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A thorough sleep history lays the foundation for accurate diagnosis and effective treatment of sleep disorders Table 27—1. Detailed history and review of the sleep complaint, as well as predisposing, precipitating, and perpetuating factors. Review of the difficulties falling asleep, maintaining sleep, and awakening early. Timing of sleep and wakefulness over the h day.

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Bedtime routines, sleep setting, preoccupations, anxiety, beliefs about sleep and sleep loss, fears about consequences of sleep loss, nightmares, enuresis, and sleepwalking. Medical and neurologic history and examination and routine laboratory examinations. Review of use of prescription and nonprescription medications, hypnotics, alcohol, and stimulants. Evidence of sleep-related breathing disorders: Snoring; orthopnea, dyspnea; headaches; falling out of bed; nocturia; obesity; short, fat neck; enlarged tonsils; narrow upper oral airway; and foreshortened jaw retrognathia.

Sleep & Psychiatric Disorders

Social and occupational history, marital status, living conditions, financial and security concerns, and physical activity. Sleep environment—ambient noise, light, and temperature. Typical exposure to light sunlight and artificial and darkness across a h day. Interview with bed partners or persons who observe the patient during sleep. Tape recording of respiratory sounds during sleep to screen for sleep apnea. In: Salzman C ed. Clinical Geriatric Psychopharmacology, 4th edn. Steps for a sleep disturbance algorithm.

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Philadelphia: Saunders, , pp. During the evaluation, the patient's bed partner or other informants should be included whenever possible.

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