Clinical Sleep Health: Assessment, Diagnosis, and Treatment
The clinical frame
Clinical sleep health questions test whether you can move from symptom to differential to test to plan. Anchor on the classic presentations: obstructive sleep apnea (snoring, witnessed apneas, daytime sleepiness, elevated BMI), central sleep apnea (Cheyne-Stokes breathing, heart failure), insomnia disorder (difficulty initiating or maintaining sleep with daytime impairment despite adequate opportunity), restless legs syndrome (urge to move, worse at rest, relieved by movement, worse in evening), and narcolepsy (cataplexy, sleep paralysis, hypnagogic hallucinations, short REM latency).
Concepts to own
- Screening tools: Epworth Sleepiness Scale measures propensity to doze, not insomnia severity; STOP-BANG screens OSA risk.
- Diagnostic pathways: home sleep apnea testing vs in-lab polysomnography; multiple sleep latency test for narcolepsy; actigraphy for circadian patterns.
- Treatment: PAP adherence, oral appliances, positional therapy, CBT-I as first-line for chronic insomnia, and bright light therapy for circadian phase disorders.
- Comorbidities: hypertension, atrial fibrillation, type 2 diabetes, and depression commonly co-occur; treat sleep to improve them.
Traps
Questions love to blur excessive sleepiness with fatigue; to imply that a normal Epworth score rules out OSA; or to suggest medication before behavioral therapy for chronic insomnia. Another trap is assuming all apneas are obstructive-central apneas need different management.
Worked example
A 52-year-old with snoring, witnessed apneas, BMI 34, and Epworth 16: proceed to sleep testing for OSA, not to a stimulant. If instead the patient has chronic insomnia with normal sleep opportunity and no snoring, CBT-I is first-line-not a hypnotic.