Insomnia means you can’t sleep, right? Yes, but that doesn’t mean identifying and diagnosing the problem is always that straightforward. Some people have become so accustomed to not getting the sleep they need that they’re simply unaware they have chronic insomnia. In other cases, minor sleep problems slowly get progressively worse, and individuals don’t realize they should talk to their doctor about it.
Learn more about what symptoms you should watch for, how doctors diagnose insomnia, and when you should consider getting help.
Signs and Symptoms That Mean You May Have Insomnia
Insomnia, which you might have after just one night of bad sleep, involves any one of these three main characteristics or symptoms, explains Sara Nowakowski, PhD, a clinical psychologist and sleep researcher at the University of Texas Medical Branch in Galveston.
- You can’t fall asleep at night. Lying awake for 30 minutes or longer once you get into bed should raise a red flag.
- You wake up in the middle of the night and can’t fall back to sleep within 30 minutes.
- You wake up earlier in the morning than you anticipated.
- Fatigue or sleepiness
- Problems focusing, concentrating, or paying attention
- Poor performance at school or work
- Moodiness or irritability
- Impulsiveness or aggression
- Lack of energy or motivation
- Concerns or frustration about your sleep
While acute insomnia is short-lived, usually ending after whatever triggered the disruption in sleep disappears, chronic insomnia can linger for weeks or months, even years. Its official definition means sleep woes that occur at least three nights a week for a period of three months. Individuals with chronic insomnia may not even be aware that they’re not sleeping, Dr. Nowakowski says.
Does Having Insomnia Mean You Don’t Sleep at All?
Insomnia means you have trouble sleeping. Having insomnia does not mean you don’t get any sleep over the course of a night.
Insomniacs tend to think they get very little sleep, but when their sleep is tested objectively, total sleep time is much greater than they thought, explains Gerard J. Meskill, MD, a neurologist and sleep disorders specialist with Comprehensive Sleep Medicine Associates in Houston. “Patients will tell me they see every hour on the clock, but I remind them that they didn’t see every minute.”
What’s going on? Blame something called paradoxical insomnia, or sleep state misperception, when people oscillate between sleep and wakefulness. “When there are gaps in conscious perception, the brain’s tendency is to sew the clips of time together to form a continuous story, which is why sleep is perceived inappropriately as wakefulness,” Dr. Meskill says.
That disrupted sleep, however, means your sleep quality is not as good as it should be for you to get the restful, restorative slumber you need. Any amount of insomnia warrants help from your doctor.
How Doctors Diagnose Insomnia and the Information They Need to Know
If you start experiencing interruptions to sleep on a regular basis, it’s time to loop in your doctor. Your family physician is a good place to start. “If you’re having any issues with sleep, you need to bring it up with your doctor,” says Sheila Tsai, MD, a pulmonologist and the section head of sleep medicine at National Jewish Health in Denver.
Start With Your Primary Care Provider
Sleep is a crucial part of health. While some family physicians and other primary care doctors are starting to ask about how much sleep you’re getting (much like when they ask if you smoke or drink), some do not address it with their patients, Dr. Tsai says. So if you do have trouble sleeping, bring it up. “Your doctor may be able to explore coexisting or contributing conditions to insomnia — like anxiety, depression, or sleep apnea — and help you manage it,” Tsai says.
In some cases, a simple conversation about good sleep habits and how you can incorporate them into your life will be enough to make the changes you need to sleep better.
You May Need to See a Sleep Specialist
If your symptoms require even further assistance, your doctor will recommend a sleep specialist, Nowakowski says. You can find a sleep specialist in your area by visiting the Society for Behavioral Sleep Medicine or the American Academy of Sleep Medicine.
There’s No One Test for Insomnia
Currently, there is no specific diagnostic test for insomnia. Instead, your primary care provider or a sleep specialist will use a variety of tools to evaluate your symptoms and determine the best treatment approach. Tools that can be helpful in measuring insomnia symptoms include: (2)
- A sleep log (a diary you keep to track the details of your sleep over several days, weeks, or months)
- A sleep inventory (a more extensive questionnaire about your sleep habits, medical history, and personal health)
- Blood tests (which help the doctor rule out underlying medical conditions)
- A sleep study (an overnight sleep test in a lab that lets a doctor objectively evaluate your sleep)
Using all of these tools gives doctors a picture of the factors affecting your sleep and helps them determine if there might be an underlying psychological or medical problem behind your sleep trouble that needs to be addressed, or what type of help you need.
One critical component of diagnosing insomnia is accurately and comprehensively measuring the problems the condition is causing so that all of those symptoms can be addressed in a treatment plan. For instance, if there’s an unidentified underlying medical condition, say, arthritis, that’s contributing to your insomnia, any amount of behavioral therapy you do may be futile if no one’s addressing the chronic pain keeping you awake at night.
If you have sleep problems, here are some topics you may want to bring up with your doctor, according to the National Sleep Foundation:
- What your sleep troubles look like, when you experience them, and how often
- How long you have had trouble sleeping
- Your typical sleep routine (including daytime naps, if you take them)
- Whether your weekend and weeknight sleep schedules are different
- What you do when you can’t sleep
- Any feelings of anxiousness, stress, or worry when you can’t sleep
- Where you sleep and what your sleep environment looks like
- Whether you’ve recently started a new job, moved, or had any other major life changes
- Any chronic medical conditions
And remember, the sooner you tell your doctor about sleep problems, the easier they tend to be to address. Insomnia can be like a bad habit, in that the longer you let it continue, the tougher it is to change (which is what happens when acute insomnia becomes chronic insomnia). You want to address your sleep problems — or the underlying problems triggering them — before they become a bad habit.