Doctors do largely depend on patient's reports of insomnia. Insomnia includes quite a variety of presentations.
First, a problem with the initiation of sleep. Most of us will fall asleep within 30 minutes after going to bed. If the individual takes longer than 30 minutes to fall asleep, that is called problems with the initiation of sleep. Common causes of this include:
- stress
- anxiety
- coming home late
- insufficient time for unwinding
- excessive use of social media
- late-night exercise
- too much caffeine, etc.
Second, a problem with the maintenance of sleep. This means that the person keeps waking up throughout the night. Common causes include:
- anxiety
- depression
- nocturia (passing urine at night, could be due to diabetes, enlarged prostate and other causes)
- obstructive sleep apnea
- alcohol intake
Third, early morning awakening. This means waking up at least 2 hours earlier compared with normal waking-up times and this could be due to advance sleep phase syndrome or depression.
Fourth, lack of restful sleep. This can be due to anxiety, depression or obstructive sleep apnea.
Apart from patient reports, it is also possible to do an overnight sleep study to examine the quality and duration of sleep at night. This is called polysomnography. Sleep disorder is often done when the doctor suspects that the person may have obstructive sleep apnea or excessive movements during sleep.
For some patients, it may be challenging to distinguish insomnia disorder from a circadian rhythm sleep disorder (problems due to biological clock). A useful investigation is an actigraphy. If a person can get access to an actigraphic assessment of his or her sleep, that will help with diagnosis.
An actigraph is a device worn like a wristwatch that measures body movement and stores the information in an internal microchip for computer analysis. Active and inactive periods across several weeks are then displayed graphically, and it is possible to see what times of the day and night the natural peaks and troughs in movement occur. If they are out of alignment with the normal sleep (inactive) and wake (active) cycles, then this might suggest that the person has a circadian problem.
