Date:
Patient: [Patient Name], [MRN]
Attending Physician: [Physician Name]
Reason for Visit: Evaluation for suspected circadian rhythm sleep disorder (CRSD), sleep history, and discussion of management options.
SOAP
Subjective (S):
History of Present Illness:
Inquire about the following details of sleep problems:
Sleep difficulties (onset insomnia, difficulty maintaining sleep, early morning awakening, excessive daytime sleepiness)
Duration and severity of sleep disturbances
Impact on daytime functioning (work, school, social activities)
Sleep hygiene practices (bedtime routine, screen time before sleep)
Travel history (jet lag can disrupt sleep patterns)
Use of sleep aids (prescription or over-the-counter)
Past Medical History:
Briefly summarize relevant past medical history, including:
Psychiatric conditions (anxiety, depression) – can co-occur with CRSDs
Neurological disorders (e.g., Parkinson’s disease) – some may cause sleep disturbances
Medications – some medications can disrupt sleep patterns
Social History:
Inquire about work schedule (shift work can disrupt circadian rhythm).
Ask about caffeine and alcohol intake (can affect sleep quality).
Objective (O):
Mental Status Exam:
Briefly assess mood, alertness, and cognitive function.
Sleep Logs (if available):
Review sleep logs kept by the patient to assess sleep patterns and identify potential disruptions.
Physical Exam:
Perform a general physical exam to rule out any underlying medical conditions that may be causing sleep problems.
Assessment (A):
Type of Circadian Rhythm Sleep Disorder (if suspected):
Based on sleep history and symptoms, consider the specific type of CRSD:
Delayed Sleep Phase Syndrome (DSPS) – difficulty falling asleep and waking up at desired times
Advanced Sleep Phase Syndrome (ASPS) – falling asleep and waking up earlier than desired
Non-24-Hour Sleep-Wake Disorder (N24HSWD) – sleep-wake cycle not aligned with a 24-hour day
Irregular Sleep-Wake Rhythm Disorder (ISWRD) – erratic sleep patterns with no consistent sleep-wake cycle
Differential Diagnosis:
Consider other sleep disorders (e.g., sleep apnea, restless legs syndrome) or medical conditions that might mimic CRSD symptoms.
Plan (P):
Sleep Hygiene Education:
Educate the patient on healthy sleep habits to promote better sleep quality:
Regular sleep schedule (go to bed and wake up at consistent times, even on weekends)
Relaxing bedtime routine
Creating a sleep-conducive environment (dark, quiet, cool)
Limiting screen time before bed
Regular exercise (but not too close to bedtime)
Light Therapy (if indicated):
Consider light therapy for specific CRSDs (e.g., DSPS) to help regulate the circadian rhythm.
Melatonin Therapy (if indicated):
Consider melatonin supplementation for some CRSDs to promote sleep onset.
Medications (if indicated):
In some cases, short-term use of sleep medications may be considered to help regulate sleep patterns.
Referral (if indicated):
Consider referral to a sleep specialist for patients with complex CRSDs, those who fail to respond to initial interventions, or require further evaluation (e.g., sleep study).
Follow-up:
Schedule follow-up visits to monitor sleep patterns, response to treatment, and daytime functioning.
Define the frequency of follow-up based on the severity of sleep disturbances and response to interventions.
Patient Education:
Educate the patient about circadian rhythm sleep disorders, their causes, and the importance of treatment adherence.
Discuss the benefits of sleep hygiene practices and light therapy (if applicable).
Explain the potential side effects of medications (if prescribed).
Offer resources for support groups or educational materials on managing CRSDs.