How to diagnose chronic insomnia?

Question

Hello doctor,

My husband is 39 years old and has been suffering from severe insomnia for nearly eight months now, and is averaging barely two to three hours of broken and completely unrestful sleep every single night, despite trying every over-the-counter sleep aid and relaxation technique he has come across.

He has an extremely demanding job, deals with significant daily stress, and has started making serious errors at work because of chronic sleep deprivation; his job is now genuinely at risk.

Can a general physician properly evaluate whether my husband's severe, persistent insomnia is being driven by something medical, such as sleep apnea, an anxiety disorder, or thyroid dysfunction, rather than just chalking everything up to work stress?
What urgent investigations should be conducted immediately to identify any treatable underlying cause before his occupational and overall health deteriorates any further?

He has become a completely different and unrecognizable person due to this relentless sleep deprivation.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

I am really sorry your husband is going through this. Eight months of such severe sleep loss can deeply affect mood, thinking, and overall health, and it makes sense that you are worried, given the impact on his work and personality.

A general physician can and should carry out a thorough evaluation rather than assuming it is only stress, because persistent insomnia like this may be linked to conditions such as insomnia disorder (a sleep disorder that can make it hard to fall asleep or stay asleep) itself, but also obstructive sleep apnea, generalized anxiety disorder, depression, or endocrine issues like hyperthyroidism.

An initial workup typically includes.

A detailed sleep and medical history.
Screening for mental health symptoms.
Review of medications and caffeine or stimulant use.
Basic blood tests such as thyroid function tests, complete blood count, glucose, and, sometimes, iron levels.

If there are signs like loud snoring, gasping during sleep, or excessive daytime sleepiness, a sleep study is important to evaluate for sleep apnea.

Keeping a structured sleep diary for a couple of weeks can help identify patterns, and standardized questionnaires are often used to assess severity.

A referral to a sleep specialist is worth pushing for, along with evidence-based treatment, such as cognitive behavioral therapy for insomnia, which is often more effective than medications alone.

If he is experiencing severe daytime impairment, confusion, or any safety concerns, such as drowsy driving, this should be treated as urgent and addressed immediately.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.