Chapter 31: Sleep Problems Assessment & Management

Sleep Problems Assessment & Management from Advanced Health Assessment and Clinical Diagnosis in Primary Care presents a comprehensive framework for the clinical evaluation and management of sleep disorders across the lifespan, addressing the physiological, psychological, and environmental factors contributing to sleep disturbances. The text begins by defining normal sleep architecture, detailing the progression through the four stages of Non-Rapid Eye Movement (NREM) sleep and Rapid Eye Movement (REM) sleep, while explaining the regulatory roles of circadian rhythms and sleep cycles. A significant portion of the chapter focuses on diagnostic reasoning, utilizing screening tools such as the BEARS instrument to identify pediatric sleep issues and the Epworth Sleepiness Scale to quantify excessive daytime somnolence in adults. The narrative extensively categorizes major sleep pathologies, including insomnia, hypersomnia, and parasomnias. It provides in-depth clinical criteria for diagnosing Obstructive Sleep Apnea (OSA), highlighting physical markers such as tonsillar hypertrophy, macroglossia, and neck circumference greater than 17 inches in men. Neurological and movement disorders are also examined, specifically Restless Legs Syndrome (RLS)—often associated with low serum ferritin levels—and Periodic Limb Movement Disorder (PLMD), as well as Narcolepsy, characterized by cataplexy and sleep paralysis. The chapter further differentiates between pediatric parasomnias like night terrors and nightmares, and addresses behavioral issues such as trained night crying or feeding. Finally, it explores age-related sleep changes, such as delayed sleep phase syndrome in adolescents and the fragmentation of sleep in older adults, while reviewing objective diagnostic methods like polysomnography (PSG), actigraphy, and sleep diaries to support evidence-based differential diagnoses.