Relevant personal and societal factors (isolation, loneliness, bereavement, change in residence, security, or financial concerns) that may indicate a temporary situational insomnia are key historical factors. Medical and psychiatric conditions that can impair sleep, including drug and alcohol history, also should be carefully investigated (Table 2).
A thorough but focused physical examination, including neurologic and mental status assessment, should seek confirmation of conditions suggested in the history, including evidence of comorbid, insomnia promoting conditions listed in Table 2.