Sleep Disorders

Glossary

"A ruffled mind makes a restless pillow". - Charlotte Bronte

Sleep History as Part of a Sleep Disorder Screening

If you complain about insomnia, you doctor may request a sleep and health history from you. Sometimes this will be a quick in-office interview, or you might also be asked to fill out a written questionnaire or write up what you can remember about your bedtime experiences, medical history, and behavior. If you see a “sleep specialist” doctor, you will almost certainly be asked to fill out a history.

Alcohol, caffeine, tobacco, and over-the-counter medicines all have potential effects on sleep architecture and the onset or continuation of insomnia. Caffeine and nicotine are stimulants and alcohol is a depressant. OTC drugs can have different effects – cold medications with ephedrine and similar compounds are typically stimulants while antihistamines have sedative properties. All of these can be habit-forming to some extent. Use, increased or decreased dosages, and abstention after a period of use can all affect sleep quality and architectures.

Prescription drugs also profoundly influence sleep, which is why no sleep history is complete without a detailed inventory of current and recent medicine taken. This includes drugs taken explicitly for sleep as well as a host of other conditions, including high blood pressure and respiratory problems. Glucocorticoids, bronchodilators, sedatives, and beta blockers all can be culprits in sleep problems.

Psychological history enters into the history a sleep specialist will inquire about. This includes stressful events, family and job situation, and general mood. Psychiatric issues, diagnosed or anecdotal, are always critical in evaluation of insomnia and other sleep disorders. Most psychiatric illnesses have sleep disturbances as a symptom.

Other medical conditions that can influence sleep include endocrine diseases, gastrointestinal diseases, heart disease, menopause, and respiratory conditions.

Sleep history questionnaires also ask about sleep hygiene practices and lifestyle factors such as exercise habits and position of sleeping area near windows. To the extent that the patient understands his or her own sleep problems, a subjective description will be requested. The doctor will want to know when the insomnia is experienced (e.g. when trying to get to sleep, in the middle of the night), number of awakenings per night, snoring, etc. The patient may be asked to keep a sleep log for a week or more.

The sleep history is only one part of what goes into the doctor’s evaluation of the situation. Other physical examination tests may be required, including sleep-specific laboratory tests like polysomnography.

Lab Tests in Evaluation of Sleep Disorders

Polysomnography has become the established test for diagnosis of sleep disorders in problem cases. Because it is expensive and time consuming, it is used only when there is cause for concern of a serious disorder.

Actigraphy involves fitting the patient’s body with a device to record movement during the night. Simple actigraph machines are worn on the wrist and can be purchased for home use. The results from these tests are not as conclusive as from a polysomnography in determining sleep latency, sleep time, and transition between stages, but some doctors and sleep nurses find them useful.

Psychiatric tests may be adminstered if the doctor feels they are necessary. Sleep-specific tests such as the multiple sleep latency test (MSLT) are also employed. Many sleep experts employ the Pittsburgh Sleep Quality Index.

Blood and urine tests may be ordered as part of an overall physical examination or to look for specific problems that the doctor might worry about. Common problems sleep doctors might look for include iron deficiency, diabetes, and thyroid problems.