The Executive Committee of the American Academy of Sleep Medicine (AASM) developed 21 candidate recommendations for ways in which medical waste could be minimized while care for patients with sleep disorders is improved. It recently released its top 5.
1. Avoid polysomnography in chronic insomnia patients unless symptoms suggest a comorbid sleep disorder.
Chronic insomnia is diagnosed by a clinical evaluation that includes a thorough sleep history along with a medical, substance and psychiatric history. Some instruments can be helpful at the clinical encounter: these include self-administered questionnaires, sleep logs completed at home and symptom checklists. Although polysomnography (PSG) may confirm self-reported symptoms of chronic insomnia, it does not provide additional information necessary for diagnosis of chronic insomnia. However, PSG is indicated in some specific circumstances, for example when sleep apnea or sleep-related movement disorders are suspected, the initial diagnosis is uncertain, behavioral or pharmacologic treatment fails, or sudden arousals occur with violent or injurious behavior.