Screen for sleep apnea from the history before starting any sleep medication: snoring, what a partner notices, and nighttime awakenings. Do not give sleep medications to someone with untreated apnea, since they suppress the respiratory drive. Not everyone needs a sleep study, and a primary sleep disorder is less common in psychiatric patients than people expect.
How we screen
Ask every patient before starting a sleep medication: do you snore at night, does your partner say you snore, and if you wear a sleep tracker, does it show a lot of sleep disturbance or movement?
“I ask every patient that I start a sleep medication, do you snore at night? Does your partner say you're snoring at night? If you have an aura ring, do you have a lot of sleep disturbances or movement in your aura ring”
18:17Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 Go off the clinical history rather than sending everyone for a sleep study. Refer when you hear something at least suspicious for apnea, such as multiple nighttime awakenings.
“I go off the clinical history, though. I'm not sending everyone to a sleep study. If I hear something that sounds at least suspicious for sleep apnea, like multiple nighttime awakenings”
59:00Insomnia and Sleep Medications in PsychiatryDec 2024 A sleep study can also reveal paradoxical insomnia, where patients who report total sleeplessness are in fact sleeping.
“one explanation for total sleeplessness is perception. In paradoxical insomnia, patients think they are not sleeping, but they are sleeping. You will discover that through a sleep study”
50:35How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026
Side effects and safety
Do not give sleep medications to someone with untreated sleep apnea. You will be suppressing the respiratory drive they need.
“you're not supposed to give sleep medications to untreated sleep apnea. It's not good, right? You're just going to be suppressing their respiratory drive that they need”
1:00:25Insomnia and Sleep Medications in PsychiatryDec 2024
Pitfalls and myths
In our experience the likelihood of a primary sleep disorder is on the lower side, and even when one is treated it does not solve the other issues.
“The actual likelihood of a primary sleep disorder is actually on the lower side, in my experience. Because even when it's treated, it does not solve the other issues”
16:36Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026
It also comes up on
From these episodes
- Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 · 2 points
- How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026 · 1 point
- Insomnia and Sleep Medications in PsychiatryDec 2024 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.