Does the subject have any hallucinations which might suggest narcolepsy, schizophrenia, amphetamine-induced psychosis, severe sleep deprivation, or delirium tremens due to alcohol withdrawal? Is there any problem with concentration or memory?
Is there any pain or unpleasant sensations in the legs in the evenings which are relieved by movement, suggesting the restless legs syndrome?
Are there any abnormal movements to indicate epilepsy or cataplexy or a primary movement disorder, such as Parkinsonism, which may be related to unusual movements during sleep?
True hypersomnia in which the subject sleeps for an abnormally long duration during each 24-h cycle should be distinguished from hypersomnolence which is the sensation of sleepiness. These two symptoms should also be distinguished from mental fatigue with poor concentration or motivation, physical weariness or fatigue which usually has an organic cause or may be related to insomnia, and the feeling of subalertness which may be due to a reduced wakefulness drive or an increased drive to sleep, as in narcolepsy. The duration, frequency and timing of naps should be noted, and whether or not these are refreshing. Many patients with narcolepsy feel refreshed after a nap of 5-30 min, whereas in idiopathic hypersomnia naps are longer but are unrefreshing.
The severity of daytime sleepiness can be gauged by its frequency and the type of situation in which the subject falls asleep. If it is mild, it only occurs infrequently, at times of day when sleep would be expected, e.g. 2.00-4.00 pm or late in the evening, or at rest or in a monotonous or passive environment, e.g. as a passenger in a car, bus or train, while sitting watching television or reading, or in a meeting. It is likely to be more severe if sleep occurs despite stimulating circumstances, for instance while talking, eating or on exertion, such as walking, and if it occurs frequently and at any time of the day.
Cyclical sleepiness may be due to intermittent sleep deprivation. Patients often sleep too little during the week and catch up their sleep debt at weekends. This leads to a weekly cycle of sleepiness and recovery. Longer cycles of sleepiness are characteristic of other disorders, such as the monthly cycles in premenstrual sleepiness and even longer cycles in the Kleine-Levin syndrome. Elimination of sleepiness when sufficient sleep is allowed, for instance during holidays, suggests that sleep deprivation rather than a primary sleep disorder is the cause.
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A Guide to Natural Sleep Remedies. Many of us experience the occasional night of sleeplessness without any consequences. It is when the occasional night here and there becomes a pattern of several nights in arow that you are faced with a sleeping problem. Repeated loss of sleep affects all areas of your life The physical, the mental, and theemotional. Sleep deprivation can affect your overall daily performance and may even havean effecton your personality.