Inappropriate sleep hygiene or lifestyle
Environmental e.g. noisy household
Drug withdrawal inc. alcohol, hypnotics
Biorhythm disruption e.g. shift work, travel
Serious disorders not to be missed
Pain syndromes e.g. back, arthritis, CTS, cancer
Respiratory e.g. asthma, COPD, nasal obstruction
Post traumatic stress disorder
Restless legs/nocturnal myoclonus
Drugs: stimulants, alcohol, beta blockers, SSRIs, steroids
Thyroid/other endocrine: hyperthyroid
Urinary tract infection: nocturia
Is the patient trying to tell me something?
A consideration if nil findings.
Some cases are normal variant or idiopathic.
A careful history is required because some patients have unrealistic expectations about the required amount of sleep they need or have misperceptions of how long they have slept. Explore lifestyle factors esp. psychosocial reasons, painful conditions, drug use and abuse, appetite, energy, sexual issues and physical factors. Examine past medical history including diabetes, hypertension and cerebrovascular disease, as well as drug history, esp. alcohol. Check thyroid status, esp. hyperthyroidism.
General features: appearance of patient, vital signs including BMI, inspection of the nasal passages, throat and neck (goitre)
General respiratory and cardiovascular examination
Nil for most cases. Others according to history and findings.
Pay close attention to drugs use, esp. alcohol, caffeine, narcotics, illicit agents, SSRIs, benzodiazepines, and esp. if desperate request for drugs.
Be aware of the effects of ageing including carpal tunnel syndrome, arthritis, prostate problems and incontinence.