Insomnia diagnosis

Grunstein R. Insomnia. Diagnosis and management. AustFam Physician. 2002 31 995-1000. 

BencaRM, Ancoli-Israel S, Moldofsky H (2004) Special considerations in insomnia diagnosis and management depressed, elderly, and chronic pain populations. J Clin Psychiatry 65 (Suppl 8) 26-35... 

Chronic cocaine use can cause a syndrome of insomnia, hallucinations, delusions, and apathy. This syndrome develops around the time when the euphoria turns to a paranoid psychosis, which resembles paranoid schizophrenia. Further, after cessation of cocaine use, the hallucinations may stop, but the delusions can persist. Still, the incidence of a persistent cocaine-induced psychosis appears to be rare. One study found only 4 out of 298 chronic cocaine users receiving a diagnosis of psychotic disorder (Rounsaville et al. 1991). This incidence is approximately the... 

Let us assume that Mr. Z does indeed have leukemia. For many conditions claimed by plaintiffs, especially those that are highly subjective in nature (headaches, nausea, intermittent skin rashes, insomnia, muscle pain), a similarly objective diagnosis may not be possible this creates many problems in causation evaluation which we shall not try to cope with here. But to evaluate the likelihood that Mr. Z s leukemia was caused by one or more water contaminants, it will be necessary to determine whether there is evidence in the scientific literature that is sufficient to establish a causal link (in the sense, for example, described by lARC and discussed in Chapter 6) between exposure to any one of those contaminants and leukemia. This evaluation is referred to as an analysis of general causation. Thus, it is directed at the question of whether one or more of the chemicals to which Mr. Z was exposed is known, in a general sense, to be a cause of leukemia. If benzene is, for example, one of the chemicals found in Mr. Z s well, and it can be established that he consumed water containing benzene, then we could conclude that general causation is established. 

Patients with depression usually do not present initially to mental health professionals. Most visit their primary care physicians, complaining not of depressed mood but of other symptoms of depression. Fatigue, insomnia, loss of appetite, loss of interest in sex, muscle tension, body aches, and poor concentration are all commonly reported. These so-called masked presentations of depression may in part explain the documented failure of primary care physicians to diagnose depression reliably. This underscores the importance of considering depression in the differential diagnosis of physical complaints that appear vague or exaggerated. 

Insomnia. It may seem odd to include this in the differential diagnosis of a hypersomnia, but insomnia is in fact the most common cause of daytime drowsiness. In addition, it is common for patients with narcolepsy to have some difficulty sleeping at night and for their daytime symptoms to worsen at those times. 

Narcolepsy can usually be distinguished from insomnia by the presence of one of the auxiliary symptoms (cataplexy, sleep paralysis, hypnagogic hallucinations). When the diagnosis remains unclear, then a sleep study is necessary. 

Benca RM. Diagnosis and treatment of chronic insomnia a review. Psychiatr Serv 2005 56 332-343. 

McCall WV. Diagnosis and management of insomnia in older people. 1 Am Geriatr Soc 2005 53 S272-S277... 

Anxiety and insomnia are prevalent symptoms with multiple etiologies. Effective treatments are available, but they vary by diagnosis. In most instances, the best course of action is to treat the underlying disorder rather than reflexively to institute treatment with a nonspecific anxiolytic. 

Transient disturbances may occur as a result of rapid time zone changes (as in transoceanic flights) or staying up late for a few days. Diagnosis of a sleep— wake schedule disorder, however, is made only if complaints meet criteria for an insomnia or a hypersomnia disorder. These disorders often improve when the person is able to resume a normal sleep—wake pattern. 

Buysse DJ, Reynolds CF III, Kupfer DJ, et al. Effects of diagnosis on treatment recommendations in chronic insomnia-a report from the APA/NIMH DSM-IV field trial. Sieep 1997 20 542-552. 

The symptoms of jitters, insomnia, tremors, and agitation are common in those consuming caffeine and in those with depression or the other illnesses for which these drugs are prescribed. Combining caffeine with antidepressants may exaggerate the symptoms and make it difficult for the physician to arrive at an accurate diagnosis or evaluate the drug s effectiveness. 

The remainder of this chapter discusses the characteristics of primary insomnia (PI) and secondary insomnia (SI). Each of these two sections is structured to cover prevalence, causes, and diagnosis. 

Harvey AG (2001) Insomnia Symptom or Diagnosis Clin Psychol Rev 21 1037-1059... 

Individuals with sleep disorders have great impairment in the quality of their life [9, 12, 29], Furthermore, another important aspect related to the high prevalence of insomnia is its economic cost for the health care services. This not only includes the direct costs of diagnosis and treatment (including also the over-the-counter drugs, and the cost of the associated alcoholism), but in addition the substantial indirect costs related to absenteeism, diminished productivity, accidents, and other health problems that are secondary to insomnia [30-32],... 

The diagnostic criteria for insomnia can indeed become very precise. Insomnia in the ICSD [3] was defined as the complaint of an insufficient amount of sleep or not feeling rested after the habitual sleep episode , which might denote that sleep quantity and quality should be considered as equivalent. However, there were actually two quantitative requirements in ICSD for the diagnosis of insomnia at least 20 min sleep latency and at the most 6.5 hours total sleep time, otherwise the condition was considered as sleep state misperception also called pseudoinsomnia [3],... 

According to ICD-10 [4], the sleep disturbance must have occurred at least three times per week for at least 1 month. The 1-month timeframe is essential also for primary insomnia in the American Psychiatric Association s DSM-IV classification [5], Also the patient must complain either of difficulty falling asleep or maintaining sleep, or of poor quality of sleep. However, the presence of the complaint of unsatisfactory sleep is not sufficient for the diagnosis of insomnia in its own right. It should also be a source of marked distress for the patient, and it should interfere with his/her ordinary activities in daily living. This prevents mistaking insomnia for just a symptom of another mental or physical disorder. 

Anxiety disorders are one of the most common mental disorders associated with sleep disturbances. A survey of US adult showed 24% of patients with insomnia, and 28 % of patients with hypersomnia carried a diagnosis of anxiety disorder [ 1 ]. A large survey in France also showed that about 41% of patients with insomnia complaints had a current diagnosis of anxiety disorder [2],... 

Fig. 1. Schematized hypnogram demonstrating most of the sleep disorders described in the literature using laboratory recordings of untreated persons with schizophrenia. One category of sleep disorders in schizophrenia is the insomnia type , with long sleep latency, numerous and/or long awakenings, and short sleep duration. Another type of sleep disorders is more concerned with sleep organization, e.g.., short duration of SWS and/or short latency to the onset of REM sleep. Not all disorders are found in every study since variables such as symptoms or diagnosis subtype, severity and chronicity may influence the results (see text). REMS, REM sleep. A REM sleep period is defined as a succession of REM sleep epochs not interrupted for more than 15 min.

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