A 53 year old man comes to you complaining of not having slept well for many years. He always feels tired the next day. He has tried sleeping pills, which sometimes help, but he is not keen on taking them continually and has found that the benefits they give him don’t last. He spends about 9-10 hours in bed each night (going to bed about 9 30 pm or 10 pm and getting up at 7 am) and has trouble getting to sleep. His actual hours of sleep are 5.5 to 6 each night. He wakes about three times a night and describes the quality of his sleep as poor. ### Assessment Rule out secondary causes. To assess whether he has depression or anxiety, for example, ask screening questions, take a full history of depression and anxiety, or use a scale such as the Hospital Anxiety and Depression Scale, which gives a score for both conditions. Consider sleep apnoea if he snores a lot at night, has periods of apnoea, falls asleep easily during the day (for instance, …