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  1. Bruce Arroll, professor1,
  2. Antonio Fernando III, senior lecturer in psychological medicine1,
  3. Karen Falloon, academic registrar1
  1. 1Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand
  1. Correspondence to: B Arroll b.arroll{at}auckland.ac.nz
  • Accepted 11 May 2007

A 53 year old man comes to you complaining of not having slept well for many years. He always feels tired the next day. He has tried sleeping pills, which sometimes help, but he is not keen on taking them continually and has found that the benefits they give him don’t last. He spends about 9-10 hours in bed each night (going to bed about 9 30 pm or 10 pm and getting up at 7 am) and has trouble getting to sleep. His actual hours of sleep are 5.5 to 6 each night. He wakes about three times a night and describes the quality of his sleep as poor.

What issues you should cover

Assessment

Rule out secondary causes. To assess whether he has depression or anxiety, for example, ask screening questions, take a full history of depression and anxiety, or use a scale such as the Hospital Anxiety and Depression Scale, which gives a score for both conditions. Consider sleep apnoea if he snores a lot at night, has periods of apnoea, falls asleep easily during the day (for instance, …

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