Abstract
Sleep medicine can be a particularly rewarding clinical area for neurologists. After
all, the driving organ of sleep is the brain. Many of the sleep disorders are primary
brain disorders, whereas other sleep disorders (and their medications) influence brain
function. But without an organized approach, even the engaged and motivated neurologist
can easily become frustrated when dealing with patients whose concerns center on an
undesirable degree of sleepiness. Lost in the thicket of information provided during
the patient–doctor encounter, many physicians are unable to direct the history toward
particular diagnostic hypotheses. So, rather than provide an exhaustive and disorganized
set of details about sleep medicine, the author instead shares pearls of sleep medicine
in the context of an overall framework, with the goal to foster targeted history-taking
for the successful diagnosis of a patient struggling with maintaining wakefulness.
The topic of excessive sleepiness will be covered because it is so common and because
its mastery is fundamental to approaching most patients with sleep disorders. Common
and important pitfalls regarding the topic of sleepiness—and how to avoid them—will
be discussed. Misdiagnoses and mismanagement are easy to avoid if this entire framework
is kept in mind.
Keywords
sleep - sleepiness - drowsy - fatigue - narcolepsy
