Drs Paul Doghramji and Leslie Citrome discuss daytime sleepiness and other symptoms of insomnia and their impact on quality of life.
Paul Doghramji, MD, FAAFP: We’ve talked about the poor symptoms of nighttime, but we also hinted earlier, Leslie, about daytime symptoms. How does insomnia impact the quality of life, especially in patients with comorbidities? What is happening to these people during the daytime?
Leslie Citrome, MD, MPH: Well, it sounds kind of obvious. If you don’t sleep well at night, you’re going to be tired during the day, and when you’re tired during the day, you’re not going to function very well. You can have problems with your concentration and level of alertness; the need to nap during the day, that can be a problem. You have something called presenteeism. It’s not like you’re not going to work, but when you’re at work, you’re just not all there and you’re not very productive, so it is a substantial problem. It’s also a risk for those in public safety kind of situations where someone needs to really remain alert during the day.
Paul Doghramji, MD, FAAFP: Before we talk about treatment considerations, there is one other thing I want to pass on to my primary care colleagues. Most patients with insomnia—and we’ve already said about 50% of patients who come into your office may qualify for the diagnosis of insomnia—most of them won’t tell you that they have insomnia. So be on the lookout for that. When you see your patients with the risk factors that Leslie talked about, patients who have these comorbidities, ask them about their sleep because they’re probably not going to tell you about it.
Leslie Citrome, MD, MPH: It’s interesting, they won’t tell you about it because they may think you’re not interested, or they have so many other pressing issues on their mind to resolve. If they’re coming to see you for a very specific problem, they may think that the sleep is kind of incidental to this, and they have to be encouraged from the get-go about telling us about their sleep. I use it as part of my mental status examination, and part of the overall evaluation is I need some idea of how well they’re sleeping, their appetite, and their level of concentration, for example.
Paul Doghramji, MD, FAAFP: Very important. If we’re interested in their sleep, they’re going to be interested in their sleep. Ask those questions proactively because most of the time they’re not going to ask about it.
Transcript edited for clarity