Self test insomnia: comprehensive assessment tools and when to seek help

What is Insomnia?

Clinical definition:

• Difficulty falling asleep (sleep onset insomnia)
• Difficulty staying asleep (sleep maintenance insomnia)
• Early morning awakening with inability to return to sleep
• Non-restorative sleep despite adequate sleep opportunity
• Daytime impairment as a result of sleep difficulties

Duration criteria:

• Acute insomnia: Less than 3 months, often triggered by stress or life changes
• Chronic insomnia: 3 or more nights per week for 3 months or longer
• Episodic insomnia: Recurring periods of sleep difficulties

Common Insomnia Symptoms

Nighttime symptoms:

• Taking more than 30 minutes to fall asleep
• Waking up frequently during the night
• Staying awake for long periods during the night
• Waking up too early and being unable to fall back asleep
• Feeling unrefreshed upon waking

Daytime symptoms:

• Fatigue or low energy
• Difficulty concentrating or remembering
• Mood disturbances (irritability, anxiety, depression)
• Decreased performance at work or school
• Increased errors or accidents
• Tension headaches
• Gastrointestinal symptoms
• Ongoing worries about sleep

The Insomnia Severity Index

The ISI is a validated 7-item questionnaire designed to assess the nature, severity, and impact of insomnia. Rate each item from 0-4 based on your experience over the past two weeks:

Question 1: Difficulty falling asleep

• 0 = None
• 1 = Mild
• 2 = Moderate
• 3 = Severe
• 4 = Very severe

Question 2: Difficulty staying asleep

• 0 = None
• 1 = Mild
• 2 = Moderate
• 3 = Severe
• 4 = Very severe

Question 3: Problems waking up too early

• 0 = None
• 1 = Mild
• 2 = Moderate
• 3 = Severe
• 4 = Very severe

Question 4: How satisfied/dissatisfied are you with your current sleep pattern?

• 0 = Very satisfied
• 1 = Satisfied
• 2 = Moderately satisfied
• 3 = Dissatisfied
• 4 = Very dissatisfied

Question 5: How noticeable to others do you think your sleep problem is in terms of impairing the quality of your life?

• 0 = Not at all noticeable
• 1 = A little
• 2 = Somewhat
• 3 = Much
• 4 = Very much noticeable

Question 6: How worried/distressed are you about your current sleep problem?

• 0 = Not at all worried
• 1 = A little
• 2 = Somewhat
• 3 = Much
• 4 = Very much worried

Question 7: To what extent do you consider your sleep problem to interfere with your daily functioning?

• 0 = Not at all interfering
• 1 = A little
• 2 = Somewhat
• 3 = Much
• 4 = Very much interfering

ISI Scoring and Interpretation

Total your scores (0-28 points):

• 0-7 points: No clinically significant insomnia
• 8-14 points: Subthreshold insomnia (mild)
• 15-21 points: Clinical insomnia (moderate severity)
• 22-28 points: Clinical insomnia (severe)

What your score means:

• 0-7: Your sleep appears to be within normal limits
• 8-14: You may have mild sleep difficulties that could benefit from sleep hygiene improvements
• 15-21: You likely have moderate insomnia that may require professional evaluation
• 22-28: You have severe insomnia that definitely warrants professional treatment

How to Keep a Sleep Diary

Daily tracking items:

• Bedtime: What time you got into bed
• Sleep onset time: Estimated time you fell asleep
• Sleep onset latency: How long it took to fall asleep
• Number of awakenings: How many times you woke up
• Wake after sleep onset: Total time awake during the night
• Final wake time: When you woke up for the day
• Get-up time: When you got out of bed
• Total sleep time: Estimated actual sleep duration
• Sleep quality rating: Rate 1-10 (1=very poor, 10=excellent)

Additional factors to track:

• Caffeine intake (amount and timing)
• Alcohol consumption
• Exercise (type, duration, timing)
• Naps (duration and timing)
• Medications taken
• Stress level (1-10 scale)
• Mood upon waking
• Daytime sleepiness level

Sleep Efficiency Calculation

Sleep efficiency formula:

• Sleep Efficiency = (Total Sleep Time ÷ Time in Bed) × 100
• Time in Bed = Get-up time - Bedtime
• Total Sleep Time = Time in Bed - Sleep Onset Latency - Wake After Sleep Onset

Sleep efficiency interpretation:

• 85% or higher: Normal sleep efficiency
• 80-84%: Mild sleep efficiency problems
• 75-79%: Moderate sleep efficiency problems
• Below 75%: Significant sleep efficiency problems

Example calculation:

• Bedtime: 10:30 PM
• Get-up time: 6:30 AM (8 hours in bed)
• Sleep onset latency: 45 minutes
• Wake after sleep onset: 30 minutes
• Total sleep time: 8 hours - 45 min - 30 min = 6 hours 45 minutes
• Sleep efficiency: (6.75 ÷ 8) × 100 = 84.4%

Digital Sleep Tracking Tools

Smartphone apps:

• Sleep Cycle: Uses sound analysis to track sleep phases
• Pillow: Automatic sleep tracking with heart rate monitoring
• Sleep Score: Comprehensive sleep tracking and coaching
• AutoSleep (Apple Watch): Automatic sleep detection

Wearable devices:

• Fitbit devices: Track sleep stages, duration, and quality
• Apple Watch: Sleep tracking with bedtime reminders
• Oura Ring: Detailed sleep analysis and recovery metrics
• Garmin watches: Sleep monitoring with stress tracking

Limitations to consider:

• Consumer devices may not be as accurate as clinical tools
• Movement-based tracking can misinterpret restless wakefulness as sleep
• Should supplement, not replace, subjective sleep diary data
• May increase sleep anxiety in some individuals

Epworth Sleepiness Scale

Rate your likelihood of dozing off in these situations (0-3 scale):

0 = Would never doze, 1 = Slight chance, 2 = Moderate chance, 3 = High chance

• Sitting and reading
• Watching TV
• Sitting inactive in a public place
• As a passenger in a car for an hour without a break
• Lying down to rest in the afternoon
• Sitting and talking to someone
• Sitting quietly after lunch without alcohol
• In a car, while stopped for a few minutes in traffic

Scoring:

• 0-5: Lower normal daytime sleepiness
• 6-10: Higher normal daytime sleepiness
• 11-12: Mild excessive daytime sleepiness
• 13-15: Moderate excessive daytime sleepiness
• 16-24: Severe excessive daytime sleepiness

Sleep Hygiene Assessment

Rate how often you do the following (Never/Sometimes/Often/Always):

• Go to bed at the same time each night
• Wake up at the same time each morning
• Use your bedroom only for sleep and intimacy
• Keep your bedroom cool, dark, and quiet
• Avoid caffeine 6 hours before bedtime
• Avoid alcohol 3 hours before bedtime
• Avoid large meals 2-3 hours before bedtime
• Exercise regularly, but not close to bedtime
• Have a relaxing bedtime routine
• Avoid screens 1 hour before bedtime
• Get natural light exposure during the day
• Limit daytime naps to 20-30 minutes

Assessment:

• Mostly "Always" and "Often": Good sleep hygiene
• Mix of responses: Room for improvement in sleep habits
• Mostly "Sometimes" and "Never": Poor sleep hygiene requiring attention

Pre-Sleep Arousal Scale

Rate how intensely you experience these symptoms as you attempt to fall asleep:

Cognitive arousal symptoms:

• Racing thoughts
• Worry about falling asleep
• Review or ponder events of the day
• Worry about problems other than sleep
• Being mentally alert, active
• Unable to shut down thoughts
• Thoughts keep running through your head
• Being distracted by sounds, noise in the environment

Somatic arousal symptoms:

• Heart racing, pounding, or beating irregularly
• Shortness of breath or labored breathing
• A jittery, nervous feeling in your body
• Muscle tension or tightness
• Cold feeling in hands, feet, or your body in general
• Having stomach upset
• Perspiration in palms of your hands or other parts of your body

Rating scale: 1 = Not at all, 2 = Slightly, 3 = Moderately, 4 = A lot, 5 = Extremely

Red Flags Requiring Immediate Attention

Serious symptoms:

• Loud snoring with gasping or choking sounds
• Witnessed breathing pauses during sleep
• Excessive daytime sleepiness affecting safety (driving, work)
• Sudden onset of severe insomnia
• Sleep problems accompanied by chest pain or shortness of breath
• Sleepwalking or other unusual sleep behaviors
• Violent or aggressive behavior during sleep

Mental health concerns:

• Thoughts of self-harm or suicide
• Severe depression or anxiety
• Hallucinations or delusions
• Significant mood changes affecting daily life

When to Consult a Healthcare Provider

Duration criteria:

• Sleep problems persisting for more than 2-3 weeks
• Chronic insomnia (3+ nights per week for 3+ months)
• Sleep issues significantly impacting daily functioning
• Multiple failed attempts at self-help strategies

Severity indicators:

• ISI score of 15 or higher
• Epworth Sleepiness Scale score of 11 or higher
• Sleep efficiency consistently below 80%
• Taking more than 45 minutes to fall asleep regularly
• Waking up 3+ times per night regularly

Impact on daily life:

• Difficulty concentrating at work or school
• Increased errors or accidents
• Relationship problems due to irritability
• Physical symptoms (headaches, GI issues)
• Reliance on caffeine or other stimulants

Types of Sleep Specialists

Primary care physician:

• First point of contact for sleep concerns
• Can rule out medical causes of insomnia
• May prescribe initial treatments
• Can refer to specialists when needed

Sleep medicine specialist:

• Board-certified in sleep medicine
• Specializes in all types of sleep disorders
• Can order sleep studies if needed
• Provides comprehensive sleep disorder treatment

Behavioral sleep medicine specialist:

• Psychologist specializing in sleep disorders
• Provides cognitive behavioral therapy for insomnia (CBT-I)
• Addresses psychological factors affecting sleep
• Non-medication treatment approaches

Psychiatrist:

• When sleep problems are related to mental health conditions
• Can prescribe medications for sleep and mood disorders
• Addresses underlying psychiatric conditions
• Comprehensive mental health evaluation

Information to Gather

Sleep history:

• Completed sleep diary (2-4 weeks minimum)
• Self-assessment questionnaire results
• Timeline of when sleep problems began
• Previous treatments tried and their effectiveness
• Family history of sleep disorders

Medical information:

• Current medications and supplements
• Medical conditions and recent changes
• Recent life stressors or changes
• Substance use (caffeine, alcohol, tobacco)
• Work schedule and shift patterns

Symptom details:

• Specific sleep complaints and their frequency
• Daytime symptoms and their impact
• What makes symptoms better or worse
• Sleep environment description
• Bed partner observations

Questions to Ask Your Healthcare Provider

Diagnostic questions:

• What type of sleep disorder do I likely have?
• What tests or evaluations do you recommend?
• Could my medications be affecting my sleep?
• Are there underlying medical conditions to consider?

Treatment questions:

• What treatment options are available?
• What are the benefits and risks of each option?
• How long before I see improvement?
• What can I do at home to help?
• When should I follow up?

Lifestyle questions:

• Are there activities I should avoid?
• How will this affect my work or daily activities?
• What warning signs should I watch for?
• Are there resources or support groups you recommend?