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Clinical features and diagnosis of insomnia in adults

Michael H Bonnet, PhD
Donna L Arand, PhD
Section Editor
Ruth Benca, MD, PhD
Deputy Editor
April F Eichler, MD, MPH


Insomnia is the one of the most common medical complaints. It frequently coexists with medical, psychiatric, sleep, or neurological disorders. It may also be associated with acute stress, medication or substance, poor sleep habits, or changes in the sleep environment. A separate diagnosis of insomnia should be given when the insomnia symptoms show independent onset or variation in relation to a psychiatric or medical condition such as depression or chronic pain, or when the insomnia symptoms persist after adequate treatment of the comorbid condition. However, insomnia can also exist without an associated psychiatric or medical disorder [1]. The diagnosis of insomnia requires three main components: persistent sleep difficulty, adequate sleep opportunity, and associated daytime dysfunction.

The clinical features, diagnosis, and differential diagnosis of insomnia are reviewed here. The epidemiology, consequences, and treatment of insomnia are discussed separately. (See "Overview of insomnia in adults" and "Treatment of insomnia in adults".)


Symptoms — Patients with insomnia complain of difficulty initiating sleep, difficulty maintaining sleep, or waking up too early. Although insomnia can be a presenting complaint, it may also be reported during the evaluation of another complaint or during health maintenance screening.

Patients with insomnia describe difficulty falling asleep, difficulty staying asleep, or waking up too early, despite adequate opportunity and circumstances for sleep. The degree of the sleep disturbance reported varies, but typically occurs at least three times per week and is not related to an inadequate opportunity for sleep (ie, not related to sleep restriction), an inappropriate sleep environment, or another sleep disorder. Patients may also describe variable sleep, such as one or several nights of poor sleep followed by a night of better sleep. Occasionally, patients may report having minimal sleep for several consecutive nights.

These complaints are accompanied by a report of compromised daytime function [1]:

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Literature review current through: Nov 2017. | This topic last updated: Dec 15, 2015.
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