Diagnosis of Insomnia
Because insomnia is a sleep disorder qualified by other conditions, an insomnia diagnosis usually is made as a result of one or more of these conditions (e.g., delayed sleep-phase syndrome [DSPS], stress). Assessment for insomnia begins with the documentation of a complete sleep history and an evaluation of the patient's sleep hygiene.
A medical history is obtained and a physical examination is performed to determine if underlying medical or psychiatric conditions are present. Formal testing for insomnia and other sleeping disorders is noninvasive and includes overnight polysomnography and multiple sleep latency testing (MSLT).
Insomnia as a Side Effect of Medications
There are several medications for which insomnia is a predictable side effect. Medicines that can cause insomnia include the following:
- Decongestants (pseudoephedrine)
- Bronchodilators (beta-2 agonists, theophylline)
- Antihypertensives (hydrochlorothiazide, nifedipine, methyldopa, propranolol)
- Antidepressants (fluoxetine, bupropion, sertraline)
- Antidepressants that may cause daytime drowsiness (desipramine, imipramine, nortriptyline)
- Diuretics (furosemide)
- Antiepileptics (phenytoin)
- Antiarrhythmic agents (quinidine, propranolol, verapamil)
- Histamine H2 inhibitors (cimetidine; e.g., for gastrointestinal conditions)
- Thyroid medications
- Alcohol, caffeine, nicotine