Preparing to Talk to a Clinician About Ongoing Sleep Problems

“I’m not sleeping well” is true and almost impossible for a clinician to act on. An appointment about sleep goes better when you arrive with specifics: how often, for how long, what a typical night looks like, what you have tried. This article is a preparation sheet. It will not tell you what is wrong; it will help you give the person who can assess you what they need.

Is it time to book?

In England, the NHS advises seeing a GP about sleep if any of these apply:

• changing your sleep habits has not helped;
• you have had trouble sleeping for months;
• the problem affects your daily life in a way that makes it hard to cope.

The US Centers for Disease Control and Prevention (CDC) puts it more simply: talk to a health care provider if you regularly have trouble sleeping. The route in will differ by country, whether that is a GP, a family doctor or a primary care clinic.

What to bring

• A sleep diary covering one to two weeks. The US National Heart, Lung, and Blood Institute (NHLBI) suggests keeping one for this long before the visit, noting when you go to sleep, wake and nap, how sleepy you feel in the day, when you have caffeine or alcohol, and when you exercise. See a simple sleep diary for a layout.
• A list of everything you take. The NHS suggests gathering all your medicines, including vitamins and supplements, before an appointment. The NHS also notes that many medicines can affect sleep, so include anything bought over the counter for sleep itself. Keeping an up-to-date list of medicines and supplements shows one way to set it out.
• A short timeline. When it started, whether anything changed around then, and whether it is getting better, worse or staying the same.
• What you have already tried and for how long: a fixed get-up time, less caffeine, a wind-down routine.
• Your two or three most important questions, written down. This is the NHS’s general advice for any appointment.
• Someone who has seen you sleep, if relevant. The NHS says that if another person has noticed symptoms such as pauses in your breathing, it can help to bring them along.

What you are likely to be asked

The NHLBI lists the kinds of questions a doctor may ask when assessing a sleep problem. Preparing short answers saves appointment time.

The NHLBI says a doctor may also ask about your personal and family health history, and may listen to your heart and lungs and look for physical features linked to breathing problems in sleep.

Things worth mentioning even if you are not asked

Some details are easy to leave out because they seem unrelated or embarrassing. They are useful to a clinician, so say them plainly.

• Breathing in sleep. The NHS lists breathing that stops and starts, gasping, snorting or choking noises and loud snoring as things that can happen during sleep in sleep apnoea, and advises seeing a GP if you have these or always feel very tired during the day. You may not know about them yourself; a partner or housemate might.
• Sleepiness at risky moments. Nodding off while driving or operating machinery matters. The NHS advises not driving when you feel sleepy.
• Mood and worry. The NHS names stress, anxiety and depression among the most common causes of insomnia.
• Pain, and other things that wake you. Long-term pain is on the NHS list of things that can disturb sleep.
• Shift work or regular travel across time zones. Both appear on the NHS list of common causes.
• Alcohol or anything else you use to get to sleep. A clinician needs the real picture to be useful to you.

Mentioning one of these is not a diagnosis. It is information that helps the clinician decide what to look into.

What might happen next

Knowing the range of possible next steps makes it easier to ask sensible questions. According to the NHS, a GP will try to find out what is causing the problem, and may offer cognitive behavioural therapy (CBT), either in person or as an online self-help programme. If another sleep disorder such as sleep apnoea is suspected, you may be referred to a sleep clinic. The NHS says GPs now rarely prescribe sleeping pills.

The NHLBI describes tests a doctor may consider: a sleep study to check for other sleep problems, a wrist-worn motion sensor used for 3 to 14 days to record rest and activity, or blood tests for thyroid problems and other conditions that affect sleep. For sleep apnoea, the NHS says testing usually involves wearing monitoring devices overnight, often at home.

What is offered and how long it takes will depend on where you live and how local services are organised.

These draw on the NHS’s general list of questions to ask a health professional. Questions to ask when a test or treatment is suggested goes further.

If you use a sleep tracker

You can mention what your device shows, but do not expect it to settle anything. The American Academy of Sleep Medicine said in 2018 that consumer sleep devices were not able to diagnose sleep disorders, and that their data should be read as part of a full evaluation. Devices have changed since, but the second point still stands. Bring the diary as well; it records what the device cannot.

Before you leave, and afterwards

The NHS suggests three checks before leaving the room: that you have covered everything on your list, that you can say back what you have understood, and that you know what happens next and when. Afterwards, write down what was discussed and book any tests promptly. If results do not arrive when expected, ask for them. How to prepare for a medical appointment has a fuller checklist that applies to any visit.

One appointment may not resolve a long-running sleep problem. A clear account of the pattern gives it the best chance of leading somewhere useful.