Insomnia Diagnosis

People are advised to see a doctor if their insomnia lasts for a month or longer, or if it interferes with their ability to function during their daytime activities. In most cases, insomnia is actually a symptom of some underlying problem, such as a medical or emotional condition, a bad sleep environment, or disruptive sleep habits. As a result, the goal of the diagnosis is to identify the cause of a person's insomnia.

An insomnia diagnosis is based on a person's medical history, sleep history, and a physical examination. If the cause of the insomnia remains unknown or if another sleep disorder is suspected, a sleep study may be used to help with the diagnosis.

Medical History

The first step in diagnosing insomnia is to compile a medical history, which helps identify any medical conditions that might be causing the insomnia. Questionnaires and interviews are used to gather the following information:

Health information

• Known health conditions
• Pain due to a health condition (such as arthritis or cancer) or an injury
• Prescription, over-the-counter, herbs, or illegal drugs used
• Family members who have difficulty sleeping

Work and lifestyle information

• Alcohol, caffeine, or tobacco use, especially at night
• Exercise activities and timing
• Food, beverages, or medications taken before going to bed
• Lighting, noise level, and temperature of the sleep environment
• Long-distance travel
• Sleep distractions, such as computer, phone, or TV use
• Work activities, such as alternating day-night work schedules, night shifts, or long-distance travel

Emotional information

• Feelings of anxiety, depression, or stress
• Problems at home, school, or work
• Recent loss of a loved one, employment, or valuables

Sleep History

A sleep history is designed to gather information about a person's sleep habits. A sleep diary is sometimes used to gather the information. People record the following sleep information each day over a period of one or two weeks:

• When the current sleep problem started
• How often the sleep problem occurs each week
• The routine before going to bed
• The time a person goes to bed
• The length of time it takes to fall asleep
• The number of times a person wakes up during the night
• The length of time it takes to fall back asleep
• If the person snores, including its frequency and intensity
• If the person wakes up gasping or feeling breathless
• If the person experiences any unusual limb sensations (cramps, crawling sensations, or twitching)
• If the person worries about sleep problems at night
• If the person falls asleep or has trouble staying awake during the day
• It the person's ability to function during the day has been impacted by a lack of sleep

The Epworth Sleepiness Scale is sometimes used to determine a person's sleepiness during eight daytime activities. The questionnaire has people rate the likelihood that they'll doze off during each of the following situations:

• Sitting and reading
• Watching TV
• Sitting inactive in a public place
• As a passenger in a car for an hour without a break
• Lying down to rest in the afternoon when circumstances permit
• Sitting and talking to someone
• Sitting quietly after a lunch without alcohol
• In a car, while stopped for a few minutes in traffic

Physical Examination

The physical examination is used to identify any health problems that might be causing a person's insomnia. Lab tests are often used to uncover any medical conditions that might be causing the insomnia (such as heart or lung problems).

Sleep Study

People suspected of having a sleep disorder may be asked to undergo a sleep study (polysomnogram) to find out the cause of their insomnia. The sleep study records a person's breathing, heart rhythm, brain activity, eye movements, and body movements during sleep.

The sleep study is given overnight at a Sleep Disorders Center. Sleep technicians gather information while the person sleeps or tries to sleep. The sleep study helps determine if any sleep conditions are causing the insomnia, such as:

• Sleep apnea
• Restless legs syndrome
• Periodic limb (leg) movement disorder

A Multiple Sleep Latency Test is an alternative test that is also given at a Sleep Disorders Center. The test uses polysomnography to measure daytime sleepiness during multiple brief nap periods during the day.