Conditions
Sleep disturbance initial approach
Primary care framework for insomnia and sleep complaints with red-flag screening and stepwise management.
Last reviewed 2026-02-07|sleep | insomnia | behavioral health
Assessment priorities
- Define sleep-onset versus maintenance pattern and daytime impairment burden.
- Screen for mood symptoms, substance contributors, and shift-work effects.
- Check for sleep-apnea warning features and safety risks.
Red flags
- Severe daytime somnolence affecting driving or occupational safety.
- Possible untreated sleep apnea with cardiopulmonary risk signals.
- Worsening mental-health instability or suicidality.
Initial management
- Start non-pharmacologic sleep plan with realistic behavior goals.
- Address reversible contributors including caffeine, alcohol, and schedule disruption.
- Use medication only when risk-benefit and duration limits are explicit.
Follow-up and escalation
- Reassess symptom trajectory and daytime function.
- Escalate for persistent severe impairment or apnea-risk progression.
- Reinforce return precautions for safety-critical fatigue events.