Sleep history

Routinely, all patients should be asked the following screening questions.

• Do you sleep long enough or well enough?

• Are you very sleepy during the day?

• Is your sleep disturbed at night?

Ideally, a bed partner or other relative would also be asked the same questions because the existence or severity of some forms of sleep disturbance are not known to the patient. In the case of children, parents are the main source of information but teachers' observations about daytime sleepiness or disturbance are also important.

If the answer to any of these enquiries is positive, a detailed sleep history is required. As traditional clinical history-taking schedules pay little attention to sleep, additional sleep-related enquiries will need to be made covering the following points about the sleep problem.

• Precise nature of the sleep complaint, its onset, development, and current patterns.

• Medical or psychological factors at the onset of the sleep problem or which might have maintained it.

• Patterns of occurrence of the symptoms—factors making them better or worse, weekdays compared with weekends, or work compared with holiday periods.

• Effects on mood, work, social life, other family members.

• Past and present treatments for sleep problems and their effects.

• Past and present medication or other treatments for other illness or disorder.

In addition, detailed information is required concerning the following.

• The patient's typical 24-h sleep-wake schedule: this can usefully start with the evening meal, followed by preparation for and timing of bedtime, time and process of getting to sleep, events during the night, time and ease of waking up and getting up, level of alertness, and mental state and behaviour during the day.

• An attempt should be made to establish the duration, continuity, and timing of the patient's overnight sleep as these are the most important aspects of sleep for daytime functioning. It is also important to identify events of particular diagnostic significance (e.g. loud snoring).

Compilation of a sleep history can be aided by the use of a preliminary sleep questionnaire. Some are general in their scope (45) while others are directed to particular aspects such as sleepiness,(46) including the effect of excessive sleepiness on daytime function in a number of important real-life situations. (47>

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