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 leg syndrome
- enlarged tonsils or tongue
- micrognathia and retrognathia
- lateral narrowing of oropharynx
Risk factors
- female sex
- advanced age
- chronic medical conditions
- chronic pain (e.g., hip impairment)
- psychiatric illness
- alcohol or substance misuse
- stimulant usage
- poor sleep hygiene
- traumatic brain injury
- medications
- recent travel across time zones
- night work
- thyroid dysregulation
- participation in elite sport
- sedentary behavior
Diagnostic tests
1st tests to order
- Pittsburgh Sleep Quality Index (PSQI)
- Insomnia Severity Index (ISI)
- Stanford Sleepiness Scale (SSS)
- Epworth Sleepiness Scale
- Athens Insomnia Scale (AIS)
Tests to consider
- polysomnography (PSG)
- actigraphy
- sleep diary
- thyroid-stimulating hormone (TSH)
Treatment algorithm
acute insomnia
chronic insomnia
Contributors
Authors
John W. Winkelman, MD, PhD
Chief, Sleep Disorders Clinical Research Program
Department of Psychiatry
Massachusetts General Hospital
Professor of Psychiatry
Harvard Medical School
Boston
MA
Disclosures
JWW has received honoraria for consulting to Avadel, CVS, Eisai, and Merck, and research grants from Merck and the RLS Foundation.
Acknowledgements
Dr John W. Winkelman would like to gratefully acknowledge Dr Teofilo Lee-Chiong and Dr Vipin Malik, previous contributors to this topic.
Disclosures
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)
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