Sleeping Difficulty

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What to Expect at your Health Care Provider's Office

The medical history will be obtained and a physical examination performed.

Medical history questions documenting your symptom in detail may include:

• type
  • Do you have difficulty falling asleep or staying asleep (insomnia)?
  • Do you awaken from sleep not feeling rested?
  • Do you awaken many times at night?
• time pattern
  • Is the problem persistent?
  • For how long?
  • Did the problem seem to be resolving after changing your work shift pattern?
• aggravating factors
  • Did it begin after stopping the use of alcohol at bedtime?
  • Did it begin after stopping the use of a sleeping aid
  • What medications do you take?
  • Do you take any herbal supplements or alternative medicine remedies?
  • Do you drink much coffee? Have you recently cut down on your coffee intake?
  • Is there any excessive stress or anxiety?
• sleep schedule
  • How much do you normally sleep? What hours?
  • What do you do during the few hours before you go to bed?
  • Do your sleep schedule change frequently? (shift work)
  • Do you fall asleep at inappropriate times or places?
  • Does your sleep schedule change drastically on weekends?
• associated complaints
  • Does it occur in response to reminders of a traumatic event?
  • Does it occur around the time you ingest some form of a stimulant substance?
  • Does it occur around the time you use a hypnotic medication?
  • Are you associating the bedroom with insomnia?
  • Do you worry excessively about sleep?
  • Are there also breath holding spells or times of snoring?
  • Do you have physical aches or pains that prevent you from sleeping?
  • What other symptoms are also present?

• sleep log record
• psychological tests
• thyroid tests (TSH, T3, T4)

In some rare cases, your health care provider may want you to see a sleep medicine specialist who will perform a sleep study (polysomnography)

MEDICATIONS
In most cases, this will not be necessary. Your health care provider can explore with you the possibility of using prescribed medications if everything else has failed.

Some antidepressants such as Elavil (amitriptyline) can be used at bedtime because they are sedating. They require a prescription. If insomnia is caused by depression, proper treatment of the depression with other appropriate medications or therapy should solve the problem. Benzodiazepines such as Valium (diazepam) or Ativan (lorazepam) are anti-anxiety medications that can also help induce sleep. They must be used with caution because they can be addictive. They too require a prescription.

Newer medications called hypnotics are now available. They are help reduce the time needed to fall asleep but are far less likely to be addictive than benzodiazepines. Ambien (zolpidem) and Sonata (zaleplon) are two examples.

After seeing your health care provider:
If a diagnosis was made by your health care provider related to sleeping difficulty, you may want to note that diagnosis in your personal medical record.