Symptom
Insomnia
Insomnia can drive mood, anxiety, attention, appetite, metabolic risk, and medication response. It should not sit in the margin of the psychiatric note.
Review frame
How Insomnia gets reviewed
Inputs
- Labs
- PHQ-9 and GAD-7
- Insomnia screen
- Medication and supplement list
- Sleep, caffeine, alcohol, and substance pattern
- Symptom timeline
- Top goals
Output
- Symptom and timeline summary
- Lab-pattern read in psychiatric context
- Medication, supplement, sleep, and substance review
- Psychiatric-medical differential
- Named pathway for care or monitoring
Not this
- Not emergency care
- Not a diagnosis from labs
- Not a medication or supplement change by website
- Not a replacement for primary care, psychiatry, or therapy
- Not proof that biology explains every symptom
Clinical read
Insomnia needs a differential, not a reflex label.
The psychiatric explanation may be real
Insomnia may be a symptom, a driver, or both. It can belong to anxiety, depression, bipolar disorder, trauma, stimulant load, circadian mismatch, or sleep physiology.
The body can amplify the signal
Stimulants, caffeine, nicotine, alcohol rebound, cannabis pattern, sedative tolerance, or medication timing Sleep apnea risk, restless legs, pain, reflux, nocturia, or circadian disruption Thyroid, iron/ferritin, cortisol timing questions, or hormone transition Mania/hypomania risk when reduced sleep comes with energy, impulsivity, or grandiosity
One cause is not assumed
The goal is to decide what fits, what does not fit, and what still needs a clinician.
Common contributors
What can cause, mimic, or amplify this symptom.
- Stimulants, caffeine, nicotine, alcohol rebound, cannabis pattern, sedative tolerance, or medication timing
- Sleep apnea risk, restless legs, pain, reflux, nocturia, or circadian disruption
- Thyroid, iron/ferritin, cortisol timing questions, or hormone transition
- Mania/hypomania risk when reduced sleep comes with energy, impulsivity, or grandiosity
Useful inputs
Labs and screens are chosen by pattern.
- Ferritin when restless legs or low iron pattern fits
- TSH when thyroid symptoms fit
- Glucose/metabolic markers when nocturnal symptoms fit
- Insomnia severity screen plus PHQ-9 and GAD-7
- Medication, caffeine, alcohol, cannabis, stimulant timing
Common questions
Questions people ask before they start.
Can this symptom diagnose the problem?
No. This symptom can change what belongs in the differential. A responsible review still requires clinical history, symptoms, timing, medication context, risk review, and the appropriate clinician relationship.
What does the review actually give me?
A written psychiatric-medical synthesis: what appears more likely, what remains possible, what seems less likely, what needs another clinician, and what should be monitored or left alone.
Is this emergency care?
No. If symptoms are acute, dangerous, rapidly worsening, or involve possible self-harm, psychosis, mania, delirium, withdrawal, chest pain, neurologic symptoms, or medical instability, use emergency or urgent care.