| Detailed description of the sleep problem(s) |
- Type of problem (eg, bedtime resistance, difficulty initiating sleep, and/or nighttime awakenings)
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- Onset, frequency, and duration
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- Child's usual sleep schedule (weekdays and weekends)
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- Sleeping environment, including presence of siblings, television, or other noise or distraction
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- Pre-sleep activities, including exercise, video games, or other stimulating activities
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- Parents' response to the problem and previous treatment attempts
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| Potential psychosocial contributors |
- Potential triggers at time of onset (eg, change in schedule, stressful family event, or birth of a sibling)
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- Other psychosocial triggers (eg, marital discord, mental health problems, or medical illness [in parents, child, or other family members])
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- Child's developmental history, temperament, and any behavioral problems
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- Screen time, including time of day
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| Potential biologic contributors (may also have psychosocial effects) |
- Other primary sleep disorders, especially:
- Obstructive sleep apnea – Symptoms may include frequent snoring; loud snoring; observed pauses in breathing; mouth breathing; or daytime hyperactive, inattentive, or somnolent behavior
- Restless legs syndrome – Symptoms include the urge to move the legs (especially in the evening and at rest), leg discomfort, restless sleep, and kicking movements during sleep
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- Child's medical history, especially disorders that may interfere with sleep, such as allergies and atopic dermatitis, seizure disorders, or rheumatologic conditions
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- Medications or caffeine, especially stimulants or psychoactive medications
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- Family history for insomnia or psychopathology
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| Additional focused history for adolescents with insomnia |
- Bedtime, sleep onset, and waking time, especially on weekends versus school days
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- Access to and use of electronics in bedroom (computer, television, e-readers)
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- Medications or caffeine, specially stimulants or psychoactive medications; drug and/or alcohol use
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- Preferred sleep schedule and if insomnia resolves when sleeping on preferred schedule
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- Anxiety about falling or staying asleep and anticipated consequences
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- Activities in bed other than sleeping (doing homework; use of social media, phone, texting, social games)
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- Daytime napping (when and for how long)
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- Daytime sleepiness (dozing off at school, while doing homework, on car rides)
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