Advertisement

Assessment of Sleep Duration, Sleep Habits, Napping, and Circadian Rhythms in the Patient Complaining of Fatigue

  • John Herman
Chapter

Abstract

When a patient complains of job-related fatigue or chronic fatigue, a critical component of his or her evaluation is to determine if the fatigue is secondary to the patient’s sleep schedule, or to a sleep disorder, or to a circadian rhythm disorder. This chapter provides the reader with a description of how that evaluation should proceed and what tests, studies, and procedures to employ.

First, this chapter describes how to determine if the patient is obtaining adequate sleep or is chronically sleep deprived. Secondly, it describes how to determine if a sleep disorder is present. Finally, it explains how to determine if a circadian rhythm disorder is the cause of chronic fatigue. For each of these, the chapter will discuss scales, diaries, sleep logs, and actigraphy for ruling in or out a diagnosis with a reasonable degree of certainty.

Keywords

Circadian rhythm disorder Fatigue Sleepiness Insomnia Memory Attention Cognition Early morning awakenings 

References

  1. 1.
    Ohayon M, Carskadon MA, Guilleminault C, et al. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Maurice M, Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111.CrossRefGoogle Scholar
  3. 3.
    Kripke DF, Lawrence Garfinkel L, Wingard DI, et al. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002;59(2):131–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Monk TH, Buysse DJ, Kennedy KS, et al. Measuring sleep habits without using a diary: the sleep timing questionnaire. Sleep. 2003;26(2):208–12.CrossRefPubMedGoogle Scholar
  5. 5.
  6. 6.
    Yi H, Shin K, Shin C. Development of the sleep quality scale. J Sleep Res. 2006;15(3):309–16.CrossRefPubMedGoogle Scholar
  7. 7.
    Swanson LM, Arendt JT, Rosekind MR, et al. J Sleep Res. 2011;20:487–94.CrossRefPubMedGoogle Scholar
  8. 8.
    Riemann D, Kloepfer C, Berger M. Functional and structural brain alterations in insomnia: implications for pathophysiology. Eur J Neurosci. 2009;29(9):1754–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Bastien CH, Vallieres A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307.CrossRefPubMedGoogle Scholar
  10. 10.
    Gałuszko-Węgielnik M, Jakuszkowiak-Wojten K, Wiglusz MS, et al. The efficacy of cognitive-behavioural therapy (CBT) as related to sleep quality and hyperarousal level in the treatment of primary insomnia. Psychiatr Danub. 2012;24(Suppl 1):S51–5.PubMedGoogle Scholar
  11. 11.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.CrossRefPubMedGoogle Scholar
  13. 13.
    Lichstein KL, Means MK, Noe SL, et al. Fatigue and sleep disorders. Behav Res Ther. 1997;35(8):733–40.CrossRefPubMedGoogle Scholar
  14. 14.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485–91.CrossRefGoogle Scholar
  15. 15.
    Cheng F, Yegneswran B, Islam S, et al. STOP questionnaire—a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812–21.CrossRefGoogle Scholar
  16. 16.
    Farney RJ, Walker BS, Rarney RM, et al. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med. 2011;7(5):459–65.PubMedPubMedCentralGoogle Scholar
  17. 17.
  18. 18.
    Kryger MH. Atlas of clinical sleep medicine. Philadelphia: Saunders/Elsevier; 2010. p. 149–66.Google Scholar
  19. 19.
    Weissbluth M. Naps in children: 6 months-7 years. Sleep. 1995;18(2):82–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Hays JC, Blazer DG, Foley DJ. Risk of napping: excessive daytime sleepiness and mortality in an older community population. J Am Geriatr Soc. 1996;44(6):693–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Arora V, Dunphy C, Chang VY, et al. The effects of on-duty napping on intern sleep time and fatigue. Ann Intern Med. 2006;144(11):792–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Briones B, Adams N, Strauss M, et al. Relationship between sleepiness and general health status. Sleep. 1996;19(7):583–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Williams G, Pirmohamed J, Minors D, et al. Dissociation of body-temperature and melatonin secretion circadian rhythms in patients with chronic fatigue syndrome. Clin Physiol. 1996;16(4):327–37.CrossRefPubMedGoogle Scholar
  24. 24.
    Ancoli-Israel S, Cole R, Alessi C, et al. The role of actigraphy in the study of sleep and circadian rhythms. American Academy of Sleep Medicine Review Paper. Sleep. 2003;26(3):342–92.CrossRefPubMedGoogle Scholar
  25. 25.
    Philips Home Health Care Solutions, Shevlin Corporate Park, Building C, 920 SW Emkay Ave, Suite 100, Bend, Oregon 97702.Google Scholar
  26. 26.
    American Academy of Sleep Medicine. International classification of sleep disorders: diagnostic and coding manual. 2nd ed. Westchester: American Academy of Sleep Medicine; 2005. p. 118–23.Google Scholar
  27. 27.
    Horne JA, Ostberg O. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol. 1976;4:97–110.PubMedGoogle Scholar
  28. 28.
    Zavada A, Gordijn MC, Beersma DG, et al. Comparison of the Munich Chronotype Questionnaire with the Horne-Östberg’s morningness-eveningness score. Chronobiol Int. 2005;22(2):267–78.CrossRefPubMedGoogle Scholar
  29. 29.
    Crowley SJ, Acebo C, Fallone G, et al. Estimating dim light melatonin onset (DLMO) phase in adolescents using summer or school-year sleep/wake schedules. Sleep. 2006;29(12):1632–41.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • John Herman
    • 1
  1. 1.UT Southwestern Medical CenterDallasUSA

Personalised recommendations