Text adapted from: "The adult patient with a sleep disorder," in Psychiatry in primary care by Dora Zalai, M.R. Goolam Hussain and Colin Shapiro (CAMH, 2019).
Inadequate sleep has many negative health implications, including high rates of fatigue (a more common symptom of a sleep disorder than sleepiness per se), cardiac and vascular complications, higher risk of driving accidents, compromised immune function, impaired cognition and more rapid deterioration of many medical conditions.
The effect of sleep disorders on the pathophysiology of other medical conditions is particularly relevant to primary care practitioners because managing sleep problems represents a valuable opportunity for intervention to manage the co-occurring medical condition. Furthermore, sleep disorders may limit the efficacy of treatments for hypertension, cardiac failure, mood disorders and epilepsy.
Patients with insomnia symptoms should be screened for sleep disorders and referred to a sleep clinic if other sleep disorders, such as sleep apnea, need to be ruled out. If online tools are not effective for patients who have chronic insomnia—as either a stand-alone condition or comorbid with other medical conditions—offer them CBT-I and refer them to a trained clinician, such as a psychologist. Also consider referral to CBT-I if the patient wants to stop taking hypnotic medications but is concerned that insomnia symptoms will return. These patients can receive CBT-I with medication tapering.
Excessive daytime sleepiness
If sleepiness and fatigue are clearly related to sleep restriction, suggest that the patient enter into a contract with you to increase time for sleep on a regular basis. Suggest a trial period of one month with a clear benefit in terms of resolving the underlying problem.
Patients with other causes of excessive sleepiness should be referred for a more formal sleep assessment at a sleep clinic.