Diagnosing Chronic Insomnia Disorder
Many research studies have concluded chronic insomnia as a common sleep disorder. Moreover, the association between co-morbid psychological disorder and chronic insomnia is common. Comparatively, long-term sleeplessness is more complex condition than acute or transient insomnia cases. It is imperative for clinicians to be aware of causes and symptoms of insomnia. Not to mention, early recognition would help to control possible consequences of insomnia.
Chronic insomnia signs and symptoms should always be in the mind of the physician. In fact, each depressed or anxious person suspected of sleep loss. Same is true for memory deficit or daytime sleepiness. Additionally, the physician should rule out insomnia while dealing with disorders like mood swings, tiredness, chronic pain etc. Insomnia can be symptom or disorder itself. Generally, sleeplessness of these patients often overlooked due to ignorance or high intensity of other symptoms.
Taking Sleep History
Generally, the detailed sleep history of patient concludes the insomnia diagnosis. For this reason below symptoms need detailed evaluation.
- Difficulty in falling asleep
- Difficulty in retaining sleep for the required duration
- Awakening too early
- Frequent sleep awakenings
- Poor quality of sleep or unrefreshing sleep
A patient may have one or more of above symptoms. Generally, extreme insomnia cases show a mixed picture. Each symptom needs evaluation based on it onset, duration, frequency, and severity. Additionally, perpetuating factors and total course of symptom need investigation. Moreover, data of patient past experience with given symptom is important. Similarly, past history of symptom and treatment response information adds value.
Conditions prior to sleep
This information helps to assess the physical and mental preparedness for sleeping. Sleep hygiene practices are of utter importance for controlling long-term sleeplessness. The information about pre-bedtime activities helps to know compliance with sleep hygiene practice. Additionally, information about the bedroom environment and mental comfort level adds value.
- Dinner time and contents
- Mental pleasure and comfort level
- Sleeping time
- Exposure to factors which are incompatible with sleeping
- Presence of sleep distractions in the bedroom (light, heat, sound, fanning etc) environment
It is important to realize, sleep is a natural physiological phenomenon. Each living being requires a definite amount of sleep. Obviously, sleeping helps to rejuvenate all physiological and mental processes in the living being. Most of the physiological processes impact from disturbed scheduling. Same is true for sleeping. Aligning to regular sleep schedules helps body and mind to prepare for sleeping. The compliance with sleep schedule enhances sleep initiation. On the contrary, non-compliance impacts sleep duration and quality.
Evaluation of below factors while taking sleep history provides valuable insights:
- The time at which patient went to bed
- The time required for falling asleep
- What impacted sleep initiation or onset
- What impacted the duration of sleeping
- Reasons for awakening in-between
- How many times patient woke up
- What behavior caused the patient to wake up in-between
- What type of symptoms were responsible for in-between awakenings
- Total Sleep Duration
Other history details
Besides above sleep data, some other factors help to assess the condition.
- Physical and mental freshness during the overall day
- Information from close relatives especially from the bed partner
- Daytime sleepiness
- Difficulty in performing regular tasks
- Cognitive dysfunction
- Digestive symptoms
- Mood swings
- Exacerbation of comorbid symptoms
- Overall quality of life