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If you complain about insomnia, you doctor may request a sleep and health history from you. Sometimes this will be a quick in-office interview, or you might also be asked to fill out a written questionnaire or write up what you can remember about your bedtime experiences, medical history, and behavior. If you see a “sleep specialist” doctor, you will almost certainly be asked to fill out a history.
Alcohol, caffeine, tobacco, and over-the-counter medicines all have potential effects on sleep architecture and the onset or continuation of insomnia. Caffeine and nicotine are stimulants and alcohol is a depressant. OTC drugs can have different effects – cold medications with ephedrine and similar compounds are typically stimulants while antihistamines have sedative properties. All of these can be habit-forming to some extent. Use, increased or decreased dosages, and abstention after a period of use can all affect sleep quality and architectures.
Prescription drugs also profoundly influence sleep, which is why no sleep history is complete without a detailed inventory of current and recent medicine taken. This includes drugs taken explicitly for sleep as well as a host of other conditions, including high blood pressure and respiratory problems. Glucocorticoids, bronchodilators, sedatives, and beta blockers all can be culprits in sleep problems.
Psychological history enters into the history a sleep specialist will inquire about. This includes stressful events, family and job situation, and general mood. Psychiatric issues, diagnosed or anecdotal, are always critical in evaluation of insomnia and other sleep disorders. Most psychiatric illnesses have sleep disturbances as a symptom.
Other medical conditions that can influence sleep include endocrine diseases, gastrointestinal diseases, heart disease, menopause, and respiratory conditions.
Sleep history questionnaires also ask about sleep hygiene practices and lifestyle factors such as exercise habits and position of sleeping area near windows. To the extent that the patient understands his or her own sleep problems, a subjective description will be requested. The doctor will want to know when the insomnia is experienced (e.g. when trying to get to sleep, in the middle of the night), number of awakenings per night, snoring, etc. The patient may be asked to keep a sleep log for a week or more.
The sleep history is only one part of what goes into the doctor’s evaluation of the situation. Other physical examination tests may be required, including sleep-specific laboratory tests like polysomnography.