History and examination

Helps detect any coexisting medical or psychiatric illness

Sleep history must span the entire day and should include an interview with the partner or caregiver

Interview partner or caregiver about patient's sleep habits, daytime functioning, substance use (e.g., alcohol, tobacco, caffeine), snoring, apnea, and unusual limb movement

Take medication history; physical examination should include neurologic examination, Mini-Mental State Examination

Sleep diary

A two-week sleep diary should record information on bedtime, rising time, daytime naps, sleep-onset latency, number of nighttime awakenings, total sleep time, and the patient's mood on arousal

Questions should include daytime symptoms such as somnolence and frequency of napping

Polysomnography, multiple sleep latency testing

Useful if sleep apnea or periodic limb movement disorder is suspected

Use when behavioral and psychopharmacologic treatments are unsuccessful

Actigraphy

An activity monitor or motion detector, typically worn on the wrist, records movement; the absence of movement for a given continuous period is consistent with sleep

Useful in evaluating sleep patterns in patients with insomnia, analyzing the beneficial effects of treatment measures, diagnosing circadian rhythm disorders, and evaluating sleep in patients unable to tolerate polysomnography

Neuroimaging

Use if a structural lesion (e.g., mass lesion, arteriovenous malformation) is suspected on history and examination