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Sleep disorders: When to refer to a specialist


Most cases of insomnia can be reliably assessed and effectively treated in primary care. In cases in which a five-to-eight session course of CBT or a seven-day pharmacological treatment does not relieve the symptoms, referral to a sleep specialist is recommended.


If the problem of sleepiness and fatigue is clearly related to sleep restriction, suggest that the patient enter into a contract of giving increased time for sleep on a regular basis. Suggest a trial period of one month with a clear benefit in terms of resolving the underlying problem.

Patients with excessive sleepiness should be referred for a more formal sleep assessment at a sleep clinic.

Psychiatric interviewing series

David Goldbloom and Nancy McNaughton demonstrate clinical interviewing situations.

Psychiatry in primary care toolkit

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