What criteria should I use to determine if a patient with insomnia requires referral to a sleep specialist?

Criteria for referral of a patient with insomnia to a sleep specialist include:

• Suspected presence of another sleep disorder such as parasomnia, narcolepsy, or obstructive sleep apnoea (OSA) ¹.
• Doubt regarding the diagnosis of insomnia after initial assessment in primary care ¹.
• Failure of treatment in primary care, including unsuccessful sleep hygiene measures and cognitive behavioural therapy for insomnia (CBTi) ¹.
• Insomnia occurring in individuals from occupational at-risk groups, for example, professional drivers, due to safety concerns ¹.
• Consideration of pharmacological treatment for insomnia during pregnancy, requiring specialist advice from a psychiatrist or obstetrician ¹.

Routine referral is not recommended for adults with insomnia who have isolated brief episodes of sleep paralysis or jerks on falling asleep ¹.

Referral should also be considered if symptoms suggest another sleep disorder that may require specific investigation and management, such as OSA, which has its own referral criteria including excessive sleepiness impacting safety-critical roles or comorbidities ¹,²,³.