A decision tree approach to the differential diagnosis of insomnia

Abstract

Many health care professionals (general practitioners, psychiatrists, neurologists, psychologists and practicing nurses) are often faced with the responsibility of evaluating and diagnosing a complaint of insomnia. Because these professionals all come from discipline-bound schools of thought and with limited training in sleep medicine, it should be no surprise that the manner in which the assessment and diagnostic process is undertaken can significantly differ from one professional to another, thus increasing the probability of errors in judgment, of errors in diagnosis and ultimately, of errors in the judicious selection of treatment(s). The successful treatment of insomnia requires a comprehensive evaluation and an accurate diagnosis. A common error in the management of insomnia, is to view the sleep complaint as a simple symptomatic disorder. Too often, treatment is initiated prematurely without the benefit of an adequate differential diagnosis and case conceptualisation. Because insomnia is typically associated with multiple aetiologies, a detailed investigation of its contributing and maintaining factors is essential prior to initiating treatment. In this chapter, a decision tree that can be used as a guide to the differential diagnosis of insomnia is provided for clinicians from all medical and mental health professions.