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.