Because this is a rarely discussed disease in the doctor's office, the responsibility to manage this condition often falls on the patient.

Often the first step a patient will take is to go the drug store and get a medication with the word PM in it. This is not the best option. It should certainly not be the first choice for long-term management of sleep problems. The first initial step should be to take an inventory of the sleep habits.

In order to treat a sleep problem, it must first be defined. The first step is to determine if there is any condition that would require immediate medical attention.

The next step is to take a sleep inventory as outlined in the above section.

Are there any medical problems that may be interfering with sleep? Evaluate for any:

• Pain – treating pain may help in the management of sleep.
• Are there any breathing problems such as asthma, bronchitis or emphysema? Uncontrolled lung disease can lead to problems with sleep.
• Heartburn can cause discomfort at night
• Heart disease may present with nocturnal pain or difficulty breathing
• Snoring, obesity, and large neck suggest obstructive sleep apnea.

The use of a dairy can be helpful in determining the sleep pattern. Many sleep diaries are available on the web. One diary is available through the American Academy of Sleep Medicine at: http://www.sleepeducation.com/pdf/sleepdiary.pdf. Maintaining this diary will assist the patient in determining the significance of the problem.