Choosing Wisely:

Avoid polysomnography in chronic insomnia patients unless symptoms suggest a comorbid sleep disorder.

Rationale and Comments: Chronic insomnia is diagnosed by a clinical evaluation that includes a thorough sleep history along with a medical, substance, and psychiatric history. Some instruments can be helpful at the clinical encounter; these include self-administered questionnaires, sleep logs completed at home, and symptom checklists. Although polysomnography may confirm self-reported symptoms of chronic insomnia, it does not provide additional information necessary for diagnosis of chronic insomnia. However, polysomnography is indicated in some specific circumstances; for example, when sleep apnea or sleep-related movement disorders are suspected, the initial diagnosis is uncertain, behavioral or pharmacologic treatment fails, or sudden arousals occur with violent or injurious behavior.
Sponsoring Organizations:
  • American Academy of Sleep Medicine
  • Sources:
  • Expert consensus
  • Disciplines:
  • Neurologic
  • Psychiatric and Psychologic
  • References: • Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487-504.
    • Sateia M, Doghramji K, Hauri P, Morin CM. Evaluation of chronic insomnia. Sleep. 2000;23(2):243-308.
    • Chesson A Jr, Hartse K, Anderson WM, Davila D, Johnson S, Littner M, Wise M, Rafecas J. Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 2000;23(2):237-41.
    • Reite M, Buysse D, Reynolds C, Mendelson W. The use of polysomnography in the evaluation of insomnia. Sleep. 1995;18(1):58-70.

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