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Insomnia (cont.)

When to Seek Medical Care for Insomnia

When to call the doctor

  • A person with insomnia needs a doctor's attention if it lasts longer than three to four weeks, or sooner if it interferes with a person's daytime activities and ability to function.

When to go to the hospital

  • Generally, a person will not be hospitalized for most types of insomnia. However, when a lack of sleep results in an accident or other bodily harm, the patient might be admitted to the hospital for treatment of a condition resulting from the insomnia.
  • Worsening pain or increased difficulty breathing at night also may indicate a person needs to seek emergency medical care. However, chronic insomnia, if not associated with an injury or resultant life-threatening problem typically does not belong in the emergency department. It is a condition to discuss with a primary care physician or a psychiatrist.

How Insomnia Is Diagnosed?

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

The health-care professional 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. Preparation for a visit with your primary care physician to discuss your sleep problems should include a diary or journal of your sleep or lack thereof. When do you go to bed? How long does it take for you to fall asleep? Do you wake after a few hours? Does this happen every night? Is it associated with any particular activity? What did you do before going to bed on the nights you cannot sleep? How many nights a week do you have trouble sleeping? Keeping a journal for even just two weeks before seeing your doctor will help both of you gain insight into the problem. (See the paragraph below for more information on sleep diaries.)
  • 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.

How Insomnia Can Be Treated?

In general, transient insomnia resolves when the underlying trigger is removed or corrected. Most people seek medical attention when their insomnia becomes chronic.

The main focus of treatment for insomnia should be directed towards finding the cause. Once a cause is identified, it is important to manage and control the underlying problem, as this alone may eliminate the insomnia all together. Treating the symptoms of insomnia without addressing the main cause is rarely successful. In the majority of cases, chronic insomnia can be cured if its medical or psychiatric causes are evaluated and treated properly.

The following therapies may be used in conjunction with therapies directed towards the underlying medical or psychiatric cause. They are also the recommended therapies for some of the primary insomnia disorders.

Generally, treatment of insomnia entails both non-pharmacologic (non-medical) and pharmacologic (medical) aspects. It is best to tailor treatment for an individual patient based on the potential cause. Studies have shown that combining medical and non-medical treatments typically is more successful in treating insomnia than either one alone.

Medically Reviewed by a Doctor on 5/25/2016

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