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Insomnia (cont.)

Insomnia Diagnosis

The health care practitioner will begin an evaluation of insomnia with a complete medical history. As with most medical evaluations, a complete medical history and physical examination are important aspects of assessment and treatment of insomnia.

The health care practitioner will seek to identify any medical or psychological illness that may be contributing to the patient's insomnia. A thorough medical history and examination including screening for psychiatric disorders and drug and alcohol use is paramount in evaluation of a patient with sleep problems. Physical examination may particularly focus on heart and lung examination, and measurement of size of the neck and visualizing oral and nasal air passages (to see whether sleep apnea needs to be assessed in more detail).

  • A patient with insomnia may be asked about chronic snoring and recent weight gain. This may direct an investigation into the possibility of obstructive sleep apnea. In such an instance, the doctor may request an overnight sleep test (polysomnogram). Sleep studies are frequently done in specialized "sleep labs" by doctors trained in sleep medicine, frequently working with pulmonary (lung) specialists. This test is not part of the routine initial workup for insomnia, however.

  • Sleep history can be helpful in evaluating a patient with insomnia. Sleep schedule, bedroom and sleep habits, timing and quality of sleep, daytime symptoms, and duration of insomnia can provide useful clues in the assessment of a patient with insomnia.

  • Routine medications, alcohol use, drug use, stressful social and occupational situations, sleeping habits or snoring of the bed partner, and work schedule are some of the other topics that may be discussed by your doctor when evaluating insomnia.
  • The Epworth Sleepiness Scale is a validated questionnaire that can be used to assess daytime sleepiness. This scale may be helpful in assessing insomnia.

  • Actigraphy is another technique to assess sleep-wake patterns over time. Actigraphs are small, wrist-worn devices (about the size of a wristwatch) that measure movement. They contain a microprocessor and on-board memory and can provide objective data on daytime activity.

  • A sleep diary can be filled out daily for a period of 2 weeks. The patient is asked to write down times when they go to bed, fall asleep, awake from sleep, stay awake in bed, and get up in the morning. They can record amount of daily exercise, alcohol and caffeine intake, and medication. The diary will include the patient's personal assessment of their alertness at various times of the day on two consecutive days within the 2 week period.

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Read What Your Physician is Reading on Medscape

Insomnia »

Insomnia is defined as repeated difficulty with the initiation, duration, maintenance, or quality of sleep that occurs despite adequate time and opportunity for sleep that results in some form of daytime impairment.

Read More on Medscape Reference »


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