Which clinical history findings are characteristic of insomnia?

Updated: Oct 09, 2018
  • Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Insomnia is defined as the subjective symptom of inadequate sleep quantity and quality. Patients with insomnia report difficulty falling asleep or maintaining sleep. Chronic insomnia may produce poor concentration and a low level of energy. Other symptoms include a decreased sensation of well-being and poor productivity. Some patients with primary insomnia feel that the sleep was not restorative. Distress due to inability to sleep may lead to a vicious cycle of frustration and insomnia.

Patients with hypersomnia require more sleep despite long and good sleep (about 12 hours), usually require naps in the daytime, and are not refreshed by short naps.

Patients with narcolepsy may experience the following:

  • Excessive daytime sleepiness with irresistible daytime sleep attacks

  • Sleep paralysis, in which the individual awakens unable to move

  • Cataplexy: May be subtle initially (eg, wobbly knees or dizziness) but may progress to sudden falls following a strongly experienced emotion; children uniquely may experience grimacing or jaw opening with tongue thrusting ("cataplectic faces"); during cataplexy, reflexes are absent even though the attacks usually last less than 10 seconds

  • Hypnagogic hallucinations

  • Feeling of refreshment after a sleep attack

  • Low cerebrospinal levels of hypocretin-1 occur without cataplexy in youths who develop cataplexy later

  • Nocturnal eating may occur with increased frequency of obesity

Children with obstructive sleep apnea syndrome (OSAS) have a history significant for loud snoring, breathing pauses, mouth breathing, restless sleep, and increased perspiration at night. Snoring is the most common presenting symptom. Hyperactivity and failure to thrive are common symptoms of childhood obstructive apnea.

Other symptoms in children with OSAS include excessive daytime sleepiness, morning headaches, and behavioral changes (paradoxical hyperactivity as children try to stay awake). These children also experience emotional lability, changes in school performance, and, eventually, cardiac failure.

Of the circadian rhythm sleep disorders, delayed sleep phase syndrome (DSPS) is the most common, with a prevalence of about 7% among adolescents. It is characterized by early insomnia, little or no difficulty maintaining sleep, and difficulty waking in the morning.

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