Contributing or causative factors for insomnia

As part of assessing an adult with suspected insomnia, establish if any of the factors listed in Factors that can contribute to or cause insomnia are contributing to or causing the sleep problem.

Table 1. Factors that can contribute to or cause insomnia
Factor	Common examples
insomnia is a symptom of another disorder	anxiety bipolar disorder dementia depressive disorders [NB1] hyperthyroidism Parkinson disease personality disorder psychosis
physical symptoms of a condition contribute to insomnia	dyspnoea gastro-oesophageal reflux menopause nocturia pain
drugs	alcohol [NB2] amfetamines and other psychostimulants some antiepileptics aripiprazole beta agonists caffeine [NB3] corticosteroids dopamine agonists nicotine replacement therapy [NB4] selective serotonin reuptake inhibitors (SSRIs) theophylline tobacco [NB4]
withdrawal states	alcohol withdrawal benzodiazepine withdrawal
poor sleep practices [NB5]	irregular bedtimes and wake times napping eating heavy meals before bed vigorously exercising before bed using electronic devices in bed poor sleep environment—bright light, pets or children in the bedroom, noise, feeling insecure or unsafe, uncomfortable bedding and extreme temperatures can make sleeping difficult
Note: NB1: Although all forms of insomnia may be a symptom of major depression, late (terminal) insomnia is especially indicative of major depression. NB2: Alcohol makes sleep less refreshing and can shorten sleep duration, reduce rapid eye movement (REM) sleep and cause sleep-maintenance insomnia. NB3: Drinking caffeine later in the day (or in excessive amounts) can cause sleep problems. NB4: Nicotine is a stimulant and can cause sleep troubles; particularly when used in the evening. NB5: See Good sleep practices for adults for good sleep practices.