When is referral to a sleep specialist indicated for the treatment of insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Primary care physicians should be able to diagnose and treat transient or short-term insomnia. Chronic insomnia is often more difficult to treat, and referral to a specialist may be indicated. Patients with comorbid medical conditions may benefit from referral to the appropriate specialist.

Patients should be referred to a sleep specialist in the following cases:

  • If the history suggests obstructive sleep apnea or restless legs syndrome/periodic leg movement disorder

  • In cases of primary insomnia, particularly if it is psychophysiologic insomnia and of long duration

  • The patient requires daily or near-daily sedative-hypnotics for insomnia for 30 days or more

Many sleep centers have a staff psychologist who specializes in treating insomnia. The advantages include experience in cognitive-behavioral techniques and providing sleep education, greater available time for the often-frequent follow-up that is needed, and the ability to ascertain whether other psychological factors are present that may need further evaluation by a psychiatrist.

Patients with a history of depression should be treated with an antidepressant or referred to a psychiatrist, based on the physician's comfort level in treating depression, the severity of depression, and the response to therapy. In addition, patients with a history of substance abuse or another major psychiatric disorder should also be referred to a psychiatrist.


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