Test Your Knowledge

Insomnia may take time to diagnose, depending on its cause. A physical examination and a review of the patient's medical history and medications may be sufficient to pinpoint the source of the problem for most people. If not, physicians may seek to determine whether a medical or psychiatric condition is contributing to insomnia.

Physicians may conduct a sleep history, in which patients are asked questions about sleep habits. Physicians may also ask family members or bed partners to describe symptoms observed while the patient is sleeping. Questions physicians ask patients may include:

• When did your insomnia begin?
  
  
• Is your sleep environment conducive to sleep?
  
  
• Do you experience creeping, crawling or uncomfortable feelings in your legs during the night?
  
  
• Do you snore loudly, gasp, choke or stop breathing during sleep?
  
  
• What are your bedtimes and rise times during the week and on weekends?

Patients may be asked to keep a sleep diary, usually over a two-week period. Information recorded in the diary may include bedtimes, time required to fall asleep, time asleep and feelings of restfulness after awakening. Patients may also be asked to fill out a sleep questionnaire, such as the Epworth Sleepiness Scale. This tool includes questions to measure the likelihood of dozing in certain circumstances, such as sitting and reading.

Patients may be referred to a sleep center where sleep patterns are analyzed in depth by health professionals who specialize in sleep disorders. These tests are usually performed to rule out other conditions, such as sleep apnea. Some common tests that are performed to diagnose sleep disorders include:

• Polysomnogram (sleep study). Painless test conducted overnight while patients are sleeping. Electrodes are placed on the face and scalp before sleep. The test monitors electrical activity of the brain (electroencephalogram), electrical activity of the heart (electrocardiogram), movements of the muscles (electromyogram) and eye movements (electro-oculogram). These are measured as patients move through the different stages of sleep.
  
  
• Multiple sleep latency test (MSLT). Conducted in a similar method as a polysomnogram, but performed during daytime hours. The test is conducted while patients nap during daytime hours.
  
  
• Actigraphy. Records activity and movement on a monitor or motion detector. This test is usually conducted over several weeks to objectively determine how much a patient is sleeping.