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:

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.

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