Diagnosis and Treatment of Sleep Disorders

Sleep initiation and maintenance disorders are often tolerated for years. Yet cause and treatment can usually be clearly identified when approached systematically. Chronic sleep disorders are not harmless: they increase cardiovascular risk and worsen glucose tolerance^[1,2].

Chronic insomnia — more than "sleeping poorly"

Chronic insomnia affects around 6% of the adult population in Germany^[5]. It is defined as difficulties falling or staying asleep on at least three nights per week for at least three months, combined with impaired daytime functioning (fatigue, concentration problems, irritability, reduced performance). Insomnia is often dismissed as a minor complaint — in reality, it is a distinct medical condition with measurable effects on metabolism, cardiovascular risk and mental health.

Diagnosis: clinical, not instrumental

Diagnosis is clinical — based on medical history, a sleep diary over two weeks, and validated questionnaires (ISI, PSQI). Polysomnography is not required in routine work-up; it is reserved for suspected comorbid organic sleep disorders or treatment-resistant insomnia.^[6]

First-line treatment: cognitive behavioural therapy for insomnia (CBT-I)

Both the European Insomnia Guideline 2023 and the German S3 guideline recommend cognitive behavioural therapy for insomnia (CBT-I) as first-line treatment — not sleeping pills^[6]. CBT-I is a structured programme, typically covering 6–8 sessions, with several components: sleep education, stimulus control, sleep restriction, cognitive restructuring of dysfunctional thoughts about sleep, and relaxation techniques.

A meta-analysis of 241 randomised trials with more than 31,000 participants showed that CBT-I increases the probability of insomnia remission by a factor of 2.5 (OR 2.50)^[7]. The effects are sustained and persist beyond the end of treatment — unlike pharmacological approaches, which are often followed by relapse after discontinuation.

In Germany, CBT-I is available through classical psychotherapy as well as through digital health applications (DiGAs) such as somnio, which are reimbursed by statutory health insurance and deliver guideline-based CBT-I in a structured, evidence-based format. I am happy to advise you on which path is most appropriate in your situation.

Pharmacotherapy — when CBT-I is not sufficient

If CBT-I is unavailable or insufficiently effective, pharmacotherapy can be considered. Classical hypnotics (benzodiazepines and Z-drugs such as zolpidem or zopiclone) should not be used for longer than four weeks due to tolerance, dependence and fall risk^[6]. Modern alternatives with substantially lower dependence potential are now available; complementary options include low-dose sedating antidepressants (e.g., doxepin, trazodone, mirtazapine) or prolonged-release melatonin (over 55 years). Which strategy is appropriate depends on comorbidities and current medication — we discuss this individually.

Experience in sleep medicine

I bring several years of clinical experience from the sleep laboratory. This includes performing and interpreting polygraphies and polysomnographies and guideline-based treatment of various sleep disorders. Since 2025, I have been completing formal advanced training for the specialization in sleep medicine at the Sleep Center Halle/Saale.

Diagnostic approach

The first step is a detailed sleep history and the use of standardized questionnaires such as the Epworth Sleepiness Scale (ESS)^[3] and STOP-BANG^[4]. If sleep-related breathing disorders are suspected, we add an ambulatory polygraphy; for pure sleep initiation/maintenance disorders without suspicion of breathing disorders, clinical diagnosis is the focus.

We distinguish between insomnia, restless legs syndrome, sleep-related breathing disorders (SRBD / OSA), and circadian rhythm disorders. If a full sleep stage analysis is required, we offer ambulatory polysomnography as a self-pay service — measurement at home in your usual environment. For complex cases, referral to a sleep medicine center.

5. Ambulatory Polysomnography or Referral

When full sleep stage evaluation is required, I offer ambulatory polysomnography as a private service — with recording at home in your familiar environment. Alternatively, for complex cases, referral to a specialized sleep medicine center is possible.