Insomnia

Description

Alternative Names

Diagnosis

Diagnosing sleep disturbance and its cause is the most important step in restoring healthy sleep. There is little agreement, even among experts, however, on the best methods for effectively assessing a patient's insomnia. A major difficulty in diagnosing this problem is its subjective nature. One study showed that there was no difference in sleep behaviors between people who said they were insomniacs and people who said they weren't. People who believe they have insomnia may have actually had frequent brief awakenings during sleep that they perceive as being continuously awake. Some experts recommend, however that any individual should be treated aggressively if he or she believes they have insomnia and also is suffering daytime fatigue and impaired concentration and memory.

Sleep Questionnaires

A number of questionnaires are available for determining whether a patient has insomnia or other sleep disorders. For example, the physician may ask the following questions:

• How would the sleep problem be described?
• How long has the sleep problem been experienced?
• How long does it take to fall asleep?
• How many times a week does it occur?
• How restful is sleep?
• Does the difficulty lie in getting to sleep or in waking up early?
• What is the sleep environment like (Noisy? Not dark enough?)?
• How does insomnia affect daytime functioning?
• What medications are being taken (including the use of self-medications for insomnia, such as herbs, alcohol, and over-the-counter or prescription drugs)?
• Is the patient taking or withdrawing from stimulants, such as coffee or tobacco?
• How much alcohol is consumed per day?
• What stresses or emotional factors may be present?
• Has the patient experienced any significant life changes?
• Does the patients snore or gasp during sleep (an indication of sleep apnea)?
• Does the patient have leg problems (cramps, twitching, crawling feelings)?
• If there is a bed partner, is his or her behavior distressing or disturbing?
• Is the patient a shift worker?

Sleep Diary. If the patient cannot answer these questions, keeping a sleep diary is a helpful diagnostic tool. Every day for two weeks, the patient should record all sleep-related information, including responses to questions listed above described on a daily basis. A bed partner can help by adding his or her observations of the patients sleep behavior.

Measuring Sleepiness

The Epworth Sleepiness Scale. The Epworth sleepiness scale (ESS) uses a simple questionnaire to measure excessive sleepiness during eight situations.

Multiple Sleep Latency Test. The multiple sleep latency test (MSLT) employs a machine that measures the time it takes to fall asleep lying in a quiet room during the day:

• The patient takes four or five scheduled naps two hours apart.
• People with healthy sleep habits fall asleep in about 10 to 20 minutes.
• The test can detect changes in sleepiness associated with sleep deprivation in patients with insomnia.

It has limitations, however, and does not take into consideration any situations that may affect the patients' mental state and the actual home situation. The test is used mainly after other sleep disorders have been ruled out and the doctor is uncertain whether or not insomnia is a correct diagnosis.

Sleep Disorders Centers

If unexplained insomnia persists after treatment or there is evidence of a primary sleep disorder, such as sleep apnea or narcolepsy, the physician may recommend a sleep specialist or a sleep disorders center. Centers are accredited by the American Academy of Sleep Medicine. Patients should investigate centers carefully, being sure that they offer full sleep studies.

Among the signs that may indicate a need for a sleep disorders center are the following:

• Insomnia due to psychologic disorders.
• Sleeping problems due to substance abuse.
• Snoring and sudden awakening with gasping for breath (possible sleep apnea).
• Severe restless legs syndrome.
• Persistent daytime sleepiness.
• Sudden episodes of falling asleep during the day (possible narcolepsy).

At most, sleep disorders centers patients undergo an in-depth analysis, usually supervised by a multidisciplinary team of consultants who can provide both physical and psychiatric evaluations.