How is Your Sleep: A Neglected Topic for Health Care Screening

Adam J. Sorscher

doi:10.3122/jabfm.2008.02.070167

Article Figures & Data

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Table 1.

Ten Leading Topics of Counseling by Family Physicians in 2004

Topic	Visits (n)^*
Diet and nutrition	27,567
Exercise	26,267
Weight reduction	11,064
Mental health	11,058
Tobacco	5,860
Growth and development	4,301
Physiotherapy	3,872
Asthma education	3,252
Psychotherapy	2,163
Other counseling	37,626

* Total visits to family physicians offices was 207,000,000.
Source: National Ambulatory Medical Care Survey, 2004.

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Table 2.

Common Symptoms of Sleep Disorders*

Disorder	Symptoms
Insomnia	Difficulty falling asleep; difficulty maintaining sleep; leg discomfort interfering with sleep (restless legs syndrome); insufficient sleep at night; non-restorative sleep
Hypersomnolence	Difficulty staying awake in the daytime (insufficient sleep syndrome); excessive daytime sleepiness and sudden loss of muscle tone in moments of emotion (narcolepsy/cataplexy)
Sleep-disordered breathing	Loud snoring, witnessed pauses in breathing, gasping to breathe when asleep (obstructive or central sleep apnea)
Parasomnia	Trouble with dream content or quantity (nightmares, epic dreaming); eating in the middle of the night (sleep-related eating disorder); excessive movement in bed when asleep (periodic limb movement disorder); abnormal behaviors arising from sleep (REM behavior disorder; nocturnal seizure disorder); bruxism (grinding)

* Related sleep disorders (per the International Classification of Sleep Disorders) are included in italics.

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Table 3.

Presence of Screening Questions for Lifestyle Issues on Health History Database Batteries in Minneapolis/St. Paul, Minnesota

Lifestyle Issue	n (%)^*
Smoking	14 (100)
Alcohol use	14 (100)
Regular exercise	13 (93)
Illicit drug use	13 (93)
Caffeine use	11 (79)
Depressed mood	9 (64)
Seat belt use	9 (64)
Safe sex	9 (64)
Balanced diet	8 (57)
Domestic abuse	8 (57)
Contraception	8 (57)
Dairy/calcium intake	7 (50)
Bike helmet use	7 (50)
Stress problems	7 (50)
Gun safety	6 (43)
Sunscreen use	6 (43)
At least one inquiry about sleep health	6 (43)
Anxiety	5 (36)
Dental care	3 (21)
Home safety (e.g. fire alarm)	2 (14)

* n, number out of 14 primary care networks/clinics surveyed.

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Table 4.

Presence of Screening Questions for Lifestyle Issues on Health History Database Forms of Family Medicine Residency Programs in Minneapolis/St. Paul, Minnesota

Lifestyle Issue	n (%)^*
Smoking	4 (100)
Alcohol use	4 (100)
Illicit drug use	4 (100)
Depressed mood	4 (100)
Domestic abuse	4 (100)
Stress problems	4 (100)
Regular exercise	3 (75)
Contraception	3 (75)
Gun safety	3 (75)
Caffeine use	2 (50)
Seat belt use	2 (50)
Safe sex	2 (50)
Balanced diet	2 (50)
Dairy/calcium intake	2 (50)
Bike helmet use	2 (50)
At least one inquiry about sleep health	2 (50)
Sunscreen use	1 (25)
Anxiety	1 (25)
Dental care	1 (25)
Home safety (eg, fire alarm)	1 (25)

* n, number out of 4 residency clinics surveyed.

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Table 5.

Expert Recommendations/Positions Regarding Routine Clinical Preventive Services for Insufficient Sleep/Sleep Disorders

Panel/Institution	Recommendation
United States Preventive Services Task Force	None
American Academy of Family Physicians	None
The Institute for Clinical Systems Improvement	None
Aetna medical insurance plans	None
CDC's Behavioral Risk Factor Surveillance System	None
Kaiser-Permanente Clinical Research Group's “Genes, Environment, and Health” Survey	None