Evaluation and diagnosis of sleep disorders patients.

Using the biopsychosocial model, physicians can thoroughly assess patients with sleep disorders in the office setting. A careful sleep history, drug history, general medical assessment, and psychiatric evaluation along with an appraisal of the interplay between the patient's condition and his environment can provide all of the elements needed for diagnosis and treatment formulation. The main components of the sleep history include: defining the specific sleep problem, assessing the disorder's clinical course, differentiating between sleep disorders, evaluating the sleep-wakefulness patterns, questioning the bed partner, and obtaining a family history of sleep disorders. The drug history provides important information regarding the role of various medications, which may cause sleep difficulty during their administration or following withdrawal. Implementing a complete medical assessment is necessary for the identification of certain medical conditions that may be associated with sleep disorders. Finally, a thorough psychiatric evaluation and assessment of the psychosocial consequences of the patient's disorder should be conducted. In general, sleep laboratory diagnostic studies are of limited usefulness. These studies are indicated primarily when sleep apnea is suspected or when the sleep attacks of narcolepsy are present in the absence of auxiliary symptoms.