Sleep & Recovery
Sleep is not time lost. It is when memory is consolidated, blood sugar is regulated and the brain clears what it accumulated during the day. Short or fragmented sleep shows up in metabolic and cognitive measures long before anyone calls it a problem, and much of it is treatable - sleep apnoea in particular is common, under-diagnosed, and one of the more fixable things in medicine.
What this means for healthspan
Sleep affects how well you think, feel and recover. Regular poor sleep is linked with higher risks of conditions such as high blood pressure, diabetes, obesity and depression, and it can make pain, mood and concentration harder to manage. Sleep and health can affect each other in both directions.
Healthy sleep is about more than hours. Regular timing, how rested you feel, and whether breathing and movement during sleep are normal all matter. Common sleep conditions, such as insomnia and sleep apnea, can often be treated once they are recognized.
What we assess, and why
We may ask about your sleep schedule, how long it takes to fall asleep, night waking, snoring or pauses in breathing, daytime sleepiness, and what else may be affecting sleep, such as pain, mood, medicines, alcohol, caffeine or hormonal changes.
The goal is to tell apart habits that can be adjusted from sleep disorders that need specific testing or treatment. A sleep study is used only when your history suggests it is needed.
What we may assess
Sleep history, validated sleep questionnaires, daytime sleepiness, sleep schedules, possible sleep-disordered breathing and home or laboratory sleep studies when indicated.
What is used is chosen for you, according to your individual risk, clinical appropriateness, the evidence and what you decide with your physician.
Why it matters
Identifying sleep difficulties and treatable sleep disorders can improve daily functioning and support broader health goals.
Examples of assessments and investigations
These are examples of what may be considered. Which of them are used for you depends on your history, your risk and what you decide with your physician.
Sleep history and sleep diary
A detailed conversation and, often, one to two weeks of notes on bed and wake times, naps, caffeine and alcohol. It may be considered for anyone with sleep concerns.
Insomnia questionnaire
A short validated questionnaire that rates the severity of trouble falling or staying asleep. It helps us track change over time when insomnia is a concern.
Daytime sleepiness questionnaire
A short questionnaire that rates how likely you are to doze in everyday situations. It may be considered if you feel unusually tired during the day.
Sleep apnea risk questionnaire
A brief checklist covering snoring, tiredness, observed pauses in breathing, blood pressure, neck size, age and sex. It may be used for people with symptoms or risk factors, to decide whether a sleep study is needed.
Home sleep apnea test
A portable test worn overnight at home to measure breathing. It may be considered for adults with a higher likelihood of moderate to severe obstructive sleep apnea and no major heart, lung or other sleep conditions.
Sleep laboratory study
An overnight study in a sleep lab with more detailed monitoring. It may be considered when a home test is not suitable, or when other sleep disorders are suspected.
Review of contributing factors
A review of medicines, alcohol, pain, mood, restless legs symptoms, night-time urination and hormonal changes such as menopause that may be disturbing sleep.
Wearable and app data review
A look at sleep data from your own device, if you use one. These devices estimate sleep and can be inaccurate, so we treat them as a conversation starter and not as a diagnosis.
What the evidence supports, and where it is uncertain
What the evidence supports
- The Canadian 24-Hour Movement Guidelines recommend 7 to 9 hours of good quality sleep on a regular basis for adults 18 to 64, and 7 to 8 hours for adults 65 and older, with consistent bed and wake times.
- Cognitive behavioural therapy for insomnia (CBT-I) is recommended as the first treatment for chronic insomnia in adults by the American College of Physicians, and Canadian health information also describes it as a main option. Sleep medicines are generally not the first choice.
- For obstructive sleep apnea, CPAP is usually the first medical treatment. Weight management, sleeping on your side, avoiding alcohol and sedatives before bed, and oral devices may also help in selected people.
- Practical habits, such as regular sleep and wake times, limiting caffeine and alcohol near bedtime, daytime light and activity, and a quiet, dark, cool bedroom, are commonly recommended in Canadian patient information.
Limits and uncertainties
- The right amount of sleep varies by person. The recommended ranges are guides, not targets to chase, and worrying about sleep can make it worse.
- The U.S. Preventive Services Task Force found the evidence insufficient to recommend for or against screening adults without symptoms for obstructive sleep apnea. We therefore focus testing on people with symptoms or risk factors.
- Consumer sleep trackers and apps are not validated for diagnosis. They can cause worry about normal variation in sleep.
- Sleep studies can show results that are borderline or hard to interpret, and some people find CPAP difficult to use at first. Follow-up and troubleshooting are an important part of treatment.
- Supplements and sleep aids, including melatonin, have limited and mixed evidence for chronic insomnia and can cause side effects or interact with other medicines.
From findings to a plan, and what follows
How findings can inform a plan
Findings can help us suggest the most suitable next step. That may be a structured plan for sleep timing and habits, referral for CBT-I, treatment of a contributing condition such as pain, mood or menopausal symptoms, a review of medicines that disturb sleep, or testing and treatment for sleep apnea. We discuss the options with you and aim to start with an approach that is supported by evidence and has few side effects.
Follow-up, monitoring and coordination
Follow-up may include repeating the same questionnaires to see whether sleep and daytime function are changing, reviewing sleep study results with you, checking how treatment such as CPAP is going, and coordinating with your family doctor, a sleep specialist or a trained CBT-I provider. Seek urgent medical advice if you fall asleep while driving or at other dangerous times. If you are concerned about sleepiness while driving, talk with your doctor before you drive.
What happens here
The approach is the same in every area: establish where you are, change something on a cadence, then measure again to find out whether it worked. In sleep & recovery that work is organized into the programs below.
Sleep & Recovery
Assessment and improvement of sleep and recovery.
What this involves
Reliable places to read more
These are independent organizations. Monarch Health does not control their content and has no arrangement with them.
HealthLink BC
Insomnia(opens in a new tab)
HealthLink BC
Insomnia: Improving Your Sleep(opens in a new tab)
HealthLink BC
Sleep Apnea(opens in a new tab)
Canadian Society for Exercise Physiology
Canadian 24-Hour Movement Guidelines for Adults(opens in a new tab)
Canadian Sleep Society
Healthy Sleep for Healthy Canadians(opens in a new tab)
Where to go next
The other areas we work on