Symptom: Sleep, Disturbance of

Initial Grading Reminder

Grade 1: Mild difficulty falling asleep, staying asleep, or waking up early
Grade 2: Moderate difficulty falling asleep, staying asleep, or waking up early
Grade 3: Severe difficulty in falling asleep, staying asleep, or waking up early

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did the symptom start/get worse? Has it developed gradually or suddenly? Any new medications or change in doses (including steroids)? Have you had any issues with sleep disturbance in the past?

Grade the symptom

Ask the patient:

How much difficulty do you have falling asleep, staying asleep, or waking up early?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you very hot? Does your heart feel like it is racing or skipping a beat? Is your hair shedding or falling out? Do you have a swollen neck? Do you wake up in the night frequently to urinate and are you extremely thirsty and hungry?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?