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Biological and physical contributors
Timing, continuity, quantity and subjective need for sleep, and changes from baseline.
Fit, function and alternatives
A contextual factor earns a place in the formulation when case evidence links it to the presentation, not because it is present.
Check alternatives
Do not infer the process from a label, search phrase or diagnosis alone. Assess actual circumstances and source-specific population limits.
Next steps
Elicit case evidence, examine alternatives, discuss the hypothesis with the person, and revise when relevant evidence changes.
Qualification
Distinguish insomnia from reduced need for sleep and environmental disruption. Sleep–suicide associations do not provide imminent-risk prediction.
Caveats for this record