| Sleep history |
| The evaluation of insomnia rests on a careful clinical history taking. The clinician should evaluate the nature, frequency, and duration of insomnia symptoms, their chronology, and response to treatment. The patient’s symptoms should be considered across the entire 24-hour day; sleep and wakefulness affect each other in complex ways, and patients often seek treatment because of daytime symptoms and distress related to their sleep problems. |
| Key elements of the sleep history |
| - Temporal aspects of sleep: times at which the patient goes to bed, attempts to sleep, wakes up, and gets out of bed |
| - Quantitative aspects of sleep: sleep latency (time it takes to fall asleep); number and duration of awakening; wakefulness after sleep onset; total sleep time |
| - Qualitative aspects of sleep: subjective sleep quality, satisfaction |
| - Behavioral and environmental factors: nonsleep activities in bed (phone, computer, television); environment (temperature, light, sound); bed partners and pets; perceived causes of awakening |
| - Symptoms of other sleep disorders: obstructive sleep apnea (snoring, breathing pauses); restless legs syndrome (urge to move the extremities); parasomnias (unusual sleep behaviors); circadian rhythm disorders (unusual sleep timing) |
| - Daytime causes and consequences of disturbed sleep: napping; exercise; work and activities; social and family stressors; use of caffeine, alcohol, and tobacco |
| Medical and psychiatric history |
| Insomnia evaluation should include a medical/psychiatric history and physical examination to identify comorbid conditions that can exacerbate or be exacerbated by insomnia. |
| - Medical history: neurologic (stroke, migraine); pulmonary (chronic obstructive pulmonary disease, asthma); chronic pain (arthritis, fibromyalgia); endocrine (hypothyroidism, hyperthyroidism); gastroesophageal reflux; cardiovascular (congestive heart failure) |
| - Psychiatric disorders: depression; bipolar disorder; anxiety disorders; substance use disorders |
| - Medications: antidepressants; other sedatives; antihypertensives; steroids; decongestants and antihistamines; adrenergic agonists |