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Insomnia and Sleep Disorders in Primary Care Settings - Episode 3

Screening for Sleep Disorders in Primary Care Clinics

An expert in sleep medicine comments on approaching screening patients for insomnia or other sleep disorders in the primary care setting.

Paul Doghramji, MD, FAAFP: As far as primary care clinics or primary care offices, it's varied about screening for insomnia. There are some clinicians that are particularly interested in it and will ask about it often and you have just the opposite end of the spectrum where clinicians have no interest in it and will only talk about insomnia if a patient brings it out. Most primary care clinics and offices are somewhere in between where maybe they'll bring it up in certain instances, maybe they won't bring it up but clearly, there is a gap and there is a need meaning that not enough patients who have insomnia are being identified and managed properly. What needs to happen is what we discussed earlier. Knowing that most patients don't bring up their sleep problems to their primary care providers, PCPs should be proactive and bring up the possibility of insomnia in their patients by asking simple questions. When patients are coming in, let's say even for shortness of breath or coughing or what, asking how it is interfering with your sleep. How are you doing with your sleep? If they're coming in with pain, how is it doing with your sleep? If they're coming in with mood problems, how is it interfering with your sleep? Asking them the very specific questions about sleep, like how long does it take for you to fall asleep? Do you wake up in the middle of the night and if so, how long does it take for you to get back to sleep? Do you have any early morning awakening with difficulty getting back to sleep again, but also asking because of your poor sleep that you have, how do you think it's impacting you during the day? That's one thing which has come up a lot more in medical publications, where we're asking them, how is your poor sleep impacting you throughout the day? This is what needs to happen in primary care, and it's not happening as often as it should to identify these patients with insomnia that have the symptoms at night and during the day and doing something about it for improvement of not just their nighttime symptoms, but improve their daytime symptoms, but maybe even hopefully improve their comorbidities.

There are a lot of tools that have been invented for many different diseases to help screen for conditions in primary care. There are ones for depression, for anxiety, for substance abuse, for pain, for asthma, for overactive bladder. There are so many different ones and it's difficult to keep tabs of all of them. There's one for insomnia. There's one called the Insomnia Severity Index, which is not a bad idea. There's a Pittsburgh insomnia scale as well. There are several different ones that have been invented that I think a clinician can use. As a general rule, these screening tools are not necessary in primary care. Those are primarily used maybe in more research tools. What needs to happen is the primary care provider needs to know what questions to ask. All PCPs will know when somebody comes in with chest pain, what are the questions I want to ask? I already know, or abdominal pain, I know what the questions are, or shortness of breath, I know what the questions are. We need to be that proficient then at knowing what questions to ask our patients when they have insomnia. Much better than just having screening tools, knowing what questions to ask to be able to better understand what the insomnia situation is in that patient.

Transcript Edited for Clarity