eMedicine Specialties > Pulmonology > Sleep-Related Disorders

Insomnia: Differential Diagnoses & Workup

Author: Peter Smethurst, MD, Attending Physician, Pulmonary, Critical Care and Sleep Medicine, St Joseph's Medical Center
Coauthor(s): Silverio M Santiago, MD, Clinical Professor of Medicine, University of California at Los Angeles School of Medicine; Chief, Department of Pulmonary and Critical Care Medicine, Medical Director, Sleep Disorders Center, Veterans Affairs Medical Center of West Los Angeles; James A Rowley, MD, Associate Professor, Fellowship Program Director, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine
Contributor Information and Disclosures

Updated: Jul 25, 2008

Differential Diagnoses

Depression
Obstructive Sleep Apnea-Hypopnea Syndrome

Other Problems to Be Considered

Restless Legs Syndrome
Periodic Limb Movement Disorder
Sleeplessness and Circadian Rhythm Disorder
Inadequate sleep hygiene

Workup

Laboratory Studies

  • Patients with a history suggestive of chronic obstructive pulmonary disease and insomnia should have an arterial blood gas determination performed to determine if they are hypoxemic.
    • Insomnia associated with chronic obstructive pulmonary disease frequently begins with the development of nocturnal hypoxemia, although nocturnal hypoxemia is not required for insomnia to occur. Treatment with oxygen may improve the condition, but it rarely eliminates the insomnia. Nocturnal hypoxemia is present if the patient has daytime hypoxemia and frequently if he or she has exercise-related hypoxemia.
    • If the arterial blood gas result is negative for hypoxemia, an exercise desaturation study or overnight oximetry may be helpful to determine if the patient needs oxygen.

Other Tests

  • Refer patients with a history suggestive of sleep apnea or RLS/PLMD to a sleep center for possible polysomnography.
  • Neurologic testing may be indicated in patients with signs and symptoms of neurologic disease.

More on Insomnia

Overview: Insomnia
Differential Diagnoses & Workup: Insomnia
Treatment & Medication: Insomnia
Follow-up: Insomnia
Multimedia: Insomnia
References
[ CLOSE WINDOW ]

References

  1. Bonnet MH, Arand DL. 24-Hour metabolic rate in insomniacs and matched normal sleepers. Sleep. Sep 1995;18(7):581-8. [Medline].

  2. Bonnet MH, Arand DL. Caffeine use as a model of acute and chronic insomnia. Sleep. Dec 1992;15(6):526-36. [Medline].

  3. Krystal AD, Walsh JK, Laska E, Caron J, Amato DA, Wessel TC, et al. Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep. Nov 1 2003;26(7):793-9. [Medline].

  4. Brzezinski A, Vangel MG, Wurtman RJ, Norrie G, Zhdanova I, Ben-Shushan A, et al. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev. Feb 2005;9(1):41-50. [Medline].

  5. [Best Evidence] Buscemi N, Vandermeer B, Hooton N, Pandya R, Tjosvold L, Hartling L, et al. Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta-analysis. BMJ. Feb 18 2006;332(7538):385-93. [Medline].

  6. Bent S, Padula A, Moore D. Valerian for sleep: a systematic review and meta-analysis. Am J Med. Dec 2006;119(12):1005-12.

  7. American Academy of Sleep Medicine. ICSD2 - International Classification of Sleep Disorders. Diagnostic and Coding Manual. 2nd. Westchester, Ill: American Academy of Sleep Medicine; 2005:1-32.

  8. Bonnet MH, Arand DL. The consequences of a week of insomnia. Sleep. Jul 1996;19(6):453-61. [Medline].

  9. Chesson AL Jr, Anderson WM, Littner M, Davila D, Hartse K, Johnson S, et al. Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. Dec 15 1999;22(8):1128-33. [Medline].

  10. Erman MK. Insomnia. In: Poceta JS, Mitler MM. Sleep Disorders: Diagnosis and Treatment. Totowa, NJ: Humana Press; 1998:21-51.

  11. Farney RJ, Walker JM. Office management of common sleep-wake disorders. Med Clin North Am. Mar 1995;79(2):391-414. [Medline].

  12. Gillin JC, Byerley WF. The diagnosis and management of insomnia. N Engl J Med. 1990;322:239-248. [Medline].

  13. Hauri P. Primary insomnia. In: Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine. 3rd. Philadelphia, Pa: WB Saunders; 2000:633-9.

  14. Kryger M, Monjan A, Bliwise D, Ancoli-Israel S. Sleep, health, and aging. Bridging the gap between science and clinical practice. Geriatrics. Jan 2004;59(1):24-6, 29-30. [Medline].

  15. Mendelson WB, Caruso C. Pharmacology in sleep medicine. In: Poceta JS, Mitler MM. Sleep Disorders: Diagnosis and Treatment. Totowa, NJ: Humana Press; 1998:137-60.

  16. Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep. Nov 1 2006;29(11):1415-9. [Medline].

  17. Morin CM. Relief from Insomnia. New York, NY: Doubleday; 1996.

  18. Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review. Sleep. Dec 15 1999;22(8):1134-56. [Medline].

  19. National Institutes of Health. National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13-15, 2005. Sleep. Sep 1 2005;28(9):1049-57. [Medline].

  20. Nicholson AN. Hypnotics: Clinical pharmacology and therapeutics. In: Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine. New York, NY: McGraw-Hill; 1994:355-63.

  21. Roehrs T, Zorick FJ, Roth T. Transient and short-term insomnias. In: Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine. New York, NY: McGraw-Hill; 2000:624-32.

  22. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia. An American Academy of Sleep Medicine review. Sleep. Mar 15 2000;23(2):243-308. [Medline].

  23. Sevim S, Dogu O, Kaleagasi H, Aral M, Metin O, Camdeviren H. Correlation of anxiety and depression symptoms in patients with restless legs syndrome: a population based survey. J Neurol Neurosurg Psychiatry. Feb 2004;75(2):226-30. [Medline].

  24. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am. Dec 1987;10(4):541-53. [Medline].

  25. Strom L, Pettersson R, Andersson G. Internet-based treatment for insomnia: a controlled evaluation. J Consult Clin Psychol. Feb 2004;72(1):113-20. [Medline].

  26. Summers MO, Crisostomo MI, Stepanski EJ. Recent developments in the classification, evaluation, and treatment of insomnia. Chest. Jul 2006;130(1):276-86. [Medline].

  27. Terzano MG, Parrino L, Cirignotta F, Ferini-Strambi L, Gigli G, Rudelli G, et al. Studio Morfeo: insomnia in primary care, a survey conducted on the Italian population. Sleep Med. Jan 2004;5(1):67-75. [Medline].

  28. Walsh JK, Hartman PG, Kowall JP. Insomnia. In: Chokroverty S. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. Boston, Mass: Butterworth-Heinemann; 1995:219-39.

  29. Zorick FJ, Walsh JK. Evaluation and management of insomnia: an overview. In: Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine. New York, NY: McGraw-Hill; 2000:615-23.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

insomnia, sleeplessness, insomniac, sleep disturbance, sleep disorder, inadequate sleep quality, sleep complaint, transient insomnia, adjustment sleep disorder, short-term insomnia, chronic insomnia, fatigue-related motor vehicle accident, hyperarousability, hyper-arousability, sleep hygiene

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Peter Smethurst, MD, Attending Physician, Pulmonary, Critical Care and Sleep Medicine, St Joseph's Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Silverio M Santiago, MD, Clinical Professor of Medicine, University of California at Los Angeles School of Medicine; Chief, Department of Pulmonary and Critical Care Medicine, Medical Director, Sleep Disorders Center, Veterans Affairs Medical Center of West Los Angeles
Silverio M Santiago, MD is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

James A Rowley, MD, Associate Professor, Fellowship Program Director, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine
James A Rowley, MD is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Medical Editor

Gregory Tino, MD, Director of Pulmonary Outpatient Practices, Associate Professor, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Medical Center and Hospital
Gregory Tino, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Daniel R Ouellette, MD, FCCP, Associate Professor of Medicine, Wayne State University School of Medicine; Consulting Staff, Pulmonary Disease and Critical Care Medicine Service, Henry Ford Health System
Daniel R Ouellette, MD, FCCP is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Boehringer Ingleheim Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other; Pfizer Honoraria Speaking and teaching

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.