For Clinicians
This page serves as an overview for healthcare providers in evaluating and managing common sleep disorders. It highlights diagnostic approaches, general recommendations, and guidelines for referral to a sleep specialist. Proper assessment and management can significantly improve patient outcomes and quality of life.

Insufficient Sleep Syndrome
Diagnosis of insufficient sleep syndrome involves a thorough clinical history focusing on sleep duration and patterns. Tools like sleep diaries and actigraphy may be helpful in identifying and quantifying inadequate sleep habits. Recommendations typically include emphasizing sleep hygiene and implementing behavioral strategies aimed at increasing sleep duration. Referral is warranted when patients exhibit persistent symptoms despite these interventions.

Insomnia
Diagnosing insomnia requires a detailed clinical history, the use of sleep diaries, and standardized questionnaires such as the Insomnia Severity Index (ISI). First-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I), which addresses maladaptive sleep habits and thoughts. Pharmacotherapy may be considered in certain cases, however, they must be tailored to the patient with consideration for type of insomnia and side effect profile. Referral is recommended for chronic insomnia that does not respond to initial treatments or when comorbid sleep disorders are suspected.

Obstructive Sleep Apnea (OSA)
Screening for OSA often involves tools like the STOP-BANG questionnaire, with confirmation through home sleep apnea testing (HSAT) or polysomnography (PSG). Management typically includes continuous positive airway pressure (CPAP) therapy, oral appliances, surgical treatments, weight reduction strategies, and positional therapy. Referral to a specialist may be necessary for complex cases, patients who do not respond to CPAP, or when the diagnosis remains uncertain.

Restless Legs Syndrome (RLS)
The diagnosis of restless legs syndrome is clinical, based on history of symptoms including an overwhelming urge to move your legs, often paired with uncomfortable feelings like tingling or crawling. The symptoms worsen at rest, especially at bedtime, and movement temporarily relieves the discomfort of the urge to move the legs. Checking ferritin levels can aid in identifying contributing factors. Recommendations include iron supplementation if ferritin levels are below 75 ng/mL, as well as pharmacotherapy with medications like gabapentin or dopamine agonists. Referral is advised for severe or treatment-resistant cases.

Parasomnias
Parasomnias are diagnosed based on clinical history and, when necessary, polysomnography (PSG), particularly if injurious behaviors during sleep are reported. Recommendations may include ensuring safety measures and the use of medications like melatonin or clonazepam for conditions like REM sleep behavior disorder. Referral is required for complex or potentially harmful cases.

Circadian Rhythm Sleep-Wake Disorders
Diagnosing circadian rhythm disorders involves clinical history, sleep diaries, and actigraphy to evaluate misalignment between the patient’s internal clock and external cues. Management typically includes light therapy, melatonin, and gradual adjustment of sleep schedules to realign the sleep-wake cycle. Referral is indicated for severe or persistent cases.

Hypersomnias (e.g., Narcolepsy)
Hypersomnias are diagnosed through clinical history, polysomnography, and the multiple sleep latency test (MSLT). Management may often involve pharmacotherapy with stimulants such as modafinil. In narcolepsy, medications like sodium oxybate and pitolisant for symptoms including excessive daytime sleepiness and cataplexy. Referral is recommended for all suspected cases to confirm the diagnosis and provide specialized care.



Disclaimer
This page is intended for educational purposes and does not replace personalized medical care. All evaluations and treatments must be discussed with and managed by healthcare professionals. Referral to a sleep medicine specialist is strongly recommended for complex or unresponsive cases to ensure the best possible outcomes.