What is Insomnia – Diagnosis and Treatments

My name is Rachel Salas. I’m a sleep neurologist, board-certified in both specialties. I’m Dr. Virginia Runco. I’m a Johns Hopkins
behavioral sleep medicine specialist. Insomnia is difficulty falling asleep,
difficulty staying asleep, poor sleep quality or some kind of combination of those symptoms. And, we all have a night of bad sleep from here or there, but really what insomnia is… is a more long pattern of a sleep problem that’s not only a nighttime issue but it trickles
into the daytime in some ways so there is some kind of daytime symptom, whether that’s, um, it can be just sleepiness
or fatigue, struggling to stay awake during work, concentration issues at work…”I’m feeling
grumpy or moody” or even just having a lot of worries during the daytime about the sleep. So, typically it’s more commonly found in women, however you know from down from kids all the way
up to older adults…we can all on
experience it at one time or another and most people have experienced it…you
know, when when you’re studying for a test, or you have a very
high-stakes job interview, you can suffer from some acute insomnia but
when that becomes chronic, usually more than three months and you’re
experiencing it three or more times a week then it
can be actually a sleep disorder. Insomnia is diagnosed based on
what you tell the sleep specialist, so there’s no kind of lab test or blood work that you can do to say “You have insomnia.” They look at your medical history, your psychiatric history, how you describe your insomnia symptoms. However, sleep studies…the overnight
sleep studies aren’t uncommon to do sometimes in
insomnia patients because they want to rule out if there’s some underlying sleep disorder
like sleep apnea that can cause the insomnia. So, insomnia is a complicated sleep disorder because there’s always
different factors for different individuals that are contributing to it. So, the first thing that we look at is to
see, you know, what kind of behavioral issues that the patient, that may be
feeding the insomnia…. so things like maintaining good sleep
habits are very important and those are things that we do investigate. A lot of times there some simple things
that patients can change to help as part of the treatment. There’s several medications that are available.
We typically… try not to go straight to those because you know a lot of times they don’t work, and
these medications do you know, they do have a side effect
profile, so you have to be very careful …you know, when you give these. There is
the mainstay which is cognitive
behavioral sleep therapy and you know, any time I diagnose a
patient with insomnia I usually bring in my colleagues, the sleep behavioral psychologists because they really help identify what
factors are continuing the insomnia and they help to set up a plan – a treatment
strategy – for patients to change their behaviors because that’s
what the research shows has the biggest impact.