The first principle: diagnose before you prescribe
Sleep complaints look similar from the outside — "I cant sleep" or "Im always tired" cover dozens of distinct conditions. The first job of a sleep clinic is to distinguish among them. That is what determines what treatment is appropriate.
When we recommend a polysomnogram
- Habitual snoring with daytime symptoms or cardiovascular risk
- Witnessed apnea pauses
- Excessive daytime sleepiness without obvious cause
- Suspected parasomnia, REM behavior disorder, or movement disorder
- Treatment-resistant hypertension or unexplained atrial fibrillation
- Pediatric snoring with behavioral or growth concerns
When CBT-I is first-line
- Chronic insomnia without significant snoring or apnea features
- Insomnia after the acute period of a known trigger has passed
- Patients seeking durable improvement without medication
- Patients with mood or anxiety conditions where pharmacology already plays a role
When pharmacology is appropriate
- Acute insomnia from a clear, time-limited trigger
- Severe insomnia with safety implications, used short-term while CBT-I begins
- RLS that has not responded to iron repletion and behavioral measures
- Specific conditions like narcolepsy where pharmacology is foundational
What we do not do
- Prescribe sleep medication on the first visit without an evaluation
- Order a polysomnogram in the absence of indications
- Repeat a treatment that has already failed for the same patient
- Recommend surgery as a first-line option for adult sleep apnea
Standards exist so that the right treatment goes to the right patient. They are not bureaucratic — they are how we avoid wasting your time.— Seoul Sleep Center practice principle