is insomnia diagnosed?
Insomnia is diagnosed by history. In other words, a physician
determines that a patient has insomnia by speaking to them.
Sometimes sleep physicians may also ask a person to fill out
“sleep diaries,” or “sleep logs,”
in order to get a better idea about the person’s sleep
schedule and habits.
Why should I meet with a sleep specialist to treat
You should involve your primary care physician in all aspects
of your medical care. If you have a mental health professional,
you should continue to see them. At The Center for Respiratory
and Sleep Disorders we feel strongly that communication between
health professionals enhances patient care. For this reason,
we make efforts to communicate whenever possible with referring
and other involved physicians.
many insomnia therapies should be prescribed and controlled
by a sleep specialist. This is because:
Sleep may worsen before it gets better when these therapies
are used. Patients who do not have the benefit of regular
physician advice may become frustrated and give up before
results are seen. We have seen this happen, and can provide
guidance when it does.
Medical disorders may contribute to the cause and severity
of insomnia. These should be addressed by a sleep specialist
and primary care physician. These will be considered in your
Medicines may be used in conjunction with non-drug therapies.
These are usually prescribed by and controlled by a sleep
some instances a sleep specialist may wish to try one therapy
at a time, in order to truly evaluate its effectiveness. If
more than one therapy starts at the same time, it may be difficult
to figure out which one worked (or didn't work). On the other
hand, we may perform several therapies simultaneously. These
are best monitored by a specialist.How often must I follow
up with a sleep specialist? Why so often?
Most patients see us for this because they are already frustrated.
We want that frustration to end.
want patients to be successfully treated, and feel that the
best way to do this is with an intensive, closely monitored
program. People with insomnia may be followed as often as
every week until improvement occurs.
I need a sleep study to diagnose my insomnia?
Most patients with insomnia do not need a sleep study in order
to diagnose it, unless there is concern that another sleep
disorder is also present. A sleep expert is usually able to
make a diagnosis of insomnia and treat it without ordering
a sleep study.
I need to take medicines forever for my insomnia?
Most patients with insomnia which has been present for a long
time (“chronic insomnia”) are more effectively
treated with non-drug therapy. Drugs work very well in many
patients. Sleep experts are often able to help patients sleep
without them, by using other techniques.
types of treatment do you offer?
At the Center for Respiratory and Sleep Disorders, we provide
several therapies for insomnia. Whenever they are offered
we attempt to collaborate closely with the patient’s
primary care physician and mental health professional. These
Cognitive Behavioral Therapy and Stimulus Control Therapy
Medicines – Drug Therapy
are several medicines on the market which are very effective
in causing sleepiness. They are effective in treating insomnia.
Physicians prescribe these drugs often, and they work for
many people. They are particularly helpful for insomnia which
has not been present for a long time.
treating other illnesses with medications is effective for
insomnia, too. This is true especially for disorders such
as depression and anxiety. Many persons who are effectively
treated for these experience an improvement in sleep, as well.
Some of the medicines which are used for these problems tend
to cause sleepiness as a side effect. By using this side effect
to our advantage we are able to effectively treat both problems.
Restriction is a very effective non-drug therapy
for chronic insomnia. Sleep restriction therapy involves the
therapeutic use of sleep deprivation. By limiting the amount
of sleep a person attains on a given day, the person becomes
more sleepy the next day. This is continued for a few to several
days. At that point, nightime sleepiness increases enough
to allow the person to fall asleep. Sleep may be restricted
to as few to 5 hours per night.
Restriction should only be prescribed by sleep
physicians who have experience in its use.
is one of the therapies which we prescribe at The Center for
Respiratory and Sleep Disorders. When it is used, we follow
the patient on a weekly basis.
Stimulus control therapy involves the development of an environment
and atmosphere which promotes sleep. Many people who have
chronic insomnia have developed habits which are not conducive
to a restful night. Insomnia evaluation and treatment must
address these issues to determine if a change in behavior
behavioral therapy (CBT)
Cognitive behavioral therapy for insomnia involves learning
ways to cope with issues which inhibit sleep. It employs several
components including changes in schedule, changes in behavior
and sleep habits. CBT employs non-drug therapies to improve
sleep. However, use of CBT does not mean that medicines are
not helpful. In some patients both CBT and medicines are used.
CBT therapies may be used alone, or may be used along with
medicines to treat insomnia. Some CBT techniques include:
Avoidance of Naps
Stimulus Control Instructions
Sleep Hygiene Instruction (teaching good sleep habits)
Because our “body clocks” are “set”
by light, we sometimes can use light to help us sleep. By
using bright light given at the correct time of day, we are
able to help initiate sleep at night. This therapy may also
be effective in some cases of depression. At the Center for
Respiratory and Sleep Disorders we assist patients in the
use of this therapy.