Approach to the patient who cannot sleep

CLINICAL APPROACH The approach to the patient who cannot sleep starts with a comprehensive sleep history as outlined in chapter 3. In many cases the diagnosis of insomnia does not require additional testing. Figure 11.1 provides an algorithm for the diagnosis of chronic insomnia. However, as with excessive daytime sleepiness, each patient should be assessed individually. Clinicians should also keep in mind that many patients have more than one factor that causes their insomnia. The clinician must first identify all the possible contributing triggers and then determine the relevance of each one for the patient’s presenting complaint.