Diagnostic Tests for Insomnia
Insomnia: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Insomnia
includes:
- Sleep diary
- Sleep studies
Insomnia Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Insomnia:
- Sleep Disorders: Home Testing
Insomnia Diagnosis: Book Excerpts
Tests and diagnosis discussion for Insomnia:
Patients with insomnia are evaluated with the help of a medical history
and a sleep history. The sleep history may be obtained from a sleep diary
filled out by the patient or by an interview with the patient's bed
partner concerning the quantity and quality of the patient's sleep.
Specialized sleep studies may be recommended, but only if there is
suspicion that the patient may have a primary sleep disorder such as sleep
apnea or narcolepsy. (Source: excerpt from Insomnia: NWHIC)
Diagnosis of Insomnia: medical news summaries:
The following medical news items
are relevant to diagnosis of Insomnia:
Diagnostic Tests for Insomnia: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Insomnia.
INSOMNIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine studies include a CBC, sedimentation rate, urinalysis and drug screen, chemistry panel, thyroid profile, VDRL test, EKG, and chest x-ray. Arterial blood gases and pulmonary function testing should be done to rule out pulmonary disease. A venous pressure and circulation time will help rule out early congestive heart failure. Blood pressure monitoring can be used to rule out paroxysmal hypertension. If an organic brain syndrome is suspected, a CT scan or MRI of the brain should be done. If psychiatric symptoms are present, the patient should be referred to a psychiatrist. Alternatively, a therapeutic trial of psychotherapeutic agents may be initiated if the patient is not suicidal. When all of the above diagnostic tests are negative, a sleep study must be done. However, home monitors for apnea and oxygen desaturation are available and may be an inexpensive alternative to rule out obstructive sleep apnea.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
SLEEP APNEA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The most important diagnostic test is an all-night polygraphic recording (polysomnography). This will differentiate between obstructive and nonobstructive sleep apnea. If obstructive sleep apnea is suspected, a referral should be made to an ear, nose, and throat specialist. If there are abnormalities on the neurologic examination, a neurologic consultation should be sought. If idiopathic nonobstructive sleep apnea is suspected, the patient should be referred to a pulmonologist. A therapeutic trial of continuous positive airway pressure may be done. Some cases should have evaluation for a pituitary tumor, a thyroid profile, and a trial of tricyclic drugs and progesterone.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
GAIT DISTURBANCES:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine orders would include a CBC, sedimentation rate, chemistry panel, VDRL test, and urinalysis. If there is a painful limp, x-rays of the hip, knee, or ankle on the affected side should be performed. An x-ray of the lumbar spine will not usually be of great assistance, however. If plain x-rays are negative, a CT scan or MRI of the lumbar spine, hip, knee, or ankle may be of assistance in the diagnosis. A bone scan may pick up obscure fractures and other pathology.
If there are abnormalities on the neurologic examination, MRI or CT scan of the appropriate level of suspected pathology will be done. A spastic gait with abnormal cranial nerve findings would suggest a cerebral tumor or other brain disease, and a CT scan or MRI of the brain should be done. Keep in mind that the MRI is almost double the cost of a CT scan, and the diagnostic yield is not that much greater in many cases.
A spastic gait without cranial nerve signs or papilledema would suggest a spinal cord disorder, and an MRI or CT scan of the appropriate level of the spinal cord should be done. A CT scan of the cervical spine, however, is not very useful and MRI is preferred.
If multiple sclerosis is suspected, a spinal tap for myelin basic protein or gamma globulin levels should be done. A VEP study, a BSEP study, or a SSEP study will also be useful in diagnosing multiple sclerosis.
If there is an ataxic gait, cerebellar disorder should be suspected, and a CT scan of the brain may be done. However, an ataxic gait may also suggest multiple sclerosis, pernicious anemia, and tabes dorsalis. If the VDRL test is negative, a FTA-ABS test should be done. Blood levels for vitamin B
12
and folic acid will help diagnose pernicious anemia. A Schilling test, however, is sometimes necessary to facilitate this diagnosis. If muscular dystrophy is suspected, electromyographic examination and muscle biopsy will help confirm the diagnosis. If the patient has a steppage gait, the workup of peripheral neuropathy should be done, as noted on
page 350
.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Insomnia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Take a thorough sleep and health history. Find out when the patient’s insomnia began and the circumstances surrounding it. Is the patient trying to stop using a sedative? Does he take a central nervous system (CNS) stimulant, such as an amphetamine, pseudoephedrine, a theophylline derivative, phenylpropanolamine, cocaine, or a drug that contains caffeine, or does he drink caffeinated beverages?
Find out if the patient has a chronic or acute condition, the effects of which may be disturbing his sleep, particularly cardiac or respiratory disease or painful or pruritic conditions. Ask if he has an endocrine or neurologic disorder, or a history of drug or alcohol abuse. Is he a frequent traveler who suffers from jet lag? Does he use his legs a lot during the day and then feel restless at night? Ask about daytime fatigue and regular exercise. Also ask if he commonly finds himself gasping for air, experiencing apnea, or frequently repositioning his body. If possible, consult the patient’s spouse or sleep partner because the patient may be unaware of his own behavior. Ask how many pillows the patient uses to sleep.
Assess the patient’s emotional status, and try to estimate his level of self-esteem. Ask about personal and professional problems and psychological stress. Also ask if he experiences hallucinations, and note behavior that may indicate alcohol withdrawal. After reviewing complaints that suggest an undiagnosed disorder, perform a physical examination.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Insomnia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Take a thorough sleep and health history. Find out when the patient’s insomnia began and the circumstances surrounding it. Is the patient trying to stop using a sedative? Does he take a central nervous system (CNS) stimulant, such as an amphetamine, pseudoephedrine, a theophylline derivative, phenylpropanolamine, cocaine, or a drug that contains caffeine, or does he drink caffeinated beverages?
Find out if the patient has a chronic or acute condition, the effects of which may be disturbing his sleep, particularly cardiac or respiratory disease or painful or pruritic conditions. Ask if he has an endocrine or neurologic disorder, or a history of drug or alcohol abuse. Is he a frequent traveler who suffers from jet lag? Does he use his legs a lot during the day and then feel restless at night? Ask about daytime fatigue and regular exercise. Also ask if he often finds himself gasping for air, experiencing apnea, or frequently repositioning his body. If possible, consult the patient’s spouse or sleep partner because the patient may be unaware of his own behavior. Ask how many pillows the patient uses to sleep.
Assess the patient’s emotional status, and try to estimate his level of self-esteem. Ask about personal and professional problems and psychological stress. Also ask if he experiences hallucinations, and note behavior that may indicate alcohol withdrawal. After reviewing any complaints that suggest an undiagnosed disorder, perform a physical examination. (See Differential diagnosis: Insomnia, pages 450 and 451.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Insomnia:
Physical examination.
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The physical examination for insomnia is more a search for other underlying disease states than for any specific signs for insomnia, although hypertension, obesity, and thick neck suggest consideration of sleep apnea.
Testing
The diagnosis of unexplained insomnia may involve testing in a sleep laboratory using polysomnography. This provides the opportunity to monitor such parameters as the electroencephalogram (EEG), breathing, oxygen saturation, and body movements during sleep. Polysomnography can determine the disturbances in chronobiologic rhythms and loss of normal sleep–awake patterns associated with circadian rhythm disorders. The EEG results from the sleep laboratory will demonstrate a patient’s ability to progress through the five cycles of normal sleep and where in the process any disturbances may be located. For instance, a short REM sleep latency period from initiation of sleep to actual REM sleep, along with increased REM sleep, and reduced total sleep time with frequent awakenings are all associated with depression.
Diagnostic assessment
The key to diagnosing insomnia and other sleep disorders is history and sleep laboratory monitoring. Short-term problems related to difficulty with initiating sleep may be situational or environmental. Long-term problems with sleep, lasting weeks to months, may be more psychophysiologic such as with chronic anxiety or depression. A thorough history of personal or job-related issues, caffeine, alcohol and other drug use, related medical problems, abnormal leg and body movements at night, problems with daytime napping and somnolence as well as night time snoring, and apnea spells will all direct the practitioner to the cause of most problems. A good sleep study often confirms the diagnosis and leads to specific interventions.
References
1. Rakel RE. Insomnia: concerns for the family physician. J Fam Pract 1993;36:
551–558.
2. Rosekind MR. The epidemiology and occurrence of insomnia. J Clin Psychiatry 1992;53:4–6.
3. Myer TJ. Evaluation and management of insomnia. Hosp Pract (Off Ed) 1998;
Dec. 15:75–86.
4. Huari PJ. Insomnia. Clin Chest Med 1998:19:157–167.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Visual Disturbance:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Homonymous hemianopsia may be perceived as blurring or as trouble finding the start of a line of print. On closer inspection, visual loss in corresponding fields in both eyes will be detected. This usually results from a lesion in the suprageniculate pathway. The macula is usually spared in cortical lesions. Bitemporal hemianopsia is due to a chiasmal lesion such as a pituitary adenoma, anterior communicating artery aneurysm, cerebellar tumor with third ventricle hydrocephalus, or meningitis. Thiamine deficiency, methanol toxicity, or optic neuritis at the chiasm can cause true acute bilateral visual loss
An afferent pupillary defect (Marcus Gunn pupil) is diagnostic for a prechiasmal optic nerve lesion. Have the patient fixate on a far object, and then shine a bright light into his or her eyes. The initial (abnormal) response is dilation instead of brisk contraction.
Tunnel vision causes a patient to turn his or her head to avoid bumping into objects, and it can be outlined by visual field confrontation. Causes include glaucoma, retinitis pigmentosa, and quinine toxicity.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Sleep Disorders:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Insomnia may occur as difficulty falling asleep, multiple awakenings from sleep, or awakening early and being unable to fall back to sleep. If the presenting symptom is excessive daytime somnolence or fatigue, the problem may have to be reframed as one of insomnia.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Insomnia:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
To detect an underlying disorder that may affect sleep, perform a complete physical assessment. Pay close attention to findings that suggest a neurologic, cardiac, respiratory, or endocrine disorder.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vision Disturbances:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Goal ofprimary care physician is to detect any vision disturbance and torefer child to ophthalmologist for further evaluation and treatment.Normal visual acuity is estimated tobe 20/400 at birth. By 1 yr of age, acuity improves to 20/30as determined by sophisticated electrophysiologic and psychophysiologictechniques. By 2–3 yrs of age, some children have objectivevisual acuity of 20/40–20/50. 4-yr-oldscan usually read 20/30–20/40, whereas5-yr-olds should be reading 20/20–20/30.Any child with 2 or more lines of differencebetween the eyes should be suspected of having amblyopia. Neonates
Direct ophthalmoscope should be used to checkred reflex, which is reflection of light from retina. Color andintensity of reflex should be same in each eye. Mild eye misalignmentcan be normal finding at this age and usually disappears by 2 mosof age.
Infants
By 2–3mos, eyes of infants should be straight and they should be ableto follow large objects. At each visit red reflex should alwaysbe checked. Any difference in this reflex can indicate several eyeproblems, and ophthalmologic referral is mandatory.Corneal light reflex test can be usedto distinguish strabismus from pseudostrabismus. Reflection of lightsource (e.g., penlight or direct ophthalmoscope) should be in sameposition in each pupil. Normally, this reflection is just nasalof center of each pupil. If there is difference in its positionbetween 2 pupils, strabismus is present and referral is necessary. Preverbal Children
Exam forstrabismus is important at each well-child visit. In most instancesstrabismus occurs before 3 yrs of age.Esotropia (eye turning in) usuallyoccurs when child is looking at something near (e.g., picture ortoy), whereas exotropia (eye turning out) usually occurs when childis looking at object >10 ft away.Corneal light reflex and cover testscan be used to screen for these problems (see section on Strabismus). If ocularmisalignment is found, child should be referred to ophthalmologistfor further evaluation. Verbal Children
For children≥3 yrs of age, vision can be screened by several tests usingLea symbols, Tumbling E, the letters "HOTV", Snellennumbers or letters, and Allen recognition figures.Important to determine visual acuityof each eye and any difference in vision between the eyes, evenif it is just 1 line on chart.Child with vision of 20/40in both eyes or worse or difference of 2 lines in vision between theeyes should be referred for ophthalmologic evaluation.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Insomnia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Take a thorough sleep and health history. Find out when the patient's insomnia began and the circumstances surrounding it. Is the patient trying to stop using a sedative? Does he take a central nervous system (CNS) stimulant, such as an amphetamine, pseudoephedrine, a theophylline derivative, cocaine, or a drug that contains caffeine, or does he drink caffeinated beverages?
Find out if the patient has a chronic or acute condition, the effects of which may be disturbing his sleep, particularly cardiac or respiratory disease or painful or pruritic conditions. Ask if he has an endocrine or neurologic disorder, or a history of drug or alcohol abuse. Is he a frequent traveler who suffers from jet lag? Does he use his legs a lot during the day and then feel restless at night? Ask about daytime fatigue and regular exercise. Also ask if he commonly finds himself gasping for air, experiencing apnea, or frequently repositioning his body. If possible, consult the patient's spouse or sleep partner because the patient may be unaware of his own behavior. Ask how many pillows the patient uses to sleep.
Assess the patient's emotional status, and try to estimate his level of self-esteem. Ask about personal and professional problems and psychological stress. Also ask if he experiences hallucinations, and note behavior that may indicate alcohol or drug withdrawal. After reviewing complaints that suggest an undiagnosed disorder, perform a physical examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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