Diagnosis | Insomnia

Before your doctor can treat your sleeping problem, its cause needs to be identified. Often, treating the cause will eliminate insomnia.

Your doctor will perform a complete physical examination, and he or she will ask you questions about your sleeping habits, such as:

• How long does it take you to fall asleep?
• How often do you have trouble sleeping?
• What is your sleep environment like?
• Have you experienced any recent changes in your life?

The doctor may also want to interview your bed partner concerning the quantity and quality of your sleep. 

At this point, the doctor may be able to determine the type of insomnia you have –primary or secondary. 

• Primary
  A designation of primary insomnia means that your trouble sleeping is independent of other medical problems. 

• Secondary
  If you have secondary insomnia, your insomnia may be caused by an underlying health problem.

Your doctor may ask you to record some information.  The following are examples of some tools your doctor may ask you to use to aid in your diagnosis:

• Sleep Diary
  A sleep diary is a diagnostic tool to use every day for two weeks.  In it, you should record all of your sleep-related information, such as:  What time it was when you first went to bed, what you did before you went to bed, what you ate, or how often you awoke.  Your bed partner can help by adding his or her observations. View a sample sleep diary.  (pdf file)

• Epworth Sleepiness Scale (ESS)
  The ESS measures sleepiness.  Using this scale, you are asked to rate your sleepiness from 0 (no chance of dozing) to 3 (high chance of dozing) in a variety of scenarios or locations.  This scale can help you and your doctor identify if you have a problem.  View a sample ESS.

If the reason for your insomnia is unclear after the physical examination and initial conversation with your doctor, you may be referred to a sleep medicine specialist, and other tests will be performed, such as:

• Overnight sleep study (also called a polysomnography)
  This test will be conducted in a sleep laboratory.  In a specially-designed private bedroom in the sleep lab, a device will electronically transmit and record your physical activities while you sleep, including breathing, heart rhythm, limb movement, and eye movements to detect the different stages of sleep.
  
• Multiple Sleep Latency Test (MSLT)
  A machine will measure how long it takes you to fall asleep lying in a quiet room during the day.  This test is performed after other sleep disorders have been ruled out and if the doctor is unsure that insomnia is the correct diagnosis. 
  
• Actigraphy
  During Actigraphy, you will be given a small device to wear on your wrist.  The device is used to record physical activity while you sleep.  The patterns of your activity can assist your doctor in understanding your sleep habits and the impact of various treatments. View Respironics’ Actigraphy devices.

NOTE: Polysomnography, MSLT, and Actigraphy are not currently indicated as routine for the assessment of insomnia; however, these technologies may help the sleep professional by providing information that is complimentary to other diagnostic procedures, or to determine if another sleep disorder is the primary cause of the sleep complaint.

If it is discovered that sleep apnea or another disorder is causing your insomnia, additional tests will be performed in an attempt to treat the source of the problem. 

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