You are seeing Mr. Le, an 83 year old man, because of recent sleep problems. He says he hasn’t had a full night’s sleep in over a week. He currently lives alone. Please take a focused history.
History
- Onset and duration of insomnia
- Amount of sleep per night
- Quality of sleep
- Activating medications
- Activities before sleep: coffee, alcohol, exercise, smoking
- Disturbances during sleep: night terror, orthopnea, nocturia, restless leg, obstructive sleep apnea
- Smoking and alcohol history
- Thought content during periods of insomnia
- Establishes social context (wife has recently been admitted to hospital for ‘failure to cope’)
- Effect on daily activities
- Day time somnolence
- Inquires about what patient believes the insomnia is due to
- Asks about guilt
- Asks about low mood
- Poor concentration
- Poor appetite
- Psychomotor retardation
- Asks about life stresses, e.g. care-giver stress
- Homicidal/suicidal ideation
- Psychotic symptoms
- Symptoms of anxiety
- Past history of depression
- Past history of psychiatric illness
Case 3 – Sleep Problems