Sleep history

As part of assessing an adult with suspected insomnia, take a sleep history—ask the adult:

  • if they work night shifts—see Sleep–wake disturbances in shift workers
  • if they have recently undertaken international air travel—see Jet lag
  • if they have restless limbs during sleep—see Restless legs syndrome and periodic limb movements of sleep/wakefulness
  • if they snore or have sleep-disordered breathing—see Clinical assessment of obstructive sleep apnoea in adults
  • if they experience unusual behaviours during sleep—see Parasomnias
  • about the duration of the sleep problem and if it was triggered by an event:
    • acute insomnia is commonly triggered by short-term stress (eg emotional or financial stress, physical illness) and usually resolves once the acute period of stress passes
    • chronic insomnia is an established pattern of troubled sleeping1
  • for an estimate of hours slept each night—although individual sleep requirements vary, Recommended sleep times for healthy adults gives recommended sleep times for healthy adults. Sleep difficulties may be objective or subjective
  • about the nature of their insomnia (ie which portion[s] of the sleep cycle is affected):
  • trouble falling asleep indicates either sleep-onset (initial) insomnia or delayed sleep–wake phase disorder
  • waking often or for prolonged periods (more than 30 minutes) before returning to sleep indicates sleep-maintenance (middle) insomnia
  • early morning awakening (more than 30 minutes before desired wake time) and not returning to sleep indicates either late (terminal) insomnia or advanced sleep–wake phase disorder2
  • multiple portions of the sleep cycle can be affected (eg sleep-onset and sleep-maintenance insomnia often coexist)
  • if daytime symptoms (eg daytime sleepiness, waking unrefreshed, nodding off during the day) are problematic and whether their ability to function is impaired
  • how they feel about their sleep problems; whether the problem is causing distress.
Table 1. Recommended sleep times for healthy adults

[NB1]

Age

Recommended sleep time (hours)

Not recommended sleep time (hours)

18 to 25 years

7 to 9

less than 6 or more than 11

26 to 64 years

7 to 9

less than 6 or more than 10

older than 65 years

7 to 8

less than 5 or more than 9

Note:

NB1: Individual sleep requirements vary; if a person sleeps more or less than the recommended duration for their age group but is not distressed or impaired, they may be receiving adequate sleep.

Adapted with permission from Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health 2015;1(1):40-3 [URL].

1 Although insomnia disorder is formally diagnosed when insomnia symptoms occur 3 or more times a week for at least 3 months, these guidelines take a pragmatic approach to categorise insomnia, because these periods of time do not reflect clinical practice.Return
2 Although all forms of insomnia may be a symptom of depression, late (terminal) insomnia is especially indicative of depression.Return