Stephen C. Ellen, a psychiatrist and sleep medicine expert who is the medical director of The Counseling Center of Nashua, New Hampshire, recommends the following four questions for a quick initial evaluation of insomnia.

1. How long does it usually take you to fall asleep? (Normal sleep latency is about 10 minutes; while we focus on long latencies for diagnosing initial onset insomnia, patients who report very short latencies, such as 2 minutes, may be suffering sleep deprivation and should be counseled to increase sleep time.)


2. How many times a night do you wake up? (Ask this of the patient’s sleep partner as well.)


3. After each awakening, how long does it take to fall back asleep? (This, combined with the answer to question #2, gives you an accurate measure of exactly how much sleep is being lost.)


4. Do you feel refreshed upon awakening in the morning? (This is really the most important question for assessing the need for clinical intervention.)

Note: These practice tips are not a part of this month’s formal ACCME-accredited continuing medical education material.