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Sleep Disorders Workup

  • Author: Roy H Lubit, MD, PhD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych(UK)  more...
 
Updated: Jan 28, 2015
 

Laboratory and Imaging Studies

Laboratory studies appropriate for those with sleep disorders include the following:

  • Hemoglobin and hematocrit
  • Arterial blood gases
  • Thyroid function tests
  • Drug and alcohol toxicology screening

Oximetry may be performed during sleep to examine blood oxygen levels for clinically important desaturations suggestive of sleep apnea or other forms of sleep-disordered breathing.

Although no imaging studies are directly indicated for the workup of insomnia, underlying medical conditions call for appropriate investigation using suitable studies.

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Indices and Scoring Systems

A Beck Depression Index or similar clinical screening tool may be used to detect an underlying depressive illness as a contributing factor in insomnia.

An Epworth Sleepiness Score or another objective measure of daytime sleepiness may lead to clues to the presence of another underlying sleep disorder. For example, approximately 20% of patients with sleep apnea present with a history of nighttime insomnia; however, patients are excessively sleepy by day and have an abnormal score on the Epworth Sleepiness Scale.

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Sleep Journal

Subjective measures of sleep are obtained by means of a sleep journal. A sleep journal kept for approximately 2 weeks may help determine the extent of the sleep disturbance. Patients should record the total hours slept per night, the frequency of nighttime awakenings, and the level of restfulness provided after sleep.

Additional, more objective measures of sleep may be available if a patient has a sleep partner who keeps a 2-week journal or provides a relevant history.

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Electroencephalography and Polysomnography

Objective measures of sleep may be obtained by means of electroencephalography (EEG) or polysomnography (PSG). These studies may be helpful in determining sleep and wakefulness in the intensive care unit (ICU) or in the sleep laboratory.

Monitored PSG is the standard for evaluating measures of sleep. This study includes measures of multiple channels of EEG, electrooculography (EOG), chin and leg electromyography (EMG), nasal and oral airflow, oximetry, abdominal and chest movements, and electrocardiography (ECG). Monitored PSG can help the physician discriminate between rapid eye movement (REM) sleep and non-REM (NREM) sleep, as well as determining causes of sleep disturbance.

Patients with chronic medical conditions, such as fibromyalgia or anxiety disorders, often have characteristic alpha brain-wave activity that intrudes into the deeper stages of sleep. This activity can readily be seen on the EEG during PSG. Patients with insomnia often have some degree of sleep-state misperception, wherein they perceive and believe that they achieve significantly less sleep than they actually do. This can be documented by correlating the EEG findings from the PSG with patient subjective reports of sleep duration and onset.

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Contributor Information and Disclosures
Author

Roy H Lubit, MD, PhD Private Practice

Roy H Lubit, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Coauthor(s)

Curley L Bonds, II, MD Professor and Chair, Department of Psychiatry and Human Behavior, Charles Drew University of Medicine and Science; Health Sciences Clinical Professor, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Curley L Bonds, II, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American Medical Association, National Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Michael A Lucia, MD, FAASM Owner/CEO, Pulmonary, Allergy and Sleep Medicine, Sierra Pulmonary and Sleep Consultants, LLC

Michael A Lucia, MD, FAASM is a member of the following medical societies: Nevada State Medical Association, American Academy of Sleep Medicine, American Association of Cardiovascular and Pulmonary Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych(UK) Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych(UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Neuropsychiatric Association, American Society of Clinical Psychopharmacology, Royal College of Psychiatrists, American Association for Geriatric Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

Acknowledgements

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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