“He would lie in the bed and finally, with daylight, he would go to sleep. After all, he said to himself, it is probably only insomnia. Many must have it.”- Ernest Hemingway, A Clean Well Lighted Place
The etiology of an acute or chronic sleep disturbance can be simple, straightforward and attributable to a recognizable cause or stressor in your life. However, at other times the source will be a mystery that will take time, perseverance and patience to unravel.
In clinic, in order to provide effective therapy and advice, it is important for me to determine if the presenting sleep issues are due to insomnia (of various causes), a circadian rhythm disorder or inadequate sleep hygiene and environmental disturbances.
In terms of insomnia, some questions that I ask my patients to consider include:
How long does it take you to fall asleep at night?
Do you awaken in the night, and if so, how long are you awake?
Do you awaken early and are unable to return to sleep?
When did this sleeplessness begin, and was there an identifiable precipitating event?
How do you sleep in other bedrooms at home, or when traveling?
What is going on when you are awake in bed and unable to sleep?
What awakens you in the night?
How much sleep do you do best with?
What time do you go to bed and get up?
Is there a variation in your sleep on the weekend?
When it comes to establishing if the sleep disturbance is due to a circadian rhythm disorder, it is helpful to think about the relevance of some of the following questions:
What time would you go to bed and get up if the world was on your schedule?
Do you work shifts such as swing or nights? Have you in the past?
Do you travel across time zones regularly?
Are you sleepy when you go to bed?
Lastly, clinically pertinent questions that can help determine if your sleep issues are due to inadequate sleep hygiene and environmental disturbances can include:
Do you spend time awake in bed reading, watching TV, completing projects, computer work or other activity?
How much does your bedtime vary over a week?
Is your bedroom quiet, dark, cool, comfortable?
Do household members, pets or anything else wake you from sleep?