M. Reite and colleagues have suggested steps for evaluation and referral. First, patients should be screened for medical disorders that might cause insomnia. Hypertension, cardiovascular insufficiency, hyperthyroidism, and other illnesses are often accompanied by insomnia. If sleep patterns are normal but occur at the wrong time, the patient may have a circadian rhythm disorder. As noted, older patients experience age-related sleeping problems.
Many sleep disorders have a behavioral or anatomic cause.
Patients who have evidence of kicking during sleep or uncomfortable feelings in the legs should be evaluated for possible periodic limb movement or restless leg syndromes. Patients who do not have any other identifiable disorder may have psychophysiologic insomnia. If no diagnosis can be made after thorough evaluation, then polysomnography should be considered and the patient referred to a sleep disorder center. Management Physician-Patient Relationships are important for treatment of insomnia because trust may help prevent complications. These include misuse of drugs and alcohol, demoralization, and obsessive concern with insomnia.