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Insomnia

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The Medical Evaluation of Psychiatric Symptoms

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Abstract

We define insomnia as difficulty initiating sleep, difficulty in maintaining sleep, and/or early morning awakening, resulting in a sleep deficiency despite adequate opportunity for sleep and no change in the patient’s baseline “need for sleep.” Insomnia, therefore, is a symptom, reported in a patient’s history, and there is no standard objective measure of insomnia through polysomnography (PSG) or other means. The routine use of PSG alone to evaluate insomnia is not recommended, but it is important to note that a patient’s sleep report and objective data may not always agree, and the misperception of sleep quality or quantity may be an issue (Kryger, Roth, Dement. Elsevier, 2017). This chapter also endeavors to isolate sleep disruption as the primary symptom of focus, while definitions of insomnia as a disorder often describe secondary effects and impact on daytime functioning. Given the complexity of insomnia as a symptom, we discuss these secondary effects to some degree, but mainly to clarify the primary issue of sleep disturbance.

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Notes

  1. 1.

    Note about prostate cancer: Prostate cancer is a rare cause of LUTS, but still the second most diagnosed cancer in men, with an overall incidence of 131 cases per 100,000 men annually in the United States [128]. Since the advent of PSA screening, most cases are discovered while still asymptomatic and localized. However, because PSA is not specific to prostate cancer, screening with PSA can lead to a variety of harms such as overdiagnosis of a condition that might not have become clinically relevant, poor biopsy outcomes, and lingering anxiety. Thus, physicians have adopted a shared decision-making model with patients in regard to screening, noting important risk factors to include such as age, race (Black men are at the highest risk), and family history. If the patient meets any of these risk factors and is interested in screening, it should be offered.

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Authors and Affiliations

  1. Mental Health, Naval Hospital Jacksonville, Jacksonville, FL, USA

    Lan-Anh T. Tran

  2. Marine Corps Medical Home New River, United States Navy, Jacksonville, NC, USA

    Kyle J. Gray

  3. 3rd Marine Division, United States Navy, Okinawa, Japan

    Shram D. Shukla

  4. School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Michael J. Goldstein

  5. Department of Psychiatry, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Vincent F. Capaldi II

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  1. Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Eric G. Meyer

  2. Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Kelly L. Cozza

  3. Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA

    James A. Bourgeois

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Tran, LA.T., Gray, K.J., Shukla, S.D., Goldstein, M.J., Capaldi, V.F. (2023). Insomnia. In: Meyer, E.G., Cozza, K.L., Bourgeois, J.A. (eds) The Medical Evaluation of Psychiatric Symptoms. Springer, Cham. https://doi.org/10.1007/978-3-031-14372-4_4

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