From the Guidelines
To assess sleep quality, a comprehensive approach is necessary, including both subjective and objective measures, starting with validated questionnaires like the Insomnia Severity Index or Athens Insomnia Scale, as suggested by the VA/DOD CPG 1. This approach should cover specific insomnia complaints, pre-sleep conditions, sleep-wake patterns, other sleep-related symptoms, and daytime consequences, as outlined in the clinical guideline for the evaluation and management of chronic insomnia in adults 1. Key aspects to evaluate include:
- Sleep duration and latency
- Number of awakenings and early morning awakening
- Daytime symptoms like fatigue or concentration difficulties
- Sleep habits, including bedtime routines, screen use before bed, caffeine and alcohol consumption, and sleep environment For objective assessment, consider:
- Sleep diaries for 1-2 weeks
- Actigraphy (wrist-worn devices tracking movement)
- Polysomnography for suspected sleep disorders, as recommended for patients with a high pretest probability for OSA and a nondiagnostic HSAT 1 Look for signs of common sleep disorders like sleep apnea, insomnia, or restless legs syndrome, and consider the clinical practice algorithms provided in the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines for the management of chronic insomnia disorder and obstructive sleep apnea 1. The use of a comprehensive sleep assessment is crucial, as poor sleep affects cognitive function, mood regulation, immune function, and cardiovascular health, and timely diagnosis and treatment of sleep disorders can improve outcomes for patients 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Sleep Assessment
- Sleep disorders, such as insomnia, can significantly impact daytime functioning, resulting in decreased workplace productivity, proneness to errors and accidents, inability to concentrate, frequent daytime naps, and poor quality of life 2.
- Insomnia is a common type of sleep disorder defined by an ongoing difficulty initiating or maintaining sleep or nonrestorative sleep with subsequent daytime impairment 2.
- The treatment of insomnia should involve a multi-disciplinary approach, focusing on implementing behavioral interventions, improving sleep hygiene, managing psychological stressors, hypnotic treatment, and pharmacological therapy 2.
Cognitive Behavioral Therapy for Insomnia
- Cognitive behavioral therapy for insomnia (CBT-i) has been shown to improve insomnia symptoms and increase subsequent acceptance and use of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) and comorbid insomnia 3.
- CBT-i prior to initiating CPAP treatment improves CPAP use and insomnia symptoms compared to commencing CPAP without CBT-i 3.
- The combination of CBT-i and eszopiclone has been shown to be effective in treating sleep disorders in patients transferred out of the intensive care unit 4.
- Brief behavioral therapy for insomnia (BBTI) with or without eszopiclone has been shown to improve sleep quality, sleep indices, and CPAP adherence in veterans with posttraumatic stress disorder and comorbid insomnia and OSA 5.
Evaluation of Sleep Disorders
- A detailed history and physical examination are critical in the evaluation of patients with sleepiness or sleeplessness 6.
- Questions about the patient's sleep schedule or screening patients for common sleep disorders such as sleep apnea and restless legs syndrome (RLS) are useful to add to a typical neurologic evaluation to better recognize sleep disorders in this population 6.
- Polysomnography, home sleep apnea testing, multiple sleep latency tests, and actigraphy can be used with the available history and examination to determine the proper diagnosis and management plan for these patients 6.