Takeaway
Insomnia is a common condition that increases the risk of physical and mental health problems. Screening for it is an important part of patient care, and it can be quick and easy.
Lifelong Learning in Clinical Excellence | October 2, 2025 | 2 min read
By Molly Atwood, PhD, Johns Hopkins Medicine
Insomnia disorder is one of the most common sleep problems, with up to 10% of adults experiencing chronic symptoms and nearly one-third experiencing occasional bouts of poor sleep.
Screening for insomnia is especially important because insomnia isn’t just about restless nights—it increases the risk of depression, anxiety, and substance misuse, and can be linked to physical health issues like hypertension, obesity, and impaired immune function. Insomnia also commonly persists after treatment for another disorder. In other words, it’s not just a symptom of conditions like depression, anxiety, or chronic pain—when these conditions improve, sleep problems don’t completely go away.
Screening for insomnia disorder starts with two key questions:
1. Do you have trouble falling asleep, staying asleep, or waking up too early—at least three nights a week for three months or more?
2. Does this leave you drained, unfocused, or irritable in daily life?
Clinicians can listen for these patterns and ask about other potential contributors to sleep disturbance like medical conditions, substance use, or medications. Physicians can also use quick tools like the Insomnia Severity Index (ISI) or Pittsburgh Sleep Quality Index (PSQI) to measure the severity of the problem.
The goal isn’t just to count lost hours of sleep, but to spot when sleepless nights have become a disruptive, ongoing disorder that can have broad impacts on both mental and physical health if left untreated.
Here are a few tips I’d like to share from caring for patients at the Johns Hopkins Behavioral Sleep Medicine Program:
1. Ask about sleep directly.
This includes asking about difficulty falling asleep, staying asleep, or waking too early.
2. Clarify frequency and duration.
Check if symptoms occur at least three nights per week and have lasted three months or longer.
3. Explore daytime impact.
Ask if poor sleep causes fatigue, mood changes, trouble concentrating, or reduced performance.
4. Rule out insufficient sleep.
Confirm whether the person actually has enough opportunity and time to sleep.
5. Ask about medications and substances.
Note that caffeine, alcohol, nicotine, or prescribed medications that may interfere with sleep.
6. Use brief validated tools.
Consider the Insomnia Severity Index (ISI) or a short sleep questionnaire for quick screening.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.