Medical history (history of illness) represents an important component in the diagnosis of insomnia (sleep disorders). Family history
Social history
- What is your occupation?
- What are your working hours?
- Is there any evidence of psychosocial stress or strain due to your family situation?
Current medical history/systemic history (somatic and psychological complaints).
- What time do you usually go to bed? What time do you get up? (Total bedtime) [should not significantly exceed total sleep episode].
- What is the total time from falling asleep to waking up for the last time (total sleep episode)? [Normal value in older age: 6 to 8 hours]
- What is the time between the extinguishing of the light and the emergence of the first sleep signs? (Latency to fall asleep) [Normal value in older age: less than 30 minutes]
- How long do you sleep through? [< 4 hours of sleep through → sleep disorder]
- How often do you wake up during the night?
- What is the sum of waking time after falling asleep and before final awakening? (Waking lying time) [normal value in older age: up to 2 hours].
- When did the sleep disturbance first occur?
- Do motor disturbances (motor restlessness/leg movements) occur that interrupt sleep? (Extraneous history) [restless legs syndrome]
- Do you snore? Do breathing pauses (pauses in breathing) occur, resulting in restless sleep? [extraneous medical history)
- When do the sleep disturbances occur? Is there a relationship to external factors such as trauma (psychological injuries), stress or overwork?
- Do you feel tired during the day?
- Do you fall asleep several times during the day? Does it happen that they fall asleep during the day without wanting to do so?
- How much sleep do you need to feel alert and able to perform?
- Do you find it harder to concentrate?
- Do you feel cold more?
- Do you suffer from headaches?
- Do you have mood swings?
- Computer and internet use:
- Music listening (≥ 3 h/daily)?
- Computer or Internet (≥ 3 h/ daily)?
- Total time spent in front of an electronic device screen (≥ 8 h/ daily)?
If applicable, keeping/submission of a sleep diary (total bedtime; total sleep episode; time spent falling asleep; time(s) spent awake).
Vegetative anamnesis including nutritional anamnesis.
- Do you sleep regularly and sufficiently?
- Are you overweight? Please tell us your body weight (in kg) and height (in cm).
- Do you eat a balanced diet?
- Do you like to drink coffee, black and green tea? If so, how many cups per day?
- Do you drink other or additional caffeinated beverages? If so, how much of each?
- Do you smoke? If yes, how many cigarettes, cigars or pipes per day?
- Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
- Do you use drugs? If yes, what drugs (amphetamines, hashish, cocaine, marijuana) and how often per day or per week?
- Do you engage in sports? If yes, with what intensity and at what time of day?
Self anamnesis incl. medication anamnesis
- Pre-existing conditions (heart and lung disease, nervous disorders, prostate enlargement, gastrointestinal disorders (including reflux esophagitis / heartburn), anxiety disorders, depression, dementia, chronic pain, etc.).
- Operations
- Allergies
- Pregnancies
- Environmental history (physical causes; residential/environmental toxins).
- Medication history (hypnotic/sleep medication use?, Which?, Frequency?).
Medication history [ask specifically about this!]
- Alpha-2 agonist (tizanidine).
- Antibiotic
- Quinolones (cinoxacin, ciprofloxacin clioquinol, danofloxacin, difloxacin, enrofloxacin, fleroxacin, flumequin, gatifloxacin, grepafloxacin, ibafloxacin levofloxacin, Marbofloxacin moxifloxacin, nalidixic acid, norfloxacin, ofloxacin, orbifloxacin, oxolinic acid, pipemidic acid, sarafloxacin, sparfloxacin, temafloxacin, nadifloxacin).
- Antiarrhythmics
- Ic antiarrhythmics (flecainide).
- Anticholinergics (darifenacin, solifenacin, tolterodine).
- Antidementives (e.g., piracetam).
- Antidepressants
- Noradrenergic and specific serotonergic antidepressants (NaSSA) – mirtazapine.
- Selective dopamine and norepinephrine (slightly also serotonin) reuptake inhibitor (NDRI) – bupropion.
- Selective norepinephrine reuptake inhibitor (NARI) – reboxetine, viloxazine.
- Selective serotonin reuptake inhibitors (SSRI) – citalopram, fluoxetine, paroxetine, sertraline, trazodone).
- Selective serotonin–norepinephrine reuptake inhibitors (SSNRI) – duloxetine, venlafaxine.
- Tricyclic antidepressants (TCAs) – amitriptyline, amitriptyline oxide, clomipramine, desipramine, doxepin, imipramine, opipramol, nortriptyline, trimipramine).
- Antihistamines (ketotifen).
- Antimalarials (atovaquone, chloroquine, proguanil).
- Antiparkinsonian agents (levodopa* , pergolide, pramipexole* * ).
- Antipsychotics (neuroleptics).
- Atypical antipsychotics (neuroleptics) – aripiprazole.
- Antisympathetic drugs (alpha-methyldopa).
- Asthma medications (e.g., theophylline, β-sympathomimetics).
- Α2-receptor agonists (clonidine, moxonidine).
- Beta-blockers, local (betaxolol, timolol).
- Beta-blockers, systemic
- Nonselective beta-blockers (e.g., carvedilol, pindolol, propranolol, soltalol).
- Selective beta blockers (e.g., atenolol, acebutolol, betaxolol, bisoprolol, celiprolol, nebivolol, metoprolol).
- Calcium sensitizer (levosimendan).
- Hormones
- Dopamine agonists (prolactin inhibitors) – bromocriptine, cabergoline, lisuride, pramipexole, ropinirole).
- Glucocorticoids/steroids
- Oral contraceptives (non-REM sleep phase elevated, body temperature elevated) [sleep disturbances especially at the beginning of use].
- Thyroxine (thyroid hormone).
- MAO inhibitors (moclobemide, tranylcypromine).
- Medications containing caffeine (e.g., guarana) or theophylline.
- Monoclonal antibodies – pertuzumab, trastuzumab.
- MTOR inhibitors (everolimus, temsirolimus).
- Multi-tyrosine kinase inhibitor (vandetanib).
- Non-steroidal anti-inflammatory drugs (NSAID) or NSAID (non steroidal anti- inflammatory drugs) – acetylsalicylic acid (ASA), indometacin.
- Nicotine agonists (varenicline).
- Opioid antagonists (nalmefene, naltrexone).
- Phytotherapeutics (ginseng).
- Proton pump inhibitors (proton pump inhibitors, PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
- Psychotropic substances/psychostimulants such as amphetamine and its derivatives ephedrine or pseudoephedrine; methylphenidate (MPH); modafinil.
- Sedatives (bromazepam, oxazepam).
- Sympathomimetics (etilefrin)
- Tyrosine kinase inhibitors (vandetanib).
- Antivirals
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – efavirenz, nevirapine, rilpivirine.
- Nucleoside analogues (entecavir, lamivudine, telbivudine).
- Nucleoside analogues (aciclovir, brivudine, cidofovir, famciclovir, foscarnet, ganciclovir, valaciclovir).
- Cytokines (interferon ß-1a, interferon ß-1b, glatiramer acetate).
* Administered at low doses, levodopa appears to be sleep-inducing, but suppressive at higher doses. * * Limited fitness to drive due to sudden sleep attacks.
Environmental history
- Physical causes – altitude-induced sleep disturbance, noise (esp. night noise/nighttime aircraft noise), bright light, etc.
- Residential and environmental toxins – particle board, paints, wood preservatives, wall paint, floor coverings, etc.
Other causes
- Nightmares
- Gravidity (pregnancy)
- Disturbance of the biorhythm
- Light from e-book readers or tablet PCs (higher blue content than that of a bedside lamp) switches the internal clock to sleep mode with a delay
- Shift work
- Time zone changes (jet lag) etc.
- Snoring
