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- How long have you had problems with insomnia?
Why: to determine if acute or chronic. Transient insomnia can last up to 3-4 weeks and after that it is considered to be chronic.
- Is the sleep disturbance problem with sleep onset (initial insomnia), sleep maintenance (middle insomnia) or premature awakening (late insomnia)?
- What is the sleeping environment?
Why: Common problems with the sleeping environment that may contribute to insomnia and sleep disturbance include noise, extreme temperatures, poorly ventilated room, hot bedroom, cold bedroom, mattress that is too soft or hard, too much light in bedroom.
- Do you take day time naps?
Why: may cause or prolong the problem of insomnia.
- What is the age of the person with insomnia?
Why: a reduction in sleep requirements often accompanies aging. If the sleep disturbance is in a child or infant must consider hunger, colic, indigestion, dirty diaper, too hot, too cold, teething.
- Are there simple reasons for sleep disturbance?
Why: e.g. overeating before bedtime, sugar snack before bedtime, environment change (in an unfamiliar hotel or hospital bed), sleep schedule change, jet lag, shift work, mental stimulation before bedtime, sex at bedtime (some people become stimulated after sex), lack of exercise, partner who has restless legs syndrome or who snores loudly.
- What are your stressors at the moment?
Why: questions specifically about relationship, family, children, social support, occupation, general physical health and financial stresses. Stressors are a common cause of insomnia such as a change of occupation, loss of a loved one, illness, anxiety over a deadline or examination.
- Previous or current use of sedatives or hypnotics?
Why: The regular use of sedatives or hypnotics will interfere with sleep patterns and lead to chronic insomnia. Often the dosage of these medications will have been increased in the past so as to maintain hypnotic effectiveness after tolerance begins to develop. In cases of withdrawal, individuals may sleep only 1-4 hours each night ("rebound insomnia") for several weeks and will also experience an increase in anxious dr and nightmares and awakenings through the night.
- Past medical history?
Why: many medical problems may increase the risk of insomnia such as hyperthyroidism, kidney disease, Parkinson's disease, asthma, congestive cardiac failure, emphysema, chronic bronchitis, Addison's disease, Cushing's disease.
- Past psychiatric history?
Why: certain mental illnesses are well known to cause insomnia such as depression, anxiety, schizophrenia, mania.
- Medications?
Why: Some medications may cause insomnia including thyroid hormones, certain weight loss drugs, phenylpropanolamine (PPA), nasal decongestants, diuretics (due to night urination), high-potency vitamins, certain antidepressants (e.g. SSRIs and also MAOs). Withdrawal of some medications may also cause insomnia such as severe rebound insomnia with benzodiazepine sleeping pills.
- Cigarette smoking?
Why: may cause insomnia especially at bedtime. The use of nicotine patches for smoking cessation may cause vivid dreams and disturbed sleep in some people.
- Alcohol history?
Why: excessive alcohol before bedtime may cause insomnia. Typically alcohol causes increased drowsiness and reduced time to fall to sleep but even moderate amounts of alcohol can increase awakenings after sleep onset by interfering with the ability of the brain to maintain sleep.
- Caffeine intake?
Why: including coffee, tea, cola, chocolate (especially before bedtime but even in the afternoon in some people) may cause insomnia. It causes an increased time to fall to sleep, more frequent arousals during sleep, and a reduction in total sleep time for up to 8-14 hours after caffeine ingestion.
- Illicit drug use?
Why: e.g. amphetamine and cocaine usage may cause insomnia.
Sometimes, other symptoms may be present and may help your doctor analyse your condition. These may include:
- Night urination?
Why: causes of night time urination such as cystitis, prostatitis, benign enlargement of the prostate, prostate cancer, diuretic usage and diabetes may effectively cause insomnia due to the practical need to urinate.
- Pain or physical discomfort?
Why: any disease that causes any discomfort may interfere with sleep such as chronic back pain, arthritis pain, peptic ulcer pain, angina chest pain, skin ulcer pain, ear ache, tooth ache, anal itch, leg cramps.
- Shortness of breath at night?
Why: any disease that causes shortness of breath especially at night may interfere with sleep such as congestive heart failure, asthma, emphysema.
- Symptoms of hyperthyroidism?
Why: e.g. loose bowel motions, intolerance to heat, sweating of hands, muscle weakness, increased appetite, weight loss, heart palpitations, emotional disturbance, sleep disturbance.
- Symptoms of menopause?
Why: e.g. hot flushes, night sweats, heart palpitations, lightheadedness, dry vaginal, dry skin, headaches, disturbed sleep due to night sweats and hot flushes.
- Symptoms of depression?
Why: e.g. depressed mood, crying spells, anhedonia (loss of interest or pleasure), increase or decrease in appetite (usually decreased), weight loss or gain, insomnia or increased sleeping, fatigue, loss of energy, feelings of worthlessness, feelings of excessive guilt, poor concentration, difficulty making decisions, low libido, thoughts of death or suicide attempt. The great majority of individuals who experience major depression will suffer form insomnia, usually early morning wakening (usually around 3am) with difficulty returning to sleep.
- Symptoms of anxiety?
Why: e.g. nervousness, shakiness, tremor, restlessness, irritability, insomnia, poor concentration, heart palpitations, racing heart, sweating, dizziness, diarrhea, lump in throat and frequency of urination. Difficulty with getting to sleep (both at the beginning of the night and following night time awakenings) is a common feature of generalized anxiety disorder, due to increased autonomic arousal and worry.
- Symptoms of Manic-depression?
Why: e.g. episodes of depression (often psychotic in intensity) and at other times episodes of psychotic excitement (mania or hypomania). Symptoms of psychotic excitement may include elevation of mood, increased activity, insomnia, decreased need for sleep, grandiose ideas, irritability, disinhibition (which affects social, sexual and financial behavior), rapid speech and racing thought, delusions (persecutory or grandiose) and sometimes hallucinations.
- Symptoms of restless leg syndrome?
Why: e.g. irresistible urge to move their legs when awake and inactive, especially when lying in bed just prior to sleep. This interferes with the ability to fall asleep. People experience a creeping, crawling sensation deep in their calves that is only relieved by movement, particularly walking.
- Symptoms of obstructive sleep apnea?
Why: e.g. loud snoring, disturbed nocturnal sleep, daytime sleepiness, unrefreshed sleep, restless sleep, morning headache, nocturnal choking, reduced libido.
- Symptoms of narcolepsy?
Why: e.g. excessive daytime sleepiness wit involuntary daytime sleep episodes, disturbed nocturnal sleep and cataplexy (sudden weakness or loss of muscle tome, often elicited by emotion).
- Symptoms of Parkinson's disease?
Why: e.g. coarse hand tremor most marked at rest, rigidity of limbs, slowness in initiating and executing movements and speech, expressionless mask-like face and dementia. Sufferers of Parkinson's disease frequently complain of difficulty getting to sleep and increased awake time during the night.
Posted in: Diagnostic Approaches
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