What are questions to ask in the sleep history for insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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To determine the sleep schedule, ask the patient questions such as the following:

  • What time do you go to bed and get up in the morning?

  • Do you go to bed and get up at the same times every day? How about during off days?

  • Has this schedule changed recently?

Inquire about the patient's sleep environment, as follows:

  • What are the temperature, bed comfort, and noise and light levels?

  • Do you sleep better in a chair or when away from home (eg, hotel) than in your own bed?

Sleep habits can also be determined with questioning. Individuals with insomnia often have poor sleep hygiene. Questions regarding sleep hygiene are as follows:

  • Before bedtime, do you relax or do you work?

  • Do you read or watch television in bed?

  • Is the television or a light kept on during the night?

  • What do you do if you cannot fall asleep?

  • If you wake up in the middle of the night, do you fall back to sleep easily? If not, what do you do?

  • Do you take daytime naps?

  • Do you exercise? If so, at what time?

Ask patients about symptoms of other sleep disorders, such as obstructive sleep apnea (eg, snoring, witnessed apneas, gasping) and restless legs syndrome/periodic limb movement disorder (eg, restless feeling in legs on lying down, which improves with movement; rhythmic kicking during the night; sheets in disarray in the morning).

Ask about daytime effects, which should be present if the patient is truly not sleeping at night. In fact, a patient who has no daytime effects is probably getting adequate sleep and may have sleep-state misperception insomnia (sometimes called paradoxical insomnia). This rare condition, which appears to constitute less than 5% of insomnia cases, is defined by a marked discrepancy between the subjective complaint of insomnia and the objective polysomnographic findings. [7]

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