Approach to assessing an adult with insomnia

Assessing an adult with suspected insomnia helps to:

• confirm the diagnosis—a person is considered to have insomnia if they have difficulty falling or staying asleep and this results in significant daytime sequelae (eg fatigue, irritability, impaired concentration and memory) and distress
• exclude other sleep disorders
• determine if the problem is established
• identify the portion(s) of sleep cycle affected
• identify contributing or causative factors
• inform treatment
• provide a baseline for repeat assessment.

Assessment involves:

• taking a sleep history
• identifying modifiable contributing or causative factors.

A sleep diary and various sleep questionnaires can aide assessment. Consumer sleep technologies have a limited role in the assessment of sleep disorders.

For additional considerations in assessing insomnia in:

• older people, see here
• dementia, see here
• the perinatal period, see here
• inpatient settings, see here
• problem substance use, see here
• palliative care, see here.

If the diagnosis remains unclear despite adequate assessment, consider referral to a sleep specialist—a sleep study may be required.