Differential diagnosis

It is important to distinguish between sleepiness and fatigue without prominent sleepiness, which may be caused by physical disorders (eg anaemia) or primary psychiatric disorder.

• Chronic lack of sleep.
• Circadian rhythm sleep disorder, including irregular sleep-wake schedule or shift work.
• Disrupted (poor quality) sleep caused by obstructive sleep apnoea (common); caffeine, alcohol or nicotine excess; other non-prescribed drugs (including withdrawal phase).
• Increased sleep tendency, eg narcolepsy (characterized by sleep attacks and cataplexy), over-sedation by medication.

Assessment should include sleep histories and a general review. Sleep questionnaires, sleep diary or actigraphy can be valuable. Polysomnography is often needed, including respiratory measures. Other specific interventions may be appropriate, eg toxicology screen.

Last edited: 27/10/2003

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