Taking a Sleep History
Taking a sleep history can at first seem a daunting task. After all, much of what we are asking about is occurring when the patient is asleep. As a result, it can be tempting to bypass the history and rely on objective sleep studies such as the polysomnog
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Taking a Sleep History Hugh Selsick
3.1
Introduction
Taking a sleep history can at first seem a daunting task. After all, much of what we are asking about is occurring when the patient is asleep. As a result, it can be tempting to bypass the history and rely on objective sleep studies such as the polysomnogram (PSG). However, there is no substitute for a good history, and the majority of sleep disorders can be diagnosed on history alone, with objective studies often being used simply for confirmation or to look for complicating and exacerbating factors. There are generally two types of sleep history: a screening history and an in- depth history. Often the purpose of the history is simply to screen for sleep disorders, and this is something that should ideally be done in every psychiatric patient. The screening history is necessarily brief and should take no more than a few minutes. However, if a potential sleep disorder is identified, or when patients present to a clinician with a complaint of a sleep disorder, a much more detailed history is warranted. In this chapter, I will first address the detailed sleep history and then demonstrate an efficient way of quickly screening for sleep disorders that can be incorporated into a psychiatric history.
3.2
Main Complaint
It may sound obvious, but it is essential to allow the patient to explain what it is that distresses them and why they are seeking help. This not only informs your history taking but allows you to direct your treatment plan to address the patient’s concerns. Often patients will be referred to a specialist with a request from the referrer to
H. Selsick Insomnia Clinic, Royal London Hospital for Integrated Medicine, London, UK e-mail: [email protected] © Springer-Verlag GmbH Germany, part of Springer Nature 2018 H. Selsick (ed.), Sleep Disorders in Psychiatric Patients, https://doi.org/10.1007/978-3-642-54836-9_3
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address a particular problem, but that may not be the problem that particularly worries the patient. In particular, it is helpful to determine whether it is the patient, the bed partner, the employer or a physician who has raised the concern. Patients presenting with sleep disorders may present with a very clear description of their problem, but this is not always the case. They may describe their problem in layman’s terms which are at odds with the terminology we use. For example, they will often confuse nightmares and night terrors, and therefore it is essential to ask the patient to describe their symptoms in more detail. In terms of how you take a history, the presenting complaint will likely fall into one of three categories: • Difficulty initiating and/or maintaining sleep or sleeping at the wrong time. The common differential diagnoses are insomnia, restless legs and circadian rhythm disorders. • Excessive daytime sleepiness and/or snoring with or without observed apnoeas. Diagnoses to consider include obstructive sleep apnoea (OSA), periodic limb movements (PLMs), narcolepsy and idiopathic hypersomnia (IH).
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