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SLEEP
MEDICINE

The Best Sleep of Our Lives

By James H. Henderson II, MD, FCCP, FAASM

So often, I’ve had many colleagues come to me asking, what sleep syndrome and may be the primary cause of their sleep complaints.
do I do with this sleep patient? Most people require 7.5-9 hours of time in bed to achieve 7-7.5 hours
Clearly, the primary entry point to care for patients with sleep dis- of sleep each day. Widely varying sleep schedules and lengths will cause
orders is their Primary Care physician. Due to wider recognition of the symptoms that mimic or complicate organic sleep disorders. Further-
ubiquitous nature of sleep disorders, decreased reimbursement for sleep more, significant sleep schedule variation affects cognitive function,
specialty procedures, and the marked impact many disorders have on emotions, temperature regulation, GI function, urination schedules
preventive and population health, an explosion of awareness and in- and many other hormonally derived functions resulting in discomfort
creased requirements for evaluation and treatment has occurred over and fatigue.
the past 15 years. One scale that is available and helpful in assessing sleep quality is the
When a patient presents to clinic with complaints about sleep, they PSQI – Pittsburgh Sleep Quality Index. The first step to treating pa-
usually fall into one of three categories: I’m sleepy when I don’t want tients with excessive fatigue or daytime sleepiness is to have them ensure
to be; I can’t sleep when or as long as I want to; or my partner, friend they are getting sufficient sleep for a minimum of seven days, preferably
or I realize my sleep has abnormal movements or sounds. 14 days, while on a stable sleep schedule. It is only after several days of
Any sleep evaluation must begin with a thorough understanding of stable sleep that a realistic assessment of many sleep disorders becomes
the patient’s sleep schedule (including variation on and off work, week- possible. This principle of assessing sleep periods also applies to those
days and weekends) as the most common sleep disorder is insufficient who report insomnia; usually care starts with a 2-week sleep diary doc-

14 SAN ANTONIO MEDICINE • March 2024