Sleep disorders or insomnia
If you’re having trouble sleeping, your doctor will ask detailed questions about when you go to bed, how long it takes to fall asleep and how often you wake up during the night. They will also ask about daytime fatigue, mood changes, forgetfulness or trouble focusing. You’ll be asked about caffeine, alcohol, nicotine, medications, screen time and shift work because these can fragment sleep. Your provider may ask about snoring, pauses in breathing, gasping or restless legs to rule out sleep apnea or restless legs syndrome. Keeping a sleep diary for 1–2 weeks that records lights‑out time, estimated sleep time, naps, exercise, caffeine and alcohol consumption helps diagnose insomnia and distinguish it from delayed sleep phase or other circadian rhythm disorders. They may use questionnaires like the Insomnia Severity Index or Epworth Sleepiness Scale to gauge severity and a simple physical exam and review of weight and airway will screen for other sleep disorders.
Medication is usually considered only after lifestyle changes and cognitive behavioural therapy for insomnia (CBT‑I) have been tried. Short‑acting hypnotic drugs (sometimes called ‘Z‑drugs’) and benzodiazepine receptor agonists may be prescribed for a few weeks to help you fall asleep. Low‑dose sedating antidepressants such as doxepin or trazodone can improve sleep maintenance. Over‑the‑counter antihistamines like diphenhydramine are available but can cause drowsiness and confusion, especially in older adults. Melatonin supplements or melatonin‑receptor agonists help regulate your body clock. Newer dual orexin receptor antagonists (suvorexant, lemborexant, daridorexant) block wakefulness signals and may be used when other options fail. Your doctor will choose a medicine that fits your symptoms and health and will explain potential side effects and the need to avoid combining sleep aids with alcohol or other sedatives.
No blood test diagnoses insomnia, but labs can uncover conditions that disrupt sleep. Your doctor may order a complete blood count and comprehensive metabolic panel to look for anemia, infection or organ problems; thyroid tests (TSH and T4) to check for an over‑ or underactive thyroid; vitamin B12, folate and iron studies if restless legs or tingling are present; and fasting glucose or hemoglobin A1c to detect diabetes. If sleep apnea is suspected, they may arrange an overnight sleep study at a sleep center or a home sleep apnea test.
Polysomnography (overnight sleep study) records brain waves, heart rate, breathing and movements to diagnose sleep apnea or other sleep disorders. No imaging tests are needed for insomnia itself.
Talk to your doctor if it regularly takes more than 30 minutes to fall asleep or you wake up repeatedly and can’t get back to sleep; if you feel tired, irritable, depressed or unable to concentrate during the day; or if you wake too early and cannot return to sleep. Seek evaluation if your partner notices loud snoring, gasping or long pauses in breathing, or if you have creeping or uncomfortable sensations in your legs when lying down. Sudden weight gain, morning headaches, falling asleep at inappropriate times (such as while driving) or using alcohol or pills to sleep also warrant medical attention.
CBT‑I is usually delivered over six weekly sessions, and you should see your provider after 6–8 weeks to discuss your sleep diary and progress. If medication is started, follow up within 2–4 weeks to monitor effectiveness and side effects, then every few months as needed. People using CPAP or other treatments for sleep apnea should have regular follow‑ups with their sleep specialist.
Good sleep hygiene helps prevent insomnia. Go to bed and wake up at the same time every day and keep your bedroom quiet, dark, cool and relaxing. Turn off electronic devices at least 30 minutes before bed and avoid clock watching. Avoid large meals and alcohol near bedtime and skip caffeine in the afternoon or evening. Regular daytime exercise improves sleep quality – aim for at least 30 minutes of moderate activity most days. Restrict time in bed to when you’re sleepy, get up if you can’t sleep after about 15 minutes, avoid naps and use the bed only for sleep or intimacy. Exposure to natural light during the day and keeping lights dim at night helps set your body clock. Relaxation techniques such as progressive muscle relaxation, deep breathing, mindfulness and guided imagery calm a racing mind. Keep a sleep diary, track patterns and practice gratitude or journaling to reduce worry and rumination.
If insomnia persists, your primary care provider may refer you to a cognitive behavioural therapist for CBT‑I or to a sleep specialist. A sleep specialist can arrange a polysomnography or home sleep study and prescribe treatments like continuous positive airway pressure (CPAP) for sleep apnea. An ear, nose and throat (ENT) doctor or pulmonologist may evaluate obstructive sleep apnea or snoring. A psychiatrist or psychologist can address anxiety or depression, and a neurologist may be involved for restless legs syndrome. Dietitians and exercise physiologists can help with weight loss, and pain specialists or chiropractors may provide therapies for chronic pain that disrupts sleep. Your primary care provider will coordinate these referrals and review your progress.