When you visit your primary care physician to try and determine if you have insomnia, he or she will be most interested in discovering if your insomnia is a medical disorder in and of itself or a secondary manifestation of another condition, like arthritis or heartburn. Your doctor will follow several steps in order to reach a definitive diagnosis. First your doctor likely will take your clinical history and ask you several questions to help her determine the quality of your sleep, including
- How long have you had trouble sleeping?
- Had you recently experienced significant stress or an emotional upset when it began?
- How did you sleep before the sleeplessness began?
- How often do bouts of sleeplessness occur?
- Does anything in particular make it better?
- Does anything in particular make it worse?
- How long does it take you to get to sleep after you lie down?
- Are you able to sleep the night through, or do you wake up several times in the middle of the night, or awaken too early?
- Do you awake feeling refreshed or groggy?
- How many times a night do you wake up?
- How long does getting back to sleep take you after you do wake up?
- Do you have problems with fatigue and sleepiness during your regular daytime activities?
- Is your daytime sleepiness hurting your mental sharpness and job performance?
- Does your insomnia adversely impact your waking life, your mood, and your relationships at home and work?
Your doctor may also ask you about your eating and drinking habits to rule out factors such as over-consumption of caffeine as a possible cause. Your doctor will also want to know if you're taking any drugs, prescribed or not, that could possibly cause insomnia as a side effect and whether or not you exercise regularly and what time of day you exercise. Finally, your doctor will look for any co-existing medical or psychiatric conditions that could be triggering your insomnia.
This list may seem like a lot of questions, but your doctor really needs accurate answers to them all in order to make an effective assessment. One way to provide your doctor accurate information about your sleep habits is to keep a sleep diary for at least two consecutive weeks before you visit your doctor. Be sure to share the completed diary with your doctor.
When your doctor asks about your sleep history, your sleep diary becomes very valuable. If you don't keep one, your recollection of your sleep disturbances may be so vague that your doctor can't offer any help. In addition to reading through your sleep diary, your doctor will ask your bedmate for his or her impression of your sleep problems. Sometimes a bedmate has a more accurate take on the situation than the person suffering from insomnia.
Your doctor will check your diary for some of the same information she collected in your clinical history — for example, how long it takes you to get to sleep, whether or not you wake up too soon or too frequently, and how you perceive your sleep quality. Make sure you record all this information in your sleep diary.
Your doctor will also want to know when the problem started, how long it's been going on, and whether you have any easily identifiable triggers, such as emotional disturbances or substance abuse. Finally, she'll ask you about your sleep habits — whether or not you have a regular bedtime, a comfortable bed in a comfortable room, and so on.
Then your doctor will perform a complete physical examination in order to identify and/or rule out any co-existing medical conditions that may be causing your insomnia. She may also order blood and urine tests that may help rule out underlying medical causes for your sleep problems.
Your doctor won't send you to a sleep lab for a polysomnograph or other testing unless he suspects a co-existing condition including sleep apnea, periodic limb movement disorder, and sleep-related epilepsy, to name a few. Sleep studies aren't usually helpful for diagnosing insomnia, because when a patient is in a sleep lab, some of the triggers that may be responsible for her insomnia aren't present. A patient leaves behind the hot room, the frisky pet, the snoring bedmate, the neighbor's barking dog, and many other factors that can contribute to insomnia when he or she comes to a sleep lab.
After your doctor determines what type of insomnia you have and figures out what's causing it, he can prescribe appropriate treatment.