Patient Assessment and Sleep Health History
Building the sleep history
A complete sleep health history begins with the chief complaint in the patient's own words, then quantifies the sleep-wake schedule: usual bedtime and rise time, sleep latency, number and timing of awakenings, time spent awake after sleep onset, naps, and total time in bed. Ask about weekday versus weekend patterns and shift-work history, because a schedule that varies by several hours points toward a circadian problem rather than insomnia alone.
Screen for the full differential rather than anchoring on snoring: witnessed apneas, gasping, nocturia, morning headache, restless legs sensations (URGE criteria - urge to move, worse at rest, relieved by movement, worse in evening), dream enactment or sleepwalking, cataplexy and sleep paralysis, bruxism, and nocturnal gastroesophageal symptoms. Review all medications and supplements, including over-the-counter antihistamines and melatonin, plus caffeine dose and timing, alcohol, nicotine, and cannabis.
Standardized instruments add structure: Epworth Sleepiness Scale (0–24; above 10 is abnormal), Insomnia Severity Index, STOP-BANG or Berlin for risk stratification, PHQ-9 and GAD-7 for mood and anxiety, and a two-week sleep diary or actigraphy to capture habitual timing.
Traps and pitfalls
Questions often reward separating sleepiness from fatigue: the patient with low energy who never nods off needs a fatigue evaluation, not automatically a sleep study. Also watch for failure to ask about drowsy driving and occupation, ignoring the bed partner's observations, and diagnostic shortcuts based on a single symptom.
Rule of thumb: before recommending any treatment, confirm a two-week sleep diary plus a validated sleepiness scale - the diary defines the problem, the scale defines the severity.