ABSTRACT
History and examination It is often more difficult to take a history of a sleep disorder than to ask about complaints occurring during wakefulness. The patient may have little or no awareness of the problem. It may be only the patient’s partner who can describe the events. After establishing the nature and timing, relative to both the clock and the onset of sleep, it is important to establish the time that the patient goes to bed, how long it takes to fall asleep, how often and why the patient awakens during the night, and what time the patient wakes up and gets out of bed. Feeling unrefreshed on waking may be due simply to sleep inertia, but if it persists during the day it should trigger enquiry into the cause of excessive sleepiness. If enough sleep is being obtained at night, then causes of disturbed sleep, such as an adverse sleeping environment, sleep apnoeas or restless legs syndrome, should be asked for, together with specific symptoms for other conditions that may cause excessive sleepiness, such as narcolepsy.
