From the Guidelines
Blood work for insomnia is not routinely recommended, but it may be necessary to rule out underlying medical conditions that could be contributing to sleep difficulties, as suggested by the VA/DOD CPG 1. When evaluating patients with insomnia, it is essential to consider potential underlying medical causes. According to the VA/DOD CPG, there is no available evidence that recommends for or against additional diagnostic testing for patients with chronic insomnia disorder who do not respond to CBT-I or pharmacotherapy 1. However, the guideline suggests using the Insomnia Severity Index or Athens Insomnia Scale as part of a comprehensive sleep assessment 1. In clinical practice, blood work may include tests such as:
- Complete blood count (CBC) to check for anemia
- Thyroid function tests to detect hyper- or hypothyroidism
- Blood glucose tests to screen for diabetes
- Tests for vitamin deficiencies (particularly iron, vitamin D, and B12) which can affect sleep quality
- Cortisol levels to assess adrenal function
- Inflammatory markers if chronic inflammation is suspected These tests can help identify potential underlying medical conditions that may be contributing to insomnia. If blood tests reveal abnormalities, treating the underlying condition often improves sleep. However, if results are normal, the focus will likely shift to behavioral approaches like sleep hygiene, cognitive behavioral therapy for insomnia (CBT-I), or possibly short-term medication use, as recommended by the VA/DOD CPG 1. Key points to consider when evaluating patients with insomnia include:
- Using a comprehensive sleep assessment, such as the Insomnia Severity Index or Athens Insomnia Scale 1
- Ruling out underlying medical conditions that could be contributing to sleep difficulties
- Focusing on behavioral approaches like sleep hygiene and CBT-I as first-line treatment for chronic insomnia disorder 1
- Considering short-term medication use or other therapies if necessary, but only after a thorough evaluation and assessment of the patient's specific situation.
From the Research
Diagnosis of Insomnia
- Insomnia can be diagnosed based on patient interview, assessment with tools, and use of criteria 2
- The diagnostic term for the symptom of insomnia that merits specific attention is insomnia disorder 3
- Chronic insomnia is a clinical diagnosis fulfilled by specific criteria, including difficulty initiating or maintaining sleep, inability to sleep despite having adequate opportunities, and negative daytime effects due to lack of sleep 4
Treatment Options for Insomnia
- Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment approach due to its efficacy, safety, and durability of benefit 3, 5, 2
- Pharmacologic therapies, such as benzodiazepines, "z-drugs", melatonin receptor agonists, and orexin antagonists, are also available treatment options 5
- A "personomics" approach can be used to personalize care plans for patients with insomnia, considering their individual needs and characteristics 4