mms/en#1834604250
ii.Crystallized · 8 DCG Tuples
Domain-Indexed
{ Chronic_Insomnia is_a Sleep_Wake_Disorder
  @ICD11@Sleep_Wake_Disorders }
{ Chronic_Insomnia has_attribute Difficulty_Initiating_Sleep
  @…@Symptomatology }
{ Chronic_Insomnia has_attribute Difficulty_Maintaining_Sleep
  @…@Symptomatology }
{ Chronic_Insomnia has_attribute Early_Morning_Awakening
  @…@Symptomatology }
{ Chronic_Insomnia requires Adequate_Sleep_Opportunity
  @…@Diagnostic_Criteria }
{ Chronic_Insomnia causes Daytime_Impairment
  @…@Functional_Impact }
{ Chronic_Insomnia temporal_constraint ≥3_Nights/Week
  @…@Temporal }
{ Chronic_Insomnia temporal_constraint ≥3_Months_Duration
  @…@Temporal }
Base Class
Symptomatology
Diagnostic Criteria
Temporal
Functional Impact
iii.Verification · The Double Helix
Triple Concurrence

Two strands. One verifier.

No DCG enters the network alone. The human is not the inspector — the human is the rule of pairing itself.

SYMBOLIC structurally legal? NEURAL semantically faithful? HUMAN · BASE PAIR credentialed · accountable · the binding rule
Symbolic
Arity, domain consistency, fiber-internal coherence. No cycles, no contradictions.
Human
A licensed practitioner whose credentials are at stake. Confirms clinical truth.
Neural
Semantic alignment between prose intent and structured form. The reading must match.
iv.Metabolism · Three Loops
Continuous
Micro · seconds
The encounter
A clinician in São Paulo sees a patient. Within eight minutes, the network surfaces relevant DCGs from last month's Lima cluster; a boundary marker flags a population subgroup; the decision is informed without disrupting the consultation.
8 mincycle time
community knowledge accessed
Meso · weeks
Institutional refinement
The clinic notices a pattern: a community-validated rule shows different effectiveness here. A refined DCG is proposed; 23 peer clinics test it; 18 confirm, 3 partial, 2 no match. Consensus is reached. The boundary sharpens.
~ 8 wkscycle time
23 / 5tested · consensus threshold
Macro · continuous
Federated propagation
The validated refinement propagates globally. No data crosses borders; only structured judgment. A boundary discovered in Lagos sharpens treatment in Lima. Each propagation requires multi-institutional consensus — nothing imposed.
daysto global propagation
100%sovereignty preserved
Live propagation · 30-day window
142 institutional nodes 1,247 DCGs in flight