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The diagnosis of chronic insomnia disorder is based on a set of clinical rules, and as you'll see, they are a rather extreme set of rules. In general, the diagnosis of insomnia confirms the following three things: difficulties falling asleep, difficulties staying asleep, or not being refreshed or restored your sleep. The concern there is that it's such a stringent criterio, its such a high threshold, that it ends up leaving quite a lar proportion of people left out in the diagnostic cold,. Nevertheless, however, most clinicians and doctors that i know are incredibly sensitive to this, and their very sympathetic in terms of working with these rules.

There is no quick test that can determine insomnia. Instead, the diagnosis of clinical insomnia disorder is based on a set of clinical assessment and interviews. These center on three core features: 1) difficulties falling asleep, 2) difficulty staying asleep, or 3) waking up and not feeling refreshed by your sleep. Furthermore, to receive the diagnosis, you often have to be experiencing these things at least three nights per week; and having these issues for three straight months.

One meta-analysis looked at over twenty studies of people with insomnia or healthy sleep. It found far fewer differences in their sleep recordings than you would imagine. The insomnia patients did spend more time awake, and there were reductions in their deep non-REM and REM sleep. But none of the differences explain the degree of suffering for those with insomnia.

This mismatch can be illustrated by an extreme example. There is a rare variant or subtype of insomnia called sleep state misperception. It is characterized by a mismatch whereby the patient reports their sleep as very bad. But the sleep recordings show a different story. The recordings show that the patient has slept a full, normal night of sleep, but the patient will tell you that they felt as though they never slept a wink!

Such patients used to be dismissed as having nothing wrong with them. Now, science and medicine no longer take this view, and instead, understand that there is a mismatch going on, that the patient has a misperception of their sleep, and they still require clinical consideration.

So, that’s an overview of insomnia classification and diagnosis. Please note that Matt is not a medical doctor, and none of the content in this podcast should be considered medical advice in any way, shape, or form, nor prescriptive in any way.

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