When a woman in the menopausal transition reports poor sleep, the most informative history often belongs to someone who is not in your clinic. A bed partner notices snoring that stops, gasping, and legs that kick through the night. The patient notices none of these, and will describe all of them as insomnia.
The question takes ten seconds and changes the differential. 'Has anyone told you that you snore, or that you stop breathing?' and 'Does anyone complain that you kick in your sleep?' separate obstructive sleep apnoea and periodic limb movement disorder from insomnia more efficiently than any questionnaire you can hand out in a gynaecology clinic.
Where there is no bed partner, the daytime substitute works nearly as well: does she fall asleep when she does not intend to - watching television, in a waiting room, as a passenger? Sleepiness of that kind is not what broken sleep from night sweats produces.
- 'Has anyone told you that you snore or stop breathing?' - one question, asked of every woman reporting poor sleep
- 'Does anyone complain that you kick in your sleep?' for periodic limb movement
- Where there is no bed partner, ask about unintended daytime sleep instead
- Record the answer; it is the difference between a referral and a prescription
Why it matters
The findings that distinguish apnoea from insomnia are ones the patient cannot observe herself.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for obstetrics & gynaecology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free