How Is Insomnia Diagnosed?
Reviewed by: HU Medical Review Board | Last reviewed: June 2020 | Last updated: April 2023
Insomnia, or trouble falling asleep or staying asleep, is the most common sleep disorder in the U.S. About 40 million people in the U.S. experience insomnia each year. It is also one of the most common complaints that people bring up with their doctor.
There are 2 types of insomnia:1,2
- Short-term, or acute, insomnia which usually lasts for a few days or weeks. It affects 30 percent to 50 percent of people.
- Chronic insomnia occurs at least 3 times a week for 3 months or longer. This type of insomnia is less common, affecting between 5 percent and 15 percent of people.
Short-term insomnia is usually triggered by stress and tends to get better once the stress goes away. But long-term insomnia can cause serious health issues and should be addressed by a doctor. It may take several steps to diagnose the type of insomnia you have and its causes.
The tools your doctor may use to diagnose insomnia include a sleep diary, questionnaires, and a physical exam. Unlike other sleep disorders, diagnosing insomnia usually does not require tests in a sleep lab.
Your doctor may ask you to keep a sleep diary for 1 to 2 weeks to get a better idea of what your sleep problems are. A sleep diary is a detailed record of your sleep that includes:1
Be ready to talk with your doctor in detail about your sleep habits, including how relaxing your room is when you sleep. You may be asked whether the room is quiet and cool, whether pets or children sleep with you, and whether your bed partner wakes you up. A sleep diary may also provide clues that mean you have a different type of sleep disorder.1
Tests for insomnia
Your doctor may use one of several questionnaires to gauge the severity of your insomnia. You can also take these tests yourself before speaking with your doctor. The answers to these tests give your doctor an idea of how severe your sleep issues are and cover:
- When you go to bed and get up
- What wakes you up
- How long you sleep
- Whether you snore, cough, or having trouble breathing
- If your legs bother you in the evening or at night
- Whether you have other health conditions that impact sleep
- How insomnia affects your quality of life
Common self-tests include the:
How is insomnia diagnosed?
Doctors look at 4 standards to decide whether someone has insomnia. These are:1
- Problems getting to sleep, staying asleep, or waking up too early
- Sleep problems occur even though there is enough time devoted to sleep and the environment encourages sleep
- Daytime issues tied to problem sleep such as trouble concentrating at school or work, bad moods, low energy, depression, or worries about sleep
- Problems with sleeping and waking are not caused by a different sleep disorder such as sleep apnea or restless legs syndrome
There is no set standard for how mild, moderate, or severe insomnia may be considered. This is partly because the amount of sleep someone needs varies by age. It also depends on how much the person thinks their quality of life is impacted and how much daytime activities are affected.
In general, insomnia is considered when someone has trouble falling asleep or staying asleep and this impacts their sleep or waking hours. To be chronic insomnia, this should occur at least 3 times a week for 3 months or more.1
Other sleep tests
Usually, sleep center tests are not needed to diagnose insomnia. However, a few people will need more tests, such as:1
- Polysomnography (a sleep lab study), or home sleep apnea test if sleep apnea is suspected
- Multiple sleep latency test (MLST) if narcolepsy is suspected
- Actigraphy if a circadian sleep-wake rhythm disorder is suspected
Additional tests may be needed if your insomnia does not respond to treatment and improvements in sleep hygiene.