Sleep Assessment in Primary Care

Americans are not getting enough sleep. Primary care clinicians who can assess sleep needs and improve sleep quality can help patients with a wide range of conditions. IFM educator Kristi Hughes, ND, talks about the patients she sees with sleep dysfunction and the questions she asks of them in a deeper dive:


There are so many of my patients who are presenting to my office with different levels of fatigue and exhaustion, and they’re not even realizing or understanding what an important role sleep plays in their daily lives. People don’t schedule time for sleep. They’re not scheduling time for taking mini naps. We live in this work-driven, productivity mindset world today where it’s just go, go, go and get more done.

Honestly, what I see in patients (and even in my own life sometimes) is that what ends up giving is the amount of time that you spend in a good quality night sleep. When I hear patients presenting and talking about sleep dysfunctions, especially foggy brain, lack of motivation, lack of excitement—or patients who are dealing with depression symptoms, I’m going to dig much deeper into that sleep history because I want to see that they’re getting that adequate reset mechanism in place.

So, you want to explore, how long are they sleeping? How deep are they sleeping? What is the quality and how do they feel when they first get up in the morning? There are wonderful ways to track and look at sleep today. We can use different types of devices. We can read very personalized biometrics. There are tools that can be done in the home. Even just simply having your patients start by tracking when they fall asleep, how many times might they wake over the course of the night, and when are they getting up and rising in the morning, is a good place to start.

Patients often report, too, that they’re waking up in the middle of the night. When are they waking? For how long are they waking, and what is the reason that they’re getting up? Do they need to get up because they are being driven to use the restroom? Or is it heat waves or flushes that are pulling them up and out of sleep at night? Do they hurt? Are they achy and they’ve got to move, shift, and find a more comfortable position? There are a lot of reasons why patients may not be staying in a high quality deep sleep mode. It’s our responsibility to know how those sleep dysfunctions can manifest in some of those common conditions that are walking in your door.

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