Insomnia can be a symptom of many medical diseases, so your healthcare provider may first do tests to look for a variety of disorders that may be disrupting your sleep.
If a sleep disorder is suspected, your healthcare provider may refer you to a sleep clinic for an evaluation by specialists who rely on information from the following to make a diagnosis:
A sleep specialist may ask you many questions about your health and symptoms. Your sleep partner will also be asked about your symptoms, such as snoring or movement during the night, since you may not be aware of many events that happen in your sleep.
Questions your sleep specialist may ask include:
- How long has your insomnia lasted?
- Do you have trouble falling asleep, staying awake, or do you wake up too early in the morning?
- What factors have caused or contributed to your insomnia (stressful events, relationships with others, problems with money, etc.)?
- What have you done in the past to help with your insomnia?
- Do you use caffeine, alcohol, or tobacco products?
- What medicines do you take, including over-the-counter medicines and herbal remedies?
- What is your sleep routine?
- What is your evening routine (responsibilities at home, chores, childcare, exercise, eating times)?
- What is your work schedule, including shift work or a "second" job?
- What is your medical history (include any evaluation and treatment of a sleep disorder)?
- Describe your bedroom.
- Describe how you perform at work and/or school.
A sleep specialist may give you a complete physical exam. Some things the doctor may look for include a deviated nasal septum, enlarged tonsils, or a narrow throat. Such obstructions can lead to sleep apnea, which may be the cause of your insomnia.
Your doctor may have you fill out a sleep diary. This may be done for one to two weeks before your office visit. In your sleep diary, you will record information about the quality and quantity of nighttime sleep and daytime naps, including:
- The time you got into bed
- The time you tried to sleep
- How long it took you to fall asleep
- The number of times you woke up during the night
- How long you were awake
- The amount of actual sleep during the night
- The time you woke up in the morning
- The time you got out of bed
- Whether you dreamed during the night
- How you felt about the quality of your sleep
- Whether you took any medicines to help you sleep
- Whether you drank coffee or alcohol before you went to bed
- Whether you took any naps during the day
- Whether there were any events during day that may have affected your sleep
Based on your history and physical exam, your doctor may recommend a sleep study. For such a study, you usually stay overnight in a sleep lab, a specialized unit with computerized monitoring equipment that is staffed by healthcare providers and other specialists. The sleep study can help your doctor make a diagnosis and guide treatment by providing information on everything from body position and blood oxygen levels to heart rate and eye movements.
During a typical sleep study, you will be connected to electrodes that will record your brain waves and muscle movements throughout the night. A microphone will record snoring, and two belt-like straps around the chest and lower abdomen will monitor muscle movement during breathing.
Other tests your doctor may recommend include:
Multiple Sleep Latency Test (MSLT)
This is a test to objectively determine your degree of daytime sleepiness. This test is also done in a sleep lab. On the day following your overnight sleep study, you will be asked to take 4 or 5 naps over 8 to10 hours. Each nap period lasts about 20 minutes. During these naps you will be closely monitored, as you were during your sleep study.
Maintenance of Wakefulness Test (MWT)
This test measures your ability to stay awake. It consists of 4 nap opportunities. Each lasts 40 minutes. During these periods you will be asked to try to stay awake. Most people without excessive sleepiness are able to remain awake.
An actigraph is a device worn over the wrist like a watch. It records a signal when movement is detected. There are no signals recorded during sleep or inactivity. Signals are recorded with motion or activity. This can provide information about periods of rest/sleep or activity. The device is worn for several days to weeks, if needed.
Your doctor may order lab tests, including those to test for medicines known to affect one's level of alertness, such as stimulants, opiates, and antianxiety medicines.
Last reviewed on 06/26/2006
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