Summary
Definition
History and exam
Key diagnostic factors
- sleep partner complaints
- delayed sleep onset
- multiple or long awakenings
Other diagnostic factors
- impairment of functioning
- accidents
- decreased sleep time
- daytime napping
- thyrotoxicosis
- chronic pain
- restless legs syndrome
- obstructive sleep apnea
Risk factors
- female sex
- advanced age
- chronic medical conditions
- chronic pain
- psychiatric illness
- alcohol or substance misuse
- stimulant use
- poor sleep hygiene
- traumatic brain injury
- neuropsychiatric illness
- use of certain medications
- recent travel across time zones
- night work
- hyperthyroidism
- participation in elite sport
- sedentary behavior
Diagnostic tests
1st tests to order
- sleep diary
- Pittsburgh Sleep Quality Index (PSQI)
- Insomnia Severity Index (ISI)
- Stanford Sleepiness Scale (SSS)
- Epworth Sleepiness Scale (ESS)
- Athens Insomnia Scale (AIS)
- Generalized Anxiety Disorder-7 (GAD-7)
- Patient Health Questionnaire-9 (PHQ-9)
Tests to consider
- polysomnography (PSG)
- actigraphy
- thyroid-stimulating hormone (TSH)
- CBC and iron studies
- urine or blood substance use panel
Treatment algorithm
acute insomnia
chronic insomnia
Contributors
Authors
Joshua Hyong-Jin Cho, MD, PhD
Health Sciences Clinical Professor
Director, UCLA Insomnia Clinic
Cousins Center for Psychoneuroimmunology
Department of Psychiatry & Biobehavioral Sciences
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
JHC is an author of a reference cited in this topic.
Paul Barkopoulos, MD, MPH
Clinical Professor
Department of Psychiatry & Biobehavioral Sciences
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
PB is an author of a reference cited in this topic.
Anthony E. Reading, MPhil, PhD
Clinical Professor
Department of Psychiatry & Biobehavioral Sciences
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
AER declares that he has no competing interests.
Acknowledgements
Dr Joshua Hyong-Jin Cho, Dr Paul Barkopoulos, and Dr Anthony E. Reading would like to gratefully acknowledge Dr John W. Winkelman, Dr Teofilo Lee-Chiong, and Dr Vipin Malik, previous contributors to this topic.
Disclosures
JWW has received honoraria for consulting to Avadel, CVS, Eisai, and Merck, and research grants from Merck and the RLS Foundation. TLC is the Chief Medical Liaison for Philips, a company that makes devices to treat sleep apnea. VM received research funding from Philips Respironics for a study on COPD-OSA overlap.
Peer reviewers
Karl Doghramji, MD
Director
Sleep Disorders Center
Thomas Jefferson University Hospital
Philadelphia
PA
Disclosures
KD is a speaker for Sanofi-Aventis, King Pharmaceuticals, Takeda Pharmaceuticals, Sepracor, and Pfizer; a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, Sepracor, Pfizer, and Neurocrine Biosciences; and has stock in Merck.
Chiadi U. Onyike, MD, MHS
Assistant Professor
Geriatric Psychiatry and Neuropsychiatry
The Johns Hopkins Hospital
Baltimore
MD
Disclosures
CUO declares that he has no competing interests.
Roy Goldberg, MD
Medical Director
Kings Harbor Multicare Center
Bronx
NY
Disclosures
RG declares that he has no competing interests.
Craig Sawchuk, MD
Affiliate Assistant Professor
Department of Psychiatry and Behavioral Sciences
University of Washington Medical Center
Seattle
WA
Disclosures
CS declares that he has no competing interests.
David Cunnington, MD
Director
Melbourne Sleep Disorders Centre
Melbourne
Victoria
Australia
Disclosures
DC has received consulting fees from Sanofi-Aventis and Lundbeck, and honoraria for speaking from Sanofi-Aventis.
Differentials
- Restless legs syndrome
- Periodic limb movement disorder (PLMD)
- Obstructive sleep apnea (OSA)
More DifferentialsGuidelines
- Manual for the scoring of sleep and associated events
- Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults
More GuidelinesPatient information
Insomnia
Sleep apnea in adults (obstructive)
More Patient information
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