Today I am going to walk you through the actual diagnostic criteria that medical doctors and psychotherapists use to diagnose insomnia. If you struggle with sleep, think of this as a map you can bring into your discussions with your doctor.

My qualification here: I am a psychotherapist, and I am licensed to diagnose insomnia. The guidelines for diagnosis are in the DSM-5-TR — the Diagnostic and Statistical Manual, which medical professionals use to diagnose conditions.

The Diagnostic Criteria for Insomnia

1. Sleep Dissatisfaction

The first criterion for insomnia is sleep dissatisfaction — your own subjective dissatisfaction with how you sleep. This is essentially a complaint about not sleeping well, combined with one of three things: difficulty falling asleep, difficulty staying asleep during the night, or early morning awakening without being able to fall back asleep. This can be dissatisfaction with either your sleep quantity or your sleep quality.

2. Impairment and Distress

The second criterion is clinically significant distress or impairment in functioning: how you do at your job, how you do at school, even your social activities. If those are affected, the question becomes how this difficulty sleeping is impacting you during the daytime. Put simply, your sleep problems are getting in the way of your normal life.

Notice that neither of these first two criteria asks how many hours you slept. Both focus on the distress you feel about your sleep and how it affects you during the day.

3. Frequency

The third criterion is frequency. To get a diagnosis of insomnia, the sleep problem has to happen at least three nights per week.

4. Duration

The fourth criterion is duration: the sleep problem has existed for at least three months. Although, there is a little more nuance here. 

If the sleep problem has been going on for more than one month but less than three months, it is considered episodic insomnia. If there are two or more of these episodes, it is considered recurrent insomnia. If the sleep problems last the full three months or more, it is considered persistent, and it gets the full insomnia diagnosis. 

If it falls into one of the other categories, it is simply diagnosed as “other specified insomnia disorder.” Either way, it gets an insomnia diagnosis.

The comforting thing here, for many people, once they realize it, is that a few weeks of not being able to sleep well has not been shown to have a major health impact, and it is not actually diagnosed as insomnia. Almost everyone hits those rough patches at one point or another. 

5. Adequate Sleep Opportunity

The fifth criterion for a diagnosis is adequate sleep opportunity: you have the opportunity to sleep more, but are unable to.

For example, someone who is getting very little sleep because they have a newborn is sleep-deprived, but it is not insomnia. The same is true if someone has to work a double shift, or has some other reason why they do not have an adequate time and place to sleep.

A caution here about adequate sleep opportunity: when people extend the amount of time they spend in bed, trying to get more and more sleep, that can actually contribute to a sleep problem. I talk about this more in a video and blog that cover this: [link: The Eight-Hour Sleep Myth].

I also want to mention that there are a couple of other sleep disorders that can be diagnosed — for instance, if you have a job that keeps changing your sleep schedule, or that disrupts your circadian rhythm. If you are interested, I can cover the other sleep disorders in another video. Let me know in the comments.

6. Not Better Explained by Another Sleep Disorder

The sixth criterion is that the sleep problems are not better explained by a different sleep disorder. These could be narcolepsy, a breathing-related sleep disorder like sleep apnea, a circadian rhythm disorder, or a parasomnia. There cannot be any of those at play for you to get the regular insomnia diagnosis.

7. Not Related to a Substance

The seventh criterion is that the sleep problems are not related to an external substance you are taking — whether that is a medication prescribed to you, one you are taking illegally, or alcohol or tobacco, both of which contribute to sleep problems. Or caffeine, of course, since too much caffeine can disrupt your sleep. Alcohol, in particular, can be tied to the 3 a.m. waking that bothers so many people. It is worth considering all of these if you are having sleep issues.

8. Not Better Explained by a Psychological Disorder

The last criterion is that the sleep problems are not better explained by a psychological disorder, such as bipolar disorder.

Insomnia and anxiety can absolutely both be diagnosed at the same time. CBT is effective for both. CBT-I, which is CBT for insomnia, has been shown to be very effective for insomnia no matter the cause — which is genuinely interesting. I wanted to clarify this because you can have both diagnoses, and I know a lot of people watching my channel have both anxiety and insomnia.

When to See Your Doctor

There are also a number of medical issues that can contribute to, or cause, insomnia. If you have been suffering with insomnia for a long time, and you have not had a full checkup where you really talk about this with your doctor, that would be my suggestion for what to do next. CBT-I has been shown to help no matter the underlying cause, but getting to the root issue is still genuinely important.

I am about to release another video on the major medical issues that should be screened for if you have insomnia. 

Let me know your questions and comments, and what you would like me to talk about next — I do try to read the comments and respond.

See you next week.