Diagnosis and Assessment
*Assess each category*
Insomnia Disorders
Figure 1. Evaluation of Chronic Insomnia
Complaint of difficulty falling
asleep, difficulty maintaining
sleep, nonrestorative sleep
Consider
Behaviorally
Induced
Insufficient
Sleep
Adequate opportunity and
circumstances for sleep
No
Waking symptoms: Fatigue/
lethargy; concentration/
attention; memory; mood;
psychomotor; physical
Consider
Short Sleeper
No
Abnormal
pattern
of sleep-wake
timing
*Assess each category*
Comorbid Insomnia Disorders
Yes
Yes
–Restless Legs
symptoms
–Breathing
symptoms, snoring
–Abnormal sleep
movements
–Daytime sleepiness
Yes
No
*Assess each category*
Consider
Restless Legs
Syndrome,
Periodic Limb
Movement
Disorder,
Sleep Related
Breathing
Disorder,
Parasomnias
Childhood
onset, no
precipitant
Primary Insomnia Disorders
Consider
Circadian
Rhythm
Sleep Disorder
Marked
subjective
objective
mismatch,
extreme
sleep
symptoms
Yes
Consider
Idiopathic
Insomnia
No
Yes
Consider
Paradoxical
Insomnia
No
Medications,
substances
temporally
related
to insomnia
Yes
No
Medical
disorder
temporally
related
to insomnia
No
Consider
Insomnia
due to
Drug,
Substance,
or Alcohol
Yes
Psychiatric
disorder
temporally
related
to insomnia
No
Consider
Insomnia
due to
Medical
Condition
Yes
No
Consider
Insomnia
due to
Mental
Disorder
Behaviors
and practices
incompatible
with good
sleep
Presence of
acute
environmental,
physical, or
social stress
Conditioned
arousal,
learned
sleeppreventing
associations
Yes
Yes
Yes
Consider
Inadequate
Sleep
Hygiene
No
Consider
Adjustment
Insomnia
Consider Other/Unspecified Insomnia;
Reevaluate for other occult or comorbid disorders
No
No
Consider
Psychophysiological
Insomnia
