Practical diagnostic strategies and tools for insomnia.
Despite the high prevalence of insomnia in the primary care setting, only a small proportion of patients report sleep problems to their physician. Evidence shows that treatment of insomnia can ameliorate the high socioeconomic burden associated with the disorder, as well as improve patient outcomes in coexistent diseases such as depression, bipolar disorder, rheumatoid arthritis, and fibromyalgia. The first strategy for improving diagnosis of insomnia is heightened awareness of the condition. As the first point of contact for most patients, primary care physicians are in a unique position to improve rates of detection and treatment. All patients should be screened for sleep disorders with such questions as "How is your sleep?" "Do you have trouble getting to sleep or staying asleep?" and "Do you get drowsy during the day or at inappropriate times?" Medical history and physical examination may also reveal possible coexistent psychiatric and medical illnesses that put patients at higher risk for insomnia, as well as suggest involvement of prescription and nonprescription medications and environmental factors that contribute to insomnia. Diagnostic tools such as the Epworth Sleepiness Scale and the Sleep Hygiene Self-Test can aid patients and physicians in recognizing sleep problems, assessing their severity, and measuring improvement after treatment.
Doghramji
Paul P
PP
Brookside Family Practice & Pediatrics, Pottstown, PA 19464, USA. hyedoc@pol.net
D006305:Health Status Indicators; D006801:Humans; D008499:Medical Records; D011320:Primary Health Care; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000188:drug therapy