When To Seek Help - Evaluation Of Sleep Disturbances: Sleep Disorders
Content provided by the Faculty of the Harvard Medical School
When to seek help
The American Academy of Sleep Medicine recommends seeking medical advice if sleep deprivation has compromised your daytime functioning for more than a month.
You shouldn't hesitate to ask for help when you're sleeping badly following a death in the family or some other stressful event. A physician may suggest the short-term use of a sedative to help you sleep at night and thus cope better during the day and prevent development of a long-term sleep disorder.
A sample sleep history questionnaireYour physician may ask you some of the following questions during an evaluation for a sleep problem. You may find it helpful to write down your answers to these questions and bring the completed questionnaire to the exam so you and your doctor can discuss it.
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It's not always easy for people to get evaluation and treatment for a sleep problem. Doctors trained in the United States receive less than two hours of instruction on this topic during four years of medical school. According to a survey conducted by the National Sleep Foundation, most primary care physicians do not routinely ask their patients about sleep. And while most of the physicians who took part in the survey admitted they had limited knowledge about sleep-related matters, more than half did not consult with an expert in sleep medicine. This puts the responsibility on you to seek out the help you need.
Your sleep history
A sleep disturbance cannot be accurately diagnosed unless your physician is familiar with your sleep habits and history. This information may be gleaned from an interview or from written questionnaires (see "A sample sleep history questionnaire" and "Screening for sleep apnea") that you review and discuss with your doctor. A bedroom partner may be able to help answer some of these questions and should be asked to contribute to the discussion.
Some people are so used to sleep deprivation that they don't realize they're tired; instead, they may see themselves as lazy, lethargic, or not very motivated. Or they may not think it is unusual to fall asleep at a movie or while sitting at dinner with friends. Someone considered by family members to be a "good napper," able to drop off quickly and sleep through anything, may actually be displaying signs of abnormal sleepiness. During a sleep history, a physician may ask how likely you are to doze off in certain situations. The less appropriate the circumstances (such as when stopped in traffic while driving or during a conversation), the more dangerously sleepy you are considered to be.
The psychiatric interview
Sleep disturbances, particularly insomnia, are often related to psychological difficulties that respond well to treatment once they've been identified. Physicians may screen problem sleepers for symptoms of depression, anxiety, childhood physical or sexual abuse, or other psychological problems or traumatic experiences (see "Discovering the cause of sleeplessness" below). If one of these conditions is diagnosed, your primary care physician may refer you to a psychologist or psychiatrist for treatment.
| Discovering the cause of sleeplessness | ||
| Are you depressed? | ||
|
| YES | NO |
| 1. I feel downhearted, blue, and sad. | q | q |
| 2. I don't enjoy the things I used to. | q | q |
| 3. I have felt so low I've thought of suicide. | q | q |
| 4. I feel that I'm not useful or needed. | q | q |
| 5. I notice that I'm losing/gaining weight. | q | q |
| 6. I have trouble sleeping through the night. | q | q |
| 7. I am restless and can't keep still. | q | q |
| 8. My mind isn't as clear as it used to be. | q | q |
| 9. I get tired for no reason. | q | q |
| 10. I feel hopeless about the future. | q | q |
| You may be suffering from depression if
and
You should seek professional help immediately if
| ||
| Are you anxious? | ||
|
| YES | NO |
| 1. Do you feel upset or tense, maybe without even knowing why? | q | q |
| 2. Does your heart often race uncontrollably? | q | q |
| 3. Are your hands often sweaty, clammy, or extremely cold? | q | q |
| 4. Do you often have a lump in your throat? | q | q |
| 5. Do you have difficulty slowing down or relaxing? | q | q |
| 6. Do you often feel insecure or anxious? | q | q |
| 7. Do you often feel ill at ease? | q | q |
| 8. Do you often feel tired without any reason? | q | q |
| 9. Do you often worry about things you've said that might have hurt somebody's feelings? | q | q |
| 10. Do you tend to worry, even over things that you realize don't matter? | q | q |
| 11. Are you presently worrying over a possible misfortune? | q | q |
| 12. Do you often feel nervous, jittery, or high-strung? | q | q |
| 13. Are you more apprehensive about the future than other people are? | q | q |
| If you answered yes to five or more of these questions, you are probably more anxious or tense than other people, and you may need to seek professional help. | ||
| Reprinted with permission from No More Sleepless Nights by Peter Hauri, Ph.D., and Shirley Linde, Ph.D. | ||
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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