Many times when a patient comes to me with complaints of insomnia, I ask them about their sleep history. I ask them what time are they falling asleep? How long is it taking them to fall asleep? How many times are they waking up from their sleep? And do they feel that they're getting refreshed sleep where they are not sleepy during the next day?
I also do ask about their medications because a lot of medications do have a side effect of insomnia. One medication is beta blockers, which is used to treat hypertension and irregular heartbeats. Beta blockers tend to suppress melatonin and have the side effect of insomnia as well as nightmares. Another class of medications that are used to treat depression are SSRIs, or serotonin reuptake inhibitors. They affect serotonin levels which can also cause insomnia. Many medications used to treat ADHD will also trigger insomnia. These are stimulants which affect the neurotransmitters in your body which help you stay awake. So taking these too close to bedtime or in the middle of the day can also trigger insomnia if you're not metabolizing these medications fast enough.
Medical problems and mental problems can also contribute to insomnia so it's important to tell your doctor about any medical issues or mental health issues such as anxiety or depression.
Poor sleep habits can also contribute to insomnia so it's important to tell your doctor if you are watching TV or using the computer close to bedtime. If you're using the computer or you're watching TV you become engaged in what you're doing and that will cause you to become stimulated which makes it harder to fall asleep and stay asleep. Light from TVs and computers can also hamper your melatonin secretion.
Melatonin is a hormone that is secreted by our pineal gland which helps with sleep onset. Now, light is the most activating factor for us. We have receptors that are located in our retina which will take that light and send that signal to our brain that it's time to stay awake. So increasing light exposure in the evening hours will suppress our melatonin secretion.
Many people do think you need a sleep test to determine if you have insomnia or not, but that is not the case. Insomnia is purely a clinical diagnosis discussed and diagnosed through history.
So insomnia is purely a clinical diagnosis which is discovered during a history intake by your doctor.