Insomnia

Insomnia is dissatisfaction with sleep quantity or quality with one or more of: difficulty initiating sleep, difficulty maintaining sleep (frequent or prolonged awakenings), early-morning awakening with inability to return to sleep, occurring ≥3 nights/week, present for ≥3 months (chronic) or shorter (short-term), associated with daytime fatigue, mood disturbance, attention or memory issues. Insomnia is a clinical diagnosis — there's no defining lab — but several treatable medical contributors should be screened: thyroid disease (both directions), iron deficiency (drives restless legs syndrome — a major hidden cause), vitamin D deficiency, and disorders of cortisol rhythm (rarely). Most chronic insomnia is primary (psychophysiological) or comorbid with depression / anxiety; cognitive behavioural therapy for insomnia (CBT-I) is the first-line treatment.

• Primary / psychophysiological insomnia — conditioned arousal, anxiety about sleep itself.
• Depression, generalised anxiety, PTSD — sleep disturbance is core to all three.
• Hyperthyroidism — increased metabolism, sympathetic drive.
• Hypothyroidism — frequent waking, non-restorative sleep.
• Restless legs syndrome — often driven by iron deficiency (ferritin <50).
• Obstructive sleep apnoea — frequent awakenings, snoring, morning headaches, daytime sleepiness.
• Chronic pain, GORD, nocturia (BPH, diabetes) — physical interrupters.
• Substances — caffeine (half-life 6 hr), alcohol (early sleep then 3am wakening), nicotine, late evening exercise.
• Drugs — corticosteroids, stimulants, some antidepressants (especially morning fluoxetine), beta-blockers (vivid dreams).
• Menopausal hot flushes, perimenopausal anxiety.

Reasonable baseline screen for chronic insomnia: TSH ± free T4 (always), ferritin (iron deficiency drives restless legs), vitamin D (deficiency associated with poor sleep quality), full blood count. Cortisol is not routine — order only if Cushing's or Addison's features. Polysomnography (sleep study) when obstructive sleep apnoea is suspected (snoring + daytime sleepiness + BMI >30 + witnessed apnoeas). Mediora.AI surfaces the thyroid + iron + vitamin-D patterns; insomnia diagnosis and behavioural treatment are GP / sleep medicine.