Other patients need to be told to stop watching the 11 o'clock news or exercising late at night. There are many other examples. My advice to the primary care physician is to read about sleep disorders and perhaps take a course in sleep medicine. And we need to offer more courses in sleep medicine for primary physicians. The AMA, the American Family Practice Association and others have courses in which we've participated.
Sleep disorders are generally lifelong issues.
The cost of a consultation is relatively small, and not all patients will require polysomnography. Daytime sleepiness, complaints of not sleeping well at night for no obvious reason, snoring, abnormal behavior during sleep, such as sleepwalking, violence, confusion during sleep, nocturnal tumescence and pain. We recognize that sleep problems may be part of a larger context. There are very few areas of medicine where you have the opportunity to look at so many different parameters at the same time. Or if the patient is referred to us, we can often coordinate his or her pulmonary care with the appropriate clinic.