Insomnia history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Overview
The hallmark of insomnia is difficulty sleeping. History is the most important diagnostic study of choice while evaluating insomnia. Possible underlying or coexisting psychiatric or medical disorders should be evaluated along with a detailed sleep history. Patients with insomnia may have a positive history of underlying sleep disorders. Symptoms of underlying or coexisting medical disorders should be evaluated while taking the history. DSM-5 diagnostic criteria for insomnia disorder (which is a diagnosis of exclusion) are symptoms occur ≥ 3 days/week for ≥ 3 months, symptoms cause functional impairment or distress, problems initiating or maintaining sleep, and 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, and no underlying or coexisting psychiatric or medical disorder that explains symptoms.
History and Symptoms
The hallmark of insomnia is difficulty sleeping. History is the most important diagnostic study of choice while evaluating insomnia. Possible underlying or coexisting psychiatric or medical disorder should be evaluated along with a detailed sleep history. Useful tools for further evaluation include:[1]
- Sleep diaries (a form that the patient should fill for 1-2 weeks, which include sleep-wake patterns and habits)
- Insomnia-related instruments
- Glasgow Sleep Effort Scale (evaluates the effort for falling asleep)
- Insomnia Severity Index (useful for insomnia screening and evaluation of treatment response)
- Morningness-Eveningness Questionnaire (evaluates the circadian ryhthm)
- STOP and STOP-Bang Questionnaires (evaluates the possibility of obstructive sleep apnea)
History
Patients with insomnia may have a positive history of:[1]
- Difficulty falling asleep; early morning awakening; staying asleep or getting back to sleep after awakening during the night; and/or disrupted, non-refreshing sleep (might be helpful for the diagnosis of insomnia as well as the differential diagnosis among sleep disorders)
- Difficulty falling asleep in socially acceptable sleeping hours and severe daytime sleepiness (might indicate circadian rhythm sleep disorder)
- Daytime sleepiness, gasping or choking during sleep, snoring, dry mouth and/or headache in the morning, nocturia, repeated short awakenings, short sleep latency, and non-refreshing sleep (might indicate obstructive sleep apnea
- Urge of moving the limbs, particularly legs, that usually caused by “uncomfortable and unpleasant sensations" over the affected area (might indicate restless legs syndrome)
- Repetitive cramping, jerking, or twitching of legs during sleep (might indicate periodic limb movement disorder)
- Severe daytime sleepiness, cataplexy, hallucinations that occur during falling asleep or awakening, and sleep paralysis (might indicate narcolepsy)
Symptoms
- Symptoms of underlying or coexisting medical disorders (e.g., congestive heart failure, chronic obstructive pulmonary disease, gastroesophageal reflux disease, fibromyalgia, arthritis, epilepsy, migraine, menopause, pruritic skin conditions, benign prostatic hypertrophy, etc.) and psychiatric disorders (e.g., anxiety, manic phase of bipolar disorder, depression, posttraumatic stress disorder, etc.) should be evaluated while taking the history.[1]
Insomnia disorder
According to the DSM-5 diagnostic criteria, patients with insomnia disorder (which is a diagnosis of exclusion) may have a positive history of[2]:
- Symptoms occur ≥ 3 days/week for ≥ 3 months
- Symptoms cause functional impairment or distress
- Problems initiating or maintaining sleep, and 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
References
- ↑ 1.0 1.1 1.2 Sutton EL (March 2021). "Insomnia". Ann Intern Med. 174 (3): ITC33–ITC48. doi:10.7326/AITC202103160. PMID 33683929 Check
|pmid=value (help). - ↑ "Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population | Read by QxMD".