Approach to the patient with sleep complaints

Sleep disorders are both common and consequential, but too often remain undiagnosed. The insidious, chronic course of most sleep disorders and lack of patient awareness of signs and symptoms during sleep can complicate the clinical evaluation. Typical chief complaints include snoring, excessive daytime sleepiness, insomnia, and behaviors during sleep. Sleep disorders can be primary or secondary to medical, neurologic, or psychiatric conditions, so a multidisciplinary approach is often desirable. Family members can be a critical source of information as they may have observed nocturnal or daytime symptoms unrecognized by the patient. Objective testing plays an important role in assessment for obstructive sleep apnea, parasomnias, and other specific sleep disorders, and can be used most effectively in combination with a thorough clinical evaluation. Nonsleep specialists should consider obtaining assistance from sleep clinicians for more challenging presentations or management of sleep disorders unfamiliar to them.