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Insomnia (cont.)

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When should I call the doctor or other health care professional if I can't sleep?

In general, acute insomnia related to transient situational factors resolves spontaneously when the provoking factor is removed or corrected. However, medical evaluation by a doctor may be necessary if the insomnia persists or it is thought to be related to a medical or a psychiatric condition. Many people choose not to discuss their insomnia symptoms with their doctor; however, individuals should contact their doctor if insomnia is interfering with daytime activities.

There are also specialized doctors who evaluate and treat insomnia and other sleep disorders. Sleep apnea may be evaluated by board-certified sleep physicians from varying backgrounds who have specialized in sleep disorders. Other doctors who evaluate and treat sleep disorders are neurologists with a specialty in sleep disorders.

Is there a test to diagnose the condition?

Evaluation and diagnosis of insomnia may start with a thorough medical and psychiatric patient history taken by the doctor or other health care professional. As mentioned previously, many medical and psychiatric conditions can be responsible for insomnia.

A doctor will perform an examination on the patient to assess for any abnormal findings as well. Portions of the exam may include:

  • Assessment of mental status and neurological function
  • Heart, lung and abdominal exam
  • Ear, nose and throat exam
  • Measurement of the neck circumference and waist size.
  • Questions about any routine medications you are currently taking, and use of any illegal drugs, alcohol, tobacco, or caffeine.

Laboratory or blood work pertinent to these conditions can also be a part of the assessment.

Sleep patterns: The patient's family members and bed partners also need to be interviewed to ask about the patient's sleep patterns, snoring, or movements during sleep.

Sleep habits: Specific questions regarding sleep habits and patterns are also a vital part of the assessment. A sleep history focuses on:

  • Duration of sleep
  • Time of sleep
  • Time to fall sleep
  • Number and duration of awakenings
  • Time of final awakening in the morning
  • Time and length of any daytime naps
  • The typical sleep environment

Sleep logs or diaries: Sleep logs or diaries may be used for this purpose to record these parameters on a daily basis for more accurate assessment of your sleep patterns.

Sleep history: Sleep history also typically includes questions about possible symptoms associated with insomnia. You may asked about daytime functioning, fatigue, concentration and attention problems, naps, and other common symptoms of the condition.

Diagnostic tests

Other diagnostic tests may be done as part of the evaluation for insomnia, although they may not be necessary in all patients with insomnia.

Polysomnography is a test that is done in sleep centers if medical conditions such as sleep apnea are suspected. In this test, the person will be required to spend a full night at the sleep center while being monitored for heart rate, brain waves, respirations, movements, oxygen levels, and other parameters while they are sleeping. The data is then analyzed by a specially trained physician to diagnose or rule out sleep apnea or other disorders of sleep.

Actigraphy is another more objective test that may be performed in certain situations but is not routinely a part of the evaluation for insomnia. An actigraph is a motion detector that senses the person's movements during sleep and wakefulness. It is worn similar to a wrist watch for days to weeks, and the movement data are recorded and analyzed to determine sleep patterns and movements. This test may be useful in cases of primary insomnia disorder, circadian rhythm disorder, or sleep state misconception. Many commercially available devices are popular today for patients to use on their own and track their sleep patterns. The majority of these devices have not been evaluated against the gold standard devices and methods. Their role in identifying true insomnia has yet to be established in the scientific literature.

What are the treatments for insomnia; can it be cured?

The treatment of insomnia depends largely on the cause of the problem. In cases where an obvious situational factor is responsible for the insomnia, correcting or removing the cause generally cures the problem. For example, if insomnia is related to a transient stressful situation, such as jet lag or an upcoming examination, it will then be cured when the situation resolves.

Generally speaking, the treatment of insomnia can be divided into non-medical or behavioral approaches and medical therapy. Both approaches are necessary to successfully treat the problem, and combinations of these approaches may be more effective than either approach alone.

When it's related to a known medical or psychiatric condition, then appropriate treatment of that problem is in the forefront of therapy for insomnia in addition to the specific therapy for insomnia itself. Without adequately addressing the underlying cause, insomnia will likely go on despite taking aggressive measures to treat it with both medical and non-medical therapies.

Medically Reviewed by a Doctor on 4/19/2017


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