Insomnia

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Insomnia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Non-Pharmacological Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Insomnia On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Insomnia :All Images :X'-'ray' 'X'-'rays :Ultrasound' 'Echo & Ultrasound :CT' 'CT Images :MRI' 'MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Insomnia

CDC on Insomnia

Insomnia in the news

Blogs on Insomnia

Directions to Hospitals Treating Insomnia

Risk calculators and risk factors for Insomnia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Adnan Ezici, M.D[2] , Amber Ehsan Faquih, MD[3] , Kiran Singh, M.D. [4] , Jyostna Chouturi, M.B.B.S [5] , Sanjana Nethagani, M.B.B.S.[6]

Synonyms and keywords: Insomnia disorder

Overview

Historical Perspective

Pathophysiology

Classification

Causes

Differentiating Insomnia from other Diseases

Epidemiology and Demographics

Risk Factors

Common risk factors for insomnia include[1]:

  • Gender(Female)
  • Increasing age
  • Depression
  • Unemployed
  • Widow/Divorced/Separated
  • Lower educational qualification
  • Economic inactivity
  • Military Deployment
  • Racial Discrimintion

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies

History and Symptoms

DSM-5 diagnostic criteria for insomnia includes[2]:

  • Symptoms occur ≥ 3 days/week for ≥ 3 months
  • Symptoms cause functional impairment or distress
  • Problems initiating or maintaining sleep, or awakening early in the morning and being unable to return to sleep
  • Symptoms occur despite having enough time to sleep
  • Symptoms are not caused by an underlying substance or medication use
  • No underlying or coexisting psychiatric or medical disorder that explains symptoms

Laboratory Findings

  • Blood tests: Medical conditions can also cause/exacerbate sleep. Based on the questionnaire and physical exam, the doctor may recommend blood tests to check for other pre-existing conditions.[3].

Diagnostic Studies

The doctor won’t be able to confirm an insomnia diagnosis in some cases without further testing. Following are the tests one might have to undergo

  • Sleep study: Overnight sleep stud or the polysomnogram test.In this study, one has to spend the night at a sleep center with sensors on the face, scalp, eyelids, one finger, chest and limbs. The sensors then monitor brain wave activity, oxygen level, heart rate, respiratory rate and muscle movement that occur prior, during, and post sleep. Also, some daytime tests monitor sleep latency during a series of naps, evaluate abilities to stay awake and alert after a night of normal sleep. However, irrespective of home-based monitoring kits or the procedures mentioned above, they will be non-invasive and pain-free.
  • Actigraphy: Actigraphy tests, similar to overnight sleep studies, but most are conducted at home. In this one has to wear a sensor on the wrist or ankle to monitor their sleep and wakefulness pattern. Recommended Duration for wearing the sensors is three to 14 consecutive days. The test is safe for children and adults but the sensor may cause some light albeit temporary irritation.

If the diagnostic criteria for chronic or short-term insomnia based on the sleep disorder test are met, then we may advance to insomnia treatment.

Treatment

Medical Therapy | Non-pharmacological therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Management is guided by available clinical practice guidelines[4].

Case Studies

Case #1

See also

References

  1. "Insomnia Overview: Epidemiology, Pathophysiology, Diagnosis and Monitoring, and Nonpharmacologic Therapy | AJMC".
  2. "Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population | Read by QxMD".
  3. "Diagnosing Insomnia | Sleep Foundation".
  4. Mysliwiec V, Martin JL, Ulmer CS, Chowdhuri S, Brock MS, Spevak C; et al. (2020). "The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines". Ann Intern Med. doi:10.7326/M19-3575. PMID 32066145 Check |pmid= value (help).


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