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Insomnia: Getting a Diagnosis

Medically Reviewed by Brunilda Nazario, MD on July 12, 2021

You've had trouble falling asleep or staying asleep the whole night. Your symptoms seem to point to insomnia, but the only way to know for sure is to get a diagnosis.

That process starts with a visit to your doctor. You can see your primary care doctor first. If your doctor thinks you need more testing, they'll refer you to a sleep specialist for an evaluation.

No single test can diagnose insomnia. But a combination of questions and exams can help your doctor learn what's been keeping you awake.

How to Prepare

Before your appointment, your doctor might ask you to fill out a sleep diary. This diary can show how well you sleep and whether certain things you do make it harder for you to sleep.

Each day for 1 to 2 weeks, write down:

  • What time you go to bed and wake up
  • How long it takes you to fall asleep
  • How many times you wake up during the night
  • What you have to drink or eat before bed
  • How many naps you take during the day and when you take them
  • How sleepy you feel during the day
  • How much you exercise and when

You might also want to bring a list of questions to ask your doctor so that you don't forget anything during your visit.

What to Expect During Your Doctor Visit

To learn what might be causing your sleep problem, your doctor will ask about your health history and what conditions run in your family.

During a physical exam, the doctor will listen to your heart and lungs and look for risks like a large neck, which can cause sleep apnea. Your doctor will try to diagnose any problems that cause or look like insomnia, including:

The doctor will also ask about your history of sleep problems. The questions will cover things that could keep you awake, including:

An insomnia questionnaire can help your doctor make the diagnosis. The doctor will ask if you have problems falling asleep, staying asleep, or waking up to early. Other questions include how satisfied you are with the amount of sleep you get and how much the problem affects your daily life.

Tell your doctor about your symptoms and share your sleep diary. The length and frequency of your symptoms can offer important clues about the type of insomnia you have.

Short-term or acute insomnia symptoms last for less than 3 months. About 15% to 20% of people have this type of insomnia.

Chronic insomnia symptoms happen at least three times a week for at least 3 months. About 10% of people have this type.

Your doctor may diagnose you with insomnia if some or all of these things apply to you:

  • It takes you more than 30 minutes to fall asleep.
  • You wake up during the night and have trouble falling back to sleep.
  • You wake up early in the morning and can't fall back asleep.
  • You have at least 7 hours available to sleep each night and your bedroom is quiet, dark, and comfortable.
  • You feel tired, moody, or worn out during the day.
  • Too little sleep causes problems at work, school, or other parts of your daily life.
  • Your sleep problems can't be explained by another sleep disorder like sleep apnea, a medical condition, or a medicine you take.

Tests That Diagnose Insomnia

Your doctor might want you to take some of these tests to find out what's causing your sleeplessness.

Sleep study

Another name for this is a polysomnogram test. It measures how well you fall asleep and how long you stay asleep. A sleep study can help your doctor learn whether you have a sleep disorder such as sleep apnea, narcolepsy, or restless legs syndrome.

You can have this test at a sleep center. Or you can get a kit from your doctor and do it yourself at home.

During the sleep study, you wear sensors on your face, chest, arms, legs, and finger. While you sleep, these sensors monitor your:

Actigraphy

This is another type of sleep test you do at home to measure how well you sleep. You wear a sensor on your wrist or ankle for a few days or weeks to monitor you while you're asleep and awake. Actigraphy can help your doctor diagnose insomnia, sleep apnea, and other types of sleep disorders.

Blood tests. Your doctor may take a sample of blood to test for thyroid disease, low iron levels, or other conditions that can cause sleep problems.

Getting a Diagnosis

Many things can affect your sleep, from medical conditions to your pre-bedtime habits. It can take a few visits, and sometimes more than one doctor, to find out what's causing your insomnia and figure out the best way to treat it.

WebMD Medical Reference

Sources

SOURCES:

AASM: "Insomnia."

American Sleep Association: "Sleep Doctor: Sleep Disorder Specialist."

Cleveland Clinic: "How is insomnia diagnosed?"

Mayo Clinic: "Insomnia."

Medscape: "What are the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for insomnia?"

National Heart, Lung, & Blood Institute: "Insomnia," "Sleep Studies."

Oncology Nursing Society: "Insomnia Severity Index."

Sleep Foundation: "Diagnosing Insomnia," "Sleep Diary."

Stanford Health Care: "Diagnosis."

 

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