Diagnostic Tools and Testing in the Sleepy Patient

Abstract

Hypersomnia or excessive daytime sleepiness (EDS) is defined as “the inability to stay awake and alert during the major waking episodes of the day, resulting in unintended lapses into drowsiness or sleep.” It is a symptom caused not only by insufficient sleep, medications, and intrinsic sleep disorders but also by neurological conditions (such as movement disorders, neuromuscular diseases, dementia, cerebrovascular diseases, head trauma, and epilepsy) and other medical conditions (including metabolic conditions, inflammatory conditions, and cancers). History taking is of primary importance when assessing a patient who presents with daytime sleepiness; however, subjective or objective assessments are often helpful in making the correct diagnosis or in tracking the patient’s symptom severity over time to assess treatment outcome. Evaluation via subjective testing is faster and cost effective, though it may not provide enough specificity to make an accurate diagnosis. Objective evaluations can be time consuming and are significantly more expensive, but may help to effectively guide the clinician to an appropriate treatment strategy. Knowing how and when to utilize assessment tools is critical to good clinical outcomes.