Case 3 – Sleep Problems

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.


  • 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