Presenting Complaints

• Patients are distressed and sometimes disabled by the daytime effects of poor sleep.

Diagnostic Features

• Difficulty falling asleep
• Restless or unrefreshing sleep
• Frequent or prolonged awakening

Differential Diagnosis

• Short-term sleep problems may result from stressful life events, acute medical illnesses, changes in schedule. Persistent sleep problems may indicate another cause:
  • If low or sad mood is prominent, see section on Depression. Remember that sleep disturbance is a cardinal symptom of depression.
  • If daytime anxiety is prominent, see section on Generalised Anxiety.
• Consider medical conditions which may cause insomnia: (e.g., heart failure, pulmonary disease, pain conditions)
• Consider medications which may cause insomnia: (e.g., steroids, theophyline, decongestants, some other decongestants, some antidepressant drugs, like paroxetine and floxetine).
• If loud snoring is present, consider sleep apnoea. History from the bed partner is helpful. Patients with sleep apnoea often complain of daytime sleepiness but are unaware of night-time awakenings.