The Diagnosis of Insomnia

A woman who cannot sleep sitting up in her bed

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The night seems to last forever as you lie awake watching the minutes tick by on your alarm clock. You can’t fall asleep. And in the rare instance that you do, you are soon awake again, unable to continue sleeping. You can’t remember the last time you had a good night’s sleep. Insomnia may be ruining your life, but how can you be sure that’s the problem? How is insomnia diagnosed? Is it necessary to have any tests? What questions can you expect your doctor to ask of you when evaluating your difficulties sleeping?

To better understand if insomnia is the proper diagnosis and what information your health care provider may seek, let’s review an excerpt from UpToDate — a trusted electronic medical reference used by health care providers and patients alike. Then, read on for additional information about what all of this means for you.

"You may be asked to keep a daily sleep log, which is a record of sleep times and problems for one to two weeks.

"Your doctor or nurse may ask other questions to determine the cause of your insomnia. A physical examination may be performed to determine if there are medical or neurologic conditions causing or worsening your sleep problems."

Insomnia is defined as a difficulty falling or staying asleep or sleep that is not refreshing. The first task in assessing this is to determine whether the amount of sleep you are obtaining is adequate. If you simply do not spend enough time in bed, but you are able to sleep soundly when you are there, this may be a problem of sleep restriction rather than insomnia.

In order to gain a better understanding of the quantity of your sleep, it may be helpful to record your sleep patterns with a sleep log. This simple daily diary tracks your bedtimes, wake-times, and any periods that you are awake during the night or asleep during the day (such as naps). You can record the amount of time that you felt you slept. It can also be useful to record other relevant details. For example, you might note that you had a particularly stressful day prior to an especially disrupted night of sleep. The use of stimulants such as caffeine or nicotine as well as depressants like alcohol can be documented.

The benefit of a sleep log is that it is an easy and inexpensive way to document your sleep pattern over several weeks. It may be possible to begin to recognize the patterns of your sleep. For example, if you always have trouble falling asleep but you can sleep easily into the morning, this might suggest a circadian rhythm sleep disorder called delayed sleep phase syndrome. Careful analysis might also reveal the triggers that are ruining your sleep. Perhaps it is the late-night cup of tea that is causing your troubles.

A careful medical history will identify other causes of insomnia. Many disorders that cause pain can disrupt sleep. Neurological problems such as Parkinson’s disease disrupt sleep. It is important to rule out other sleep disorders that interrupt sleep, such as restless legs syndrome and sleep apnea. Problems with depression, anxiety, or post-traumatic stress disorder (PTSD) might also disrupt your sleep. Certain medications can change your sleep and reviewing these may likewise be informative. Your health care provider can also examine you to identify other conditions that might contribute to your difficulties sleeping.

If the diagnosis is in question, further testing for insomnia may be indicated. Sleep studies such as polysomnography or actigraphy may be recommended to further clarify what is causing your difficulty sleeping.

The first step toward identifying the proper treatment of your sleep problem is obtaining the correct diagnosis.

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