Sleep in Adults

Many editions of FP Essentials discuss topics that we as family physicians regularly encounter in the course of our practice. In its discussion of sleep, this issue is a little different in that it addresses a topic that has directly affected all of us.

I completed my training during the period that saw the introduction of work hour restrictions. As a medical student with some rotations exceeding 120 hours per week in the hospital, I had multiple colleagues who were in motor vehicle crashes after falling asleep at the wheel on the way home from work. I remember many days driving home with the radio blaring and the windows open in subfreezing temperatures just to stay awake long enough to get home. Although this experience was a rite of passage, the dazed look I saw in the mirror and in the faces of my colleagues after 24 hours of work without sleep reflected not only the significant cost to us as individuals but also the risk of error that our patients were forced to bear.

As is true for most of you, the effects of practicing medicine on my sleep did not stop when I became an attending physician. From late nights spent working in the electronic health record, to the middle-of-the-night patient calls or trips to the hospital, to the nights lying awake worrying about patient or practice issues, medicine has too often affected my ability to care for myself, and subsequently my patients, in the best way possible. As I have progressed through my career, I have become better at prioritizing self-care, including adequate sleep, but this continues to be a struggle at times.

Section One of this monograph reviews normal sleep and its central role in health. Section Two reviews insomnia, including risk factors, evaluation, and management with nonpharmacologic approaches and medications. Section Three reviews parasomnias. Section Four addresses sleep in the special populations of hospitalized patients and physicians.

I hope this monograph will give you the information, confidence, and motivation to address sleep issues that adversely affect both your health and the health of your patients.

Ryan D. Kauffman, MD, FAAFP, CCFP, Associate Medical Editor
Family Medicine Physician
Erie Shores Family Health Team, Leamington, Ontario, Canada

Ecler Ercole Jaqua, MD, MBA, FAAFP, AGSF, FACLM, DipABOM, AAHIVS, is an associate professor of family and geriatric medicine in the Department of Family Medicine at San Antonio Regional Hospital/OPTI-West in Upland, California. She is also medical director of the Center of Aging and the family medicine residency program director at San Antonio Regional Hospital. She is board certified in family, geriatric, lifestyle, and obesity medicine and is an HIV specialist. Dr. Jaqua has an interest in sleep disorders in adults and has authored peer-reviewed journal articles on the topic, including Inadequate Sleep & Obesity: Breaking the Vicious Cycle and Common Sleep Disorders Affecting Older Adults. Her work emphasizes the critical connection between sleep health and chronic disease management.

Mai-Linh N. Tran, MD, FAAFP, DipABLM, DipABOM, AAHIVS, is an assistant professor in the Department of Family Medicine at the Loma Linda University (LLU) School of Medicine in Loma Linda, California, and serves as core faculty at Loma Linda Health Education Consortium Family Medicine Residency. She is also medical director of the Family Medicine Clinic at Social Action Community Health. Board certified in lifestyle and obesity medicine, Dr. Tran is committed to training future physicians and addressing health care disparities, with a focus on underserved communities locally and internationally. Her work centers on integrating lifestyle medicine into patient care, especially in chronic disease management.

Nadine Grace-Abraham, MD, is an assistant professor in the Department of Family Medicine at the LLU School of Medicine. She is also a core faculty member at Loma Linda Health Education Consortium Family Medicine Residency. Dr. Grace-Abraham is board certified in family medicine and completed a fellowship in addiction medicine. She is focused on promoting healthy sleep in adults and is committed to educating future health care professionals. Her other interests include improving access and quality of care for underserved communities.

Clare Moore, DO, is an assistant professor at LLU School of Medicine. She completed her family medicine residency there in 2024 and has interests in sleep disorders and wellness. Dr. Moore has contributed to journal articles, such as Common Sleep Disorders Affecting Older Adults and the Impact of the Six Pillars of Lifestyle Medicine on Brain Health, and has been involved in Alzheimer disease research. She works to promote education in these valuable areas.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Counsel patients about appropriate sleep duration and the health risks of insufficient or excessive sleep.
• Select appropriate tests to evaluate patients presenting with sleep concerns.
• Diagnose sleep insufficiency, sleep deprivation, and insomnia.
• Summarize nonpharmacologic and pharmacologic treatment options for insomnia.
• Determine whether medications are causing or worsening parasomnias.
• Counsel patients with parasomnias about nonpharmacologic therapies that can reduce symptoms.
• List nonpharmacologic strategies to improve sleep quality in hospitalized patients.
• Describe how sleep deprivation in physicians can reduce the quality of patient care.