ABSTRACT
CLINICAL APPROACH An assessment of the sleepy patient commences with a comprehensive sleep history and relevant examination as discussed in chapter 3. The physician must then determine whether a clear diagnosis has emerged allowing a management plan to be developed or further investigations are needed. A starting point in this decision-making process is to decide whether the patient is describing sleepiness or fatigue (chap. 5). It is essential to provide patients with an understandable definition of these symptoms, as they are often used interchangeably in everyday language. In a study of 190 patients with sleep apnea, 57% described themselves as fatigued and 47% as sleepy when no definitions were provided for these terms (1). Sleepiness should be described in terms of the eyelids drooping, the head sagging, and short periods of sleep occurring inappropriately under sedentary circumstances when it is undesired. Fatigue, however, should be defined as a lack of physical energy and a sense of muscular exhaustion. When daytime sleep occurs with fatigue, it usually follows a period of rest and does not have the same irresistible quality as with hypersomnolence.
