Evaluation of the Patient with Excessive Daytime Sleepiness
| Findings on History and Physical Examination | Diagnostic Evaluation | Diagnosis | Therapy |
|---|---|---|---|
| Difficulty waking in the morning, rebound sleep on weekends, and vacations with improvement in sleepiness | Sleep log | Insufficient sleep | Sleep education and behavioral modification to increase amount of sleep |
| Obesity, snoring, hypertension | Polysomnogram | Obstructive sleep apnea (Chap. 137. Sleep Apnea) | Continuous positive airway pressure; upper airway surgery (e.g., uvulopalatopharyngoplasty); dental appliance; weight loss |
| Cataplexy, hypnogogic hallucinations, sleep paralysis | Polysomnogram and multiple sleep latency test | Narcolepsy | Stimulants (e.g., modafinil, methylphenidate); REM sleep-suppressing antidepressants (e.g., venlafaxine); sodium oxybate |
| Restless legs, kicking movements during sleep | Assessment for predisposing medical conditions (e.g., iron deficiency or renal failure) | Restless legs syndrome with or without periodic limb movements | Treatment of predisposing condition if possible; dopamine agonists (e.g., pramipexole, ropinirole) |
| Sedating medications, stimulant withdrawal, head trauma, systemic inflammation, Parkinson's disease, and other neurodegenerative disorders, hypothyroidism, encephalopathy | Thorough medical history and examination including detailed neurologic examination | Sleepiness due to a drug or medical condition | Change medications, treat underlying condition, consider stimulants |