Primary insomnia is often characterized by both difficulty falling asleep and by repeated awakenings. People often feel fatigued the next day. People who suffer from this are generally preoccupied with getting enough sleep. The more they try to sleep, the greater the sense of frustration and distress and the more elusive sleep becomes.

Clinical history (including all current medication and recreational drug use) and physical exam are usually sufficient to make the diagnosis. Polysomnography, an overnight sleep study, can be helpful to rule out other types of sleep disorders (such as breathing-related sleeping disorder).

Depression is a very common cause of secondary insomnia and it should be ruled out before primary insomnia is diagnosed. Often, insomnia is the symptom for which people with depression seek medical attention.

Depression includes more than 2 weeks of the following features: low mood or inability to feel pleasure in usually pleasurable things, a feeling of slowness or sluggishness of movement, or a feeling of agitation, irritability, anxiety, feelings of low self-worth or suicidal thoughts. Sleep can be too much, too little, unrefreshing or interrupted, especially with early morning wakening and inability to fall back asleep. Changes in appetite include eating too much or too little.

If you have insomnia, report any of these other symptoms to your health care provider so that you may be screened for depression. Antidepressant medications often solve insomnia problems related to depression, but some also cause sleep problems. If this occurs, medications may need to be adjusted.