How is insomnia diagnosed?

Medical history: A doctor will ask the individual experiencing insomnia questions to evaluate the medical history. Questions investigate mental health problems, medications (supplements, prescription and non-prescription), history of pain, leisure habits, work and home situation, and others.

Sleep history: The doctor will also inquire about the individual's sleep history. Questions inquire about length and severity of the sleeping problem, routines before sleeping, snoring, and noise levels.

Physical exam: The doctor will also give the individual a full physical exam, including blood tests for conditions that may interfere with sleep including thyroid problems.
Sleep study (Polysomnogram): A polysomnogram is a recording of the breathing, movements, heart function, and brain activity during sleep. For this study, the individual sleeps overnight at a sleep center or hospital. A sleep study will be recommended if there are signs of sleep apnea or restless legs syndrome (RLS).

Other: The Epworth Sleepiness Scale is an example of a validated questionnaire that can be used to assess daytime sleepiness. It asks questions about the chances of dozing off during various daily functions such as watching TV, sitting and reading, or driving a car. Actigraphy is another technique to assess sleep-wake patterns over time. Actigraphs are small, wrist-worn devices (about the size of a wristwatch) that measure movement. They contain a microprocessor and on-board memory and can provide objective data on daytime activity. Actigraphs measure day-to-day activity of an individual, recording movement being made during waking and sleeping hours along with light, sound, and temperature. Actigraphy is useful for assessing daytime sleepiness in situations where a laboratory sleep latency test is not appropriate. Actigraphy is used to clinically evaluate insomnia, circadian rhythm sleep disorders, excessive sleepiness, and restless leg syndrome. It is also used in the assessing of the effectiveness of treatments for these disorders.

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Insomnia is not a disease, and no specific test can diagnose it. But it can make you feel bad, and it can affect your health. It can also be a sign of other problems. Your doctor may want to do blood tests to rule out certain medical conditions such as thyroid problems. "Normal sleep" differs for each person. Checking your health and sleep history is an important first step to finding a cause for poor-quality sleep. Talk with your doctor about your medical history and any medical problems you have or any medicines you are taking.

• Your doctor can learn a lot about your insomnia and its causes by reviewing your sleep history. He or she may also ask you to keep a sleep diary for 1 or 2 weeks to track your sleep patterns and habits. Your sleep diary can help your doctor spot certain habits that may affect your sleep, or even see signs of a hidden health problem that may need to be checked out.
• If your symptoms point to mental health concerns, such as depression or anxiety, you may be referred to a mental health professional.

Sleep studies:

If your doctor thinks that you have a sleep disorder, he or she may refer you for a sleep study. When you have a sleep study, you stay overnight in a special sleep lab.

Your doctor may recommend a sleep study if your insomnia seems to be caused by breathing problems (such as sleep apnea) or periodic limb movement disorder, or if you have tried other treatments that haven't worked.

Sleep studies are not helpful for insomnia caused by mental health problems, fibromyalgia, or chronic fatigue syndrome.

There are many variations of the definition of insomnia, but basically it is diagnosed by a physician taking a careful history of your sleep and wake cycles and any problems you may have falling asleep or staying asleep. This problem with sleep should be present despite a good environment for sleep and causes daytime problems or distress. It should also occur at least three times a week before it's considered a "medical condition."