eMedicine Specialties > Neurology > Sleep-Related Diseases

Sleep Dysfunction in Women: Differential Diagnoses & Workup

Author: Gila Hertz, PhD, ABSM, Director, Center for Insomnia and Sleep Disorders, Clinical Associate Professor of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook
Coauthor(s): Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Contributor Information and Disclosures

Updated: Dec 15, 2008

Differential Diagnoses

Insomnia
Narcolepsy
Obstructive Sleep Apnea-Hypopnea Syndrome
REM Sleep Behavior Disorder
Sleeplessness and Circadian Rhythm Disorder

Other Problems to Be Considered

  • Primary insomnia should be differentiated from depressive disorder, anxiety disorder, and circadian rhythm disorder.
  • Workup for sleep-maintenance insomnia should rule out PLMD and SDB.
  • Sleep disturbance due to vasomotor symptoms should be differentiated from hormonal abnormalities.
  • Abnormal behavior during sleep should be differentiated from nocturnal seizure disorder and REM sleep behavior disorder.
  • The workup of excessive daytime sleepiness should include narcolepsy, SDB, and atypical depression.
  • Parasomnias

Workup

Imaging Studies

Imaging studies may be required in the case of patients with OSA and craniofacial dysmorphologies to evaluate potential surgical strategies (eg, jaw advancement). They also may be utilized in the workup of neurodegenerative disorders.

Other Tests

  • Polysomnography: Overnight sleep studies or polysomnograms may be done in sleep-disorder centers, at home, or as inpatient procedures. Indications include risk factors, symptoms or cardiovascular manifestations arising from sleep apnea, disorders of respiratory control, and chronic obstructive or restrictive lung disease.
  • Multiple sleep latency test (MSLT): MSLT is indicated in the assessment of excessive daytime sleepiness. It is performed following a supervised overnight polysomnogram. The presence of 2 or more sleep-onset REMs (SOREMs) in an MSLT following a normal polysomnographic study the night before supports a diagnosis of narcolepsy.
  • Sleep logs: While not technically a laboratory test, sleep logs are sleep-wake cycle diaries, generally kept for a 2-week period and correlated with the patient's subjective assessments of daytime alertness. These diaries can be particularly helpful in diagnosing circadian rhythm disorders.

More on Sleep Dysfunction in Women

Overview: Sleep Dysfunction in Women
Differential Diagnoses & Workup: Sleep Dysfunction in Women
Treatment & Medication: Sleep Dysfunction in Women
Follow-up: Sleep Dysfunction in Women
References
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References

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Further Reading

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Keywords

insomnia, sleep disorders, sleep-onset insomnia, sleep-maintenance insomnia, circadian rhythm, sleep-disordered breathing, upper airway resistance syndrome, UARS, obstructive sleep apnea, OSA, restless legs syndrome, RLS, periodic limb movement disorder, PLMD, narcolepsy, parasomnias, premenstrual syndrome, PMS, sleep deprivation, sleep hygiene, snoring, fatigue, pregnancy-related sleep disorder, menstrual cycle and sleep

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Contributor Information and Disclosures

Author

Gila Hertz, PhD, ABSM, Director, Center for Insomnia and Sleep Disorders, Clinical Associate Professor of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook
Gila Hertz, PhD, ABSM is a member of the following medical societies: American Academy of Sleep Medicine and American Psychological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Medical Editor

Carmel Armon, MD, MSc, MHS, Professor of Neurology, Tufts University School of Medicine; Chief, Division of Neurology, Baystate Medical Center
Carmel Armon, MD, MSc, MHS is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American College of Physicians, American Epilepsy Society, American Medical Association, American Neurological Association, American Stroke Association, Massachusetts Medical Society, Movement Disorders Society, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Norberto Alvarez, MD, Assistant Professor, Department of Neurology, Harvard Medical School; Consulting Staff, Department of Neurology, Boston Children's Hospital
Norberto Alvarez, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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