What should you know about DSM-5 insomnia?

The DSM-5 describes insomnia as dissatisfaction with sleep quantity or quality, such as trouble falling asleep, frequent waking, or waking before planned. The problem is considered clinically significant when it causes distress or affects daytime concentration, energy, mood, work, or relationships. A clinician also checks whether the pattern occurs despite a suitable chance to sleep and whether another sleep disorder, medicine, substance, medical problem, jet lag, burnout, depression, or anxiety may be involved.

Difficulty sleeping and daytime sleepiness can have several explanations. A sleep history helps separate a short-lived disruption from a persistent problem and identifies habits or schedules that may be maintaining it.

Book a medical appointment if poor sleep keeps affecting your days or you are relying on sleep aids. Keep a brief sleep diary showing bedtime, estimated sleep time, awakenings, waking time, naps, caffeine, alcohol, and medicines. Regular wake times, a wind-down routine, and a bedroom suited to sleep may help. A clinician may recommend structured behavioural treatment and review medicines or conditions that interfere with rest.

Get urgent help if sleep loss comes with thoughts of self-harm, dangerous confusion, fainting, chest pain, severe breathing difficulty, or inability to stay awake safely. Prompt medical review is also needed when several days of little sleep occur with unusually high energy, racing thoughts, impulsive behaviour, or a feeling that you do not need sleep.

Ask what may be disrupting sleep, whether another condition or medicine is contributing, which behavioural treatment is suitable, and when daytime sleepiness makes driving or other tasks unsafe.