What are the key components of a sleep assessment for a patient presenting with insomnia?

Key components of a sleep assessment for a patient presenting with insomnia include:

• Detailed sleep history: Assess the nature of insomnia symptoms (difficulty falling asleep, maintaining sleep, early awakening), duration, severity, and impact on daytime functioning. Identify any triggers or stressors associated with onset and maintenance of insomnia ¹.
• Assessment of sleep hygiene and behaviours: Evaluate behavioural, environmental, and temporal factors that may affect sleep, such as sleep environment, use of electronic devices before bedtime, caffeine, nicotine, alcohol intake, and exercise timing ¹.
• Screening for other sleep disorders: Consider symptoms suggestive of other sleep disorders (e.g., parasomnias, narcolepsy, obstructive sleep apnoea) such as snoring, witnessed apnoeas, unrefreshing sleep, excessive daytime sleepiness, nocturia, choking during sleep, or cognitive dysfunction ¹,².
• Use of assessment tools: Employ scales like the Epworth Sleepiness Scale and STOP-Bang Questionnaire to evaluate daytime sleepiness and risk of obstructive sleep apnoea, but do not rely solely on these for referral decisions ².
• Review of comorbidities and medications: Identify and optimise management of comorbid conditions such as anxiety, depression, or medical illnesses that may contribute to insomnia ¹.
• Assessment of occupational and safety risks: Consider the patient’s occupation, especially if it involves driving or safety-critical tasks, and advise accordingly about driving if sleepy ¹.
• Consideration of referral: If diagnosis is uncertain, treatment in primary care fails, or another sleep disorder is suspected, referral to a sleep specialist or clinic is appropriate ¹.