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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• What is insomnia?
• What causes insomnia?
• What are other causes of insomnia?
• What are the risk factors for insomnia?
• What are the symptoms of insomnia?
• When should I call the doctor about insomnia?
• How is insomnia diagnosed?
• How is insomnia treated?
• What are non-medical treatments for insomnia?
• What is sleep hygiene?
• How can stimulus control help with insomnia?
• What is sleep restriction?
• What medications are used to treat insomnia?
• What is the outlook for insomnia?
• Insomnia At A Glance
• Patient Comments: Insomnia - Treatment
• Patient Comments: Insomnia - Causes
• Find a local Sleep Specialist in your town
• Insomnia Index

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.

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.

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.