Insomnia (cont.)
What are the symptoms of insomnia?
Impairment of daytime functioning is the defining and the most common symptom
of insomnia.
Other common symptoms include:
- daytime fatigue,
- daytime sleepiness,
- mood changes,
- poor attention and concentration,
- lack of energy,
- anxiety,
- poor
social function,
- headaches, and
- increased errors and mistakes.
When should I call the doctor about insomnia?
In general, insomnia related to transient situational factors resolves
spontaneously when the provoking factor is removed or corrected. However,
medical evaluation by a doctor may be necessary if the insomnia persists or
it is thought to be related to a medical or a psychiatric condition.
There are also specialized doctors who evaluate and treat
insomnia and other sleep disorders. Sleep apnea may be evaluated and treated by pulmonologists
(lung doctors) who have specialized in sleep disorders. Other doctors
who evaluate and treat sleep disorders are neurologists with a specialty in sleep
disorders.
How is insomnia diagnosed?
Evaluation and diagnosis of insomnia may start with a thorough medical and
psychiatric patient history taken by the physician. As mentioned above, many medical
and psychiatric conditions can be responsible for insomnia.
A general physical examination to assess for any abnormal
findings is also
important, including assessment of mental status and neurological function;
heart, lung and abdominal exam; ear, nose and throat exam; and measurement of
the neck circumference and waist size. Assessment of routine medications and use
of any illegal drugs, alcohol, tobacco, or caffeine is also an important part of
the medical history. Any laboratory or blood work pertinent to these conditions
can also be a part of the assessment.
The patient's family members and bed partners also need to be
interviewed to ask about the patient's sleep patterns, snoring, or movements during sleep.
Specific questions regarding sleep habits and patterns
are also a vital part
of the assessment. A sleep history focuses on:
- duration of sleep,
- time of sleep,
- time to fall sleep,
- number and duration of awakenings,
- time of final awakening
in the morning, and
- time and length of any daytime naps.
Sleep logs or diaries
may be used for this purpose to record these parameters on a daily basis for
more accurate assessment of sleep patterns.
Sleep history also typically includes questions about possible symptoms
associated with insomnia. The physician may ask about daytime functioning,
fatigue, concentration and attention problems, naps, and other common symptoms
of insomnia.
Other diagnostic tests may be done as part of the evaluation for insomnia,
although they may not be necessary in all patients with insomnia.
Polysomnography is a test that is done in sleep centers if conditions such as
sleep apnea are suspected. In this test, the person will be required to spend a
full night at the sleep center while being monitored for heart rate, brain
waves, respirations, movements, oxygen levels, and other parameters while they
are sleeping. The data is then analyzed by a specially trained physician to
diagnose or rule out sleep apnea.
Actigraphy is another more objective test that may
be performed in certain situations but is not routinely a part of the evaluation
for insomnia. An actigraph is a motion detector that senses the person's
movements during sleep and wakefulness. It is worn similar to a wrist watch for days to weeks, and the
movement data are recorded and analyzed to determine sleep patterns and
movements. This test may be useful in cases of primary insomnia disorder,
circadian rhythm disorder, or sleep state misconception.
Next: How is insomnia treated? »
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