Sleep Problems Widespread, Take a History

America's sleep problems are so widespread that a sleep history should be a routine part of any physical, said Allan Pack, MD, professor of medicine, University of Pennsylvania, Philadelphia. "An Institute of Medicine report just issued this week reports that 70 million Americans have clinically significant sleep problems," he said here on Thursday. "There was also a 40% growth in the sleep-aid drug market in the past year," Pack added.

Allan Pack, MD, professor of medicine, University of Pennsylvania, Philadelphia. "An Institute of Medicine report just issued this week reports that 70 million Americans have clinically significant sleep problems," he said here on Thursday. "There was also a 40% growth in the sleep-aid drug market in the past year," Pack added.

In addition to being common, sleep problems are "serious" and can lead to significantly decreased quality of life and physical health as well as accidents. Despite the scope of sleep problems, most physicians do not take sleep histories. "Only 14% of medical interns questioned patients about sleep, according to a 1996 study. And the longer a physician is out of medical school, the less likely he or she is to take a sleep history," said Pack.

The need to take a sleep history is underscored by the fact that most patients do not volunteer symptoms. In fact, "many" patients are brought to sleep clinics by their bed partner, said Pack.

The most important screening questions are:

• Do you snore?
• Do you fall asleep when you don't want to? (as when driving or while watching TV)
• Do you stop breathing or struggle to breath while sleeping?
• Do you snort or gasp while sleeping?

These basic questions are a starting point to identifying the underlying etiology, including causes that are circadian, neurologic, psychiatric, behaviorial, cardiorespiratory, and medication-related.

The latter is highly important. "A lot of sleepiness and insomnia is caused by medications - it's the first thing to check for," said Pack.