What are your expectations regarding sleep?ĭo you have any other medical or mental health conditions? What are your beliefs about sleep (how sleep works, what you need to do to get a good night's sleep)? What are your activities before going to sleep (dinnertime, exercise time, bedroom activities)? Helps identify precipitating factors for insomnia helps address sleep hygiene and stimulus control measures to treat insomnia What is your sleep environment like (temperature, light, noise levels)? What are your typical sleep and wake-up times on weekdays and weekends?ĭifferentiates between insomnia and delayed sleep phase syndrome helps determine if there are comorbidities or other stressors affecting sleep 11ĭifferentiates chronic insomnia (requires treatment with cognitive behavior therapy and/or sleep hypnotics), transient insomnia (lasts less than one week), and acute insomnia (lasts less than one month)Įstablishes the severity of insomnia and possible treatment options insomnia that occurs once a week or less may be treated with a sleep hypnotic as needed Overnight polysomnography is rarely needed, unless the history suggests concurrent sleep disorders or initial treatment is ineffective. Occasionally, a sleep log ( eFigure A) or an actigraphy log ( eFigure B) used for one to two weeks may be helpful. Table 3 includes questions for patients that may be helpful in this assessment. Insomnia is usually diagnosed with a patient history that includes evaluation for contributing psychiatric or medical conditions. 10 Daytime impairment may include fatigue tiredness difficulty with memory, concentration, and attention worry about sleep mood disturbances or irritability. Insomnia is characterized by repeated difficulty with sleep initiation (the time it takes to fall asleep, normally less than 30 minutes called sleep latency in sleep studies), duration (normally seven to nine hours per night for adults also called sleep quantity), consolidation (sleep uninterrupted by arousals or awakenings), or quality that occurs despite adequate time and opportunity for sleep, resulting in daytime impairment. population has had insomnia that occurred every night for at least two weeks 9 however, many do not discuss it with their physician. Uncomfortable sensation (e.g., “creepy crawly,” aching) in both legs, symptoms are worse in the evening, improve with movement such as walking or stretchingĪpproximately 10% of the U.S. Motor activity during sleep, acting out of dreams, polysomnography showing increased muscle tone Rapid eye movement sleep behavior disorder Snoring, witnessed apneas, gasping or choking, excessive daytime sleepiness Modafinil (Provigil) or stimulants, gamma hydroxybutyric acid (sodium oxybate ), selective serotonin reuptake inhibitors It is diagnosed based on history and polysomnography findings, and treated with environmental safety measures and melatonin or clonazepam.īright light therapy in the morning, low-dose melatonin in the eveningĭifficulty initiating or maintaining sleep, daytime sleepiness with inability to nap, daytime impairment (e.g., difficulty with memory, concentration, attention worry about sleep mood disturbance irritability)Ĭognitive behavior therapy, benzodiazepine receptor agonistsĮxcessive daytime sleepiness, cataplexy, hallucinations upon falling asleep or awakening Rapid eye movement sleep behavior disorder is characterized by increased muscle tone during rapid eye movement sleep, resulting in the patient acting out dreams with possible harmful consequences. Continuous positive airway pressure is the most common and effective treatment for obstructive sleep apnea. Patients with snoring and witnessed apneas may have obstructive sleep apnea, which is diagnosed using overnight polysomnography.
Narcolepsy is treated with stimulants, such as modafinil selective serotonin reuptake inhibitors or gamma hydroxybutyric acid (sodium oxybate).
It is diagnosed using a sleep log or actigraphy, followed by overnight polysomnography and a multiple sleep latency test. Narcolepsy is characterized by excessive sleepiness, cataplexy, hypnagogic or hypnopompic hallucinations, and sleep paralysis. Restless legs syndrome is treated based on the frequency of symptoms. Restless legs syndrome is characterized by an urge to move the legs that worsens with rest, is relieved by movement, and often occurs in the evening or at night. Insomnia, defined as difficulty initiating or maintaining sleep that results in daytime impairment, is diagnosed using history findings and treated with cognitive behavior therapy, with or without sleep hypnotics. Patients with sleep disorders can be categorized as those who cannot sleep, those who will not sleep, those with excessive daytime sleepiness, and those with increased movements during sleep. Sleep disorders are common and affect sleep quality and quantity, leading to increased morbidity.
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