Diagnosis:

Having a doctor diagnose sleep disturbance and its cause is the most important step in restoring healthy sleep. However, there is little agreement, even among doctors, on the best methods for effectively assessing a patient's insomnia.

Sleep Questionnaires

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

• How would you describe your sleep problem?
• How long have you had the sleep problem?
• How long does it take to fall asleep?
• How many times a week does it occur?
• How restful is sleep?
• Do you have trouble falling asleep or do you wake up too early?
• What is the sleep environment like? (Noisy? Not dark enough?)
• How does insomnia affect daytime functioning?
• What medications do you take? (Include herbs, alcohol, and over-the-counter or prescription drugs.)
• Are you 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?
• Have you experienced any significant life changes?
• Do you snore or gasp during sleep (an indication of sleep apnea)?
• Do you have leg problems (cramps, twitching, crawling feelings)?
• If there is a bed partner? Is this person's behavior distressing or disturbing?
• Are you a shift worker?

Sleep Diary. If the patient cannot answer these questions, keeping a sleep diary is a helpful diagnostic tool. Every day for 2 weeks, the patient should record all sleep-related information (including responses to questions listed above). Other information should include time the patient went to bed, time spent falling asleep, number of nocturnal awakenings, and rising time. A bed partner's observations of the patient's sleep behavior can also help.

Measuring Sleepiness

Actigraphy. Actigraphy uses a portable device with a sensor to monitor a patient's movement. Actigraphy may be used in some situations to help give a doctor a better picture of the patient's sleep pattern. It cannot, however, determine the severity of sleep problems. Most patients with insomnia are diagnosed and treated without this test. However, actigraphy may help identify insomnia in some patients.

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 doctor 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, to be sure that they offer full sleep studies. [For more information, see In-Depth Report #65: Sleep apnea and #98: Narcolepsy.]

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

• 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.