Sleep Disorders Workup

  • Author: Roy H Lubit, MD, PhD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: May 14, 2012
 

Laboratory and Imaging Studies

Laboratory studies appropriate for those with sleep disorders include the following:

  • Hemoglobin and hematocrit
  • Arterial blood gases
  • Thyroid function tests
  • Drug and alcohol toxicology screening

Oximetry may be performed during sleep to examine blood oxygen levels for clinically important desaturations suggestive of sleep apnea or other forms of sleep-disordered breathing.

Although no imaging studies are directly indicated for the workup of insomnia, underlying medical conditions call for appropriate investigation using suitable studies.

Next

Indices and Scoring Systems

A Beck Depression Index or similar clinical screening tool may be used to detect an underlying depressive illness as a contributing factor in insomnia.

An Epworth Sleepiness Score or another objective measure of daytime sleepiness may lead to clues to the presence of another underlying sleep disorder. For example, approximately 20% of patients with sleep apnea present with a history of nighttime insomnia; however, patients are excessively sleepy by day and have an abnormal score on the Epworth Sleepiness Scale.

Previous
Next

Sleep Journal

Subjective measures of sleep are obtained by means of a sleep journal. A sleep journal kept for approximately 2 weeks may help determine the extent of the sleep disturbance. Patients should record the total hours slept per night, the frequency of nighttime awakenings, and the level of restfulness provided after sleep.

Additional, more objective measures of sleep may be available if a patient has a sleep partner who keeps a 2-week journal or provides a relevant history.

Previous
Next

Electroencephalography and Polysomnography

Objective measures of sleep may be obtained by means of electroencephalography (EEG) or polysomnography (PSG). These studies may be helpful in determining sleep and wakefulness in the intensive care unit (ICU) or in the sleep laboratory.

Monitored PSG is the standard for evaluating measures of sleep. This study includes measures of multiple channels of EEG, electrooculography (EOG), chin and leg electromyography (EMG), nasal and oral airflow, oximetry, abdominal and chest movements, and electrocardiography (ECG). Monitored PSG can help the physician discriminate between rapid eye movement (REM) sleep and non-REM (NREM) sleep, as well as determining causes of sleep disturbance.

Patients with chronic medical conditions, such as fibromyalgia or anxiety disorders, often have characteristic alpha brain-wave activity that intrudes into the deeper stages of sleep. This activity can readily be seen on the EEG during PSG. Patients with insomnia often have some degree of sleep-state misperception, wherein they perceive and believe that they achieve significantly less sleep than they actually do. This can be documented by correlating the EEG findings from the PSG with patient subjective reports of sleep duration and onset.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Roy H Lubit, MD, PhD  Assistant Clinical Professor, Mount Sinai School of Medicine; Clinical Faculty, Department of Child Psychiatry, New York University School of Medicine; Private Practice

Roy H Lubit, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Coauthor(s)

Curley L Bonds II, MD  Associate Professor and Chair, Department of Psychiatry and Human Behavior, Charles Drew University of Medicine and Science; Clinical Professor, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Curley L Bonds II, MD is a member of the following medical societies: American Medical Association and American Psychiatric Association

Disclosure: Nothing to disclose.

Michael A Lucia, MD, FAASM  Owner/CEO, Pulmonary, Allergy and Sleep Medicine, Sierra Pulmonary and Sleep Consultants, LLC

Michael A Lucia, MD, FAASM is a member of the following medical societies: American Academy of Sleep Medicine, American Association of Cardiovascular and Pulmonary Rehabilitation, and Nevada State Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of Health Sciences: Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References

  1. Zammit GK, Weiner J, Damato N, et al. Quality of life in people with insomnia. Sleep. May 1 1999;22 Suppl 2:S379-85. [Medline].

  2. Chen Q, Hayman LL, Shmerling RH, Bean JF, Leveille SG. Characteristics of Chronic Pain Associated with Sleep Difficulty in Older Adults: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study. J Am Geriatr Soc. Aug 2011;59(8):1385-92. [Medline].

  3. Yaffe K, Laffan AM, Harrison SL, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. Aug 10 2011;306(6):613-9. [Medline].

  4. Rajaratnam SM, Barger LK, Lockley SW, et al. Sleep disorders, health, and safety in police officers. JAMA. Dec 21 2011;306(23):2567-78. [Medline].

  5. Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. May 20 2009;301(19):2005-15. [Medline].

  6. Elie R, Ruther E, Farr I, Salinas E. Sleep latency is shortened during 4 weeks of treatment with zaleplon, a novel nonbenzodiazepine hypnotic. Zaleplon Clinical Study Group. J Clin Psychiatry. Aug 1999;60(8):536-44. [Medline].

  7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

  8. Anders TF, Eiben LA. Pediatric sleep disorders: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. Jan 1997;36(1):9-20. [Medline].

  9. Benca RM, Ancoli-Israel S, Moldofsky H. Special considerations in insomnia diagnosis and management: depressed, elderly, and chronic pain populations. J Clin Psychiatry. 2004;65 Suppl 8:26-35. [Medline].

  10. Bryant PA, Trinder J, Curtis N. Sick and tired: Does sleep have a vital role in the immune system?. Nat Rev Immunol. Jun 2004;4(6):457-67. [Medline].

  11. Chen W, Kushida CA. Nasal obstruction in sleep-disordered breathing. Otolaryngol Clin North Am. Jun 2003;36(3):437-60. [Medline].

  12. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?. JAMA. Sep 15 1989;262(11):1479-84. [Medline].

  13. Gillin JC, Byerley WF. Drug therapy: The diagnosis and management of insomnia. N Engl J Med. Jan 25 1990;322(4):239-48. [Medline].

  14. Hauri PJ, Hayes B, Sateia M, et al. Effectiveness of a sleep disorders center: a 9-month follow-up. Am J Psychiatry. May 1982;139(5):663-6. [Medline].

  15. Kaplan HI, Sadock BJ, Grebb JA. Normal sleep and sleep disorders. In: Kaplan and Sadock's Synopsis of Psychiatry. 7th ed. Baltimore, Md: Williams & Wilkins; 1994:699-716.

  16. Lamberg L. Promoting adequate sleep finds a place on the public health agenda. JAMA. May 26 2004;291(20):2415-7. [Medline].

  17. Lamberg L. Sleep-disordered breathing may spur behavioral, learning problems in children. JAMA. June 2007;27;297(24):2681-3. [Medline].

  18. Loewy DH, Black JE. Effective management of transient and chronic insomnia. In: CNS News. McMahon Publishing Group: New York, NY; 2000:19-22. [Full Text].

  19. No authors listed. Beauty sleep for the heart. Harv Heart Lett. May 2004;14(9):7. [Medline].

  20. Richert AC, Baran AS. A review of common sleep disorders. CNS Spectr. Feb 2003;8(2):102-9. [Medline].

  21. Schuen JN, Millard SL. Evaluation and treatment of sleep disorders in adolescents. Adolesc Med. Oct 2000;11(3):605-16. [Medline].

  22. Schwab RJ. Disturbances of sleep in the intensive care unit. Crit Care Clin. Oct 1994;10(4):681-94. [Medline].

  23. Veasey SC. Sedating, not treating sleep apnea: hit & run in primary care. J Clin Sleep Med. Oct 15 2005;1(4):372-3. [Medline].

  24. Zorner D, Geisler P. [Diagnostic Spectrum and Filtration Function of Outpatient Sleep Clinics]. Psychiatr Prax. May 2003;30(Suppl 2):173-175. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.