'How is your sleep?' produces an assessment of sleep quality, which is subjective, mood-congruent and hard to act on. 'What time did you get up yesterday, and the day before?' produces a timing, which is objective, remembered accurately, and the thing that predicts relapse in mood disorders.
Irregular wake time is the most sensitive single marker of circadian disruption you can obtain in a two-minute consultation, and it moves before mood does. A patient whose rising time has drifted by three hours across the week is destabilising whatever they say about how they feel.
So record the wake time at every visit alongside the mood rating, and make the first intervention a fixed rising time rather than a sedative. The morning anchor is what sets the rhythm; bedtime follows it, and telling a patient to go to bed earlier without fixing when they get up rarely changes anything.
- Record actual wake time at every visit, not sleep quality
- Ask for the last three days specifically - a general impression will be mood-congruent
- Set a fixed rising time as the first intervention, before adding a hypnotic
- Watch for a widening weekday-weekend gap; it precedes mood destabilisation
- Morning light exposure after rising reinforces the anchor at no cost
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