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What I Look For When a Patient Complains of Chronic Insomnia Chronic insomnia is more than simply having a few bad nights. When a patient tells me they have been struggling to fall asleep, waking repeatedly, or waking too early for weeks or months, I look beyond the number of hours they sleep. My first priority is understanding why the sleep problem has developed and what is keeping it going. I Start by Understanding the Sleep Pattern I ask patients to describe their typical night in detail. This includes when they go to bed, how long it takes to fall asleep, how often they wake up, when they finally wake for the day, and whether they feel refreshed. I also ask about daytime symptoms such as fatigue, poor concentration, irritability, excessive sleepiness, reduced motivation, or difficulty functioning at work. A sleep diary can be particularly useful because it helps identify patterns that may not be obvious during a consultation. Clinical assessment of insomnia generally includes a detailed sleep, medical, psychiatric, medication, and substance use history. I Look for Anxiety, Depression and Emotional Stress Sleep and mental health are closely connected. Anxiety can keep the mind active at night, while depression may affect sleep timing, sleep quality, and early morning waking. I therefore explore whether the patient is experiencing excessive worry, panic symptoms, low mood, loss of interest, racing thoughts, emotional stress, or other psychological concerns. Sometimes insomnia is the first symptom that brings an underlying mental health concern to attention. Identifying this relationship is important because treating only the sleep problem may not address the underlying cause. I Review Medicines, Caffeine and Other Substances I ask about prescription medicines, over the counter medicines, caffeine, nicotine, alcohol and other substances. Caffeine consumption later in the day, certain medications, substance use, or withdrawal can contribute to sleep difficulties. Understanding these factors helps distinguish between insomnia that requires specific treatment and sleep disruption caused or worsened by another factor. I Check for Other Sleep or Medical Conditions Not every patient who cannot sleep has primary insomnia. I consider whether symptoms could be associated with conditions such as sleep apnea, restless legs syndrome, circadian rhythm problems, chronic pain, thyroid disorders or other medical concerns. A sleep study is not automatically required for every person with chronic insomnia. It may be considered when the clinical history suggests another sleep disorder, particularly sleep related breathing or movement disorders. I Look at What Happens When the Patient Cannot Sleep Over time, patients can develop anxiety about sleep itself. They may start watching the clock, worrying about the next day’s performance, spending excessive time in bed awake, or trying very hard to force themselves to sleep. These responses can create a cycle of frustration, arousal and further difficulty sleeping. This is an important part of my assessment because treating chronic insomnia often means changing the relationship a person has developed with sleep. I Focus on Evidence Based Treatment Treatment should be personalised rather than based on a one size fits all approach. For chronic insomnia, Cognitive Behavioural Therapy for Insomnia, or CBT I, is strongly recommended as an evidence based treatment. It can address the thoughts, behaviours and sleep patterns that contribute to persistent insomnia. Medication may have a role in selected patients, but it should be considered after understanding the person’s symptoms, other conditions, previous treatment response, potential side effects and treatment goals. Chronic Insomnia Deserves a Proper Evaluation When someone has persistent sleep difficulties, I do not look only at bedtime habits. I look at the complete picture: sleep patterns, mental health, physical health, medications, substances, lifestyle, stress and behaviours surrounding sleep. At Dr. Prabhojit Mohanty’s mental health clinic in Mumbai, insomnia is approached as an individual clinical concern rather than simply a problem of poor sleep hygiene. The goal is to identify contributing factors and develop an appropriate treatment plan based on the patient’s needs. The clinic lists insomnia among its psychiatric services. If chronic insomnia is affecting your mood, concentration, work, relationships or daily functioning, a professional psychiatric evaluation can help identify what may be keeping the problem going and determine the most appropriate way forward. Final Takeaway Chronic insomnia can have different causes and maintaining factors, so understanding the complete clinical picture is important before deciding on treatment. If persistent sleep difficulties are affecting your mood, concentration, work or daily life, a professional evaluation can help identify the factors contributing to the problem and guide an appropriate treatment approach.Insomnia treatment and psychiatric services.If you are struggling with persistent sleep difficulties, contact the clinic to discuss an evaluation. Frequently Asked Questions (FAQs) 1. What is chronic insomnia? Chronic insomnia is persistent difficulty falling asleep, staying asleep or waking too early that affects daytime functioning. 2. What causes chronic insomnia? Chronic insomnia can be linked to anxiety, depression, stress, medicines, substances, medical conditions or other sleep disorders. 3. How is chronic insomnia evaluated? Evaluation usually includes a detailed review of sleep patterns, mental health, medical history, medicines, substances and daytime symptoms. 4. Is a sleep study needed for chronic insomnia? A sleep study is not routinely required but may be recommended when symptoms suggest sleep apnea or another sleep disorder. 5. What is the treatment for chronic insomnia? CBT-I is a strongly recommended evidence-based treatment, while medication may be considered for selected patients. Chronic insomnia is persistent difficulty falling asleep, staying asleep or waking too early that affects daytime functioning. Chronic insomnia can be linked to anxiety, depression, stress, medicines, substances, medical conditions or other sleep disorders. Evaluation usually includes a detailed review of sleep patterns, mental health, medical history, medicines, substances and daytime symptoms. A sleep study is not routinely required but may be recommended when symptoms suggest sleep apnea or another sleep disorder. CBT-I is a strongly recommended evidence-based treatment, while medication may be considered for selected patients. Contact Details: Dr. Prabhojit Mohanty Psychiatrist in Malad, Mumbai Address: Altiuz Hospital, 1st Floor, Link House, New Link Rd, near Malad West Malad, Rajan
