EP1: Can Sleepiness Be Measured? The Epworth, MSLT and Clinical Judgment

So when I hear those terms and when I'm considering those terms in my evaluation of a patient, I'm really thinking about somebody who is fighting the urge to fall asleep, who they feel sleepy.

Now, for example, in our clinic, we use the clinic rooms at night for our sleep studies, so they have a bed in them.

And oftentimes one of the things I'll ask patients to get at this symptom, because a lot of people will come to us saying, "I feel tired." And tired can mean a thousand different things.

And so what I say is, "See that bed right there? If I were to leave this room and let you take a nap in that bed, do you think you could fall asleep? Would you be happy about that?" And there's people that are like, "No, no.

It's not that.

I just feel exhausted." And then there's the people that say, "Absolutely.

If you could do that right now [laughs] that would be fantastic, 'cause I'm about to fall asleep." And it's that second group that when we're r- and again, all types of tiredness are important because they are pointing to a problem typically.

But when I think about hypersomnolence, it's those individuals that say, "Leave me alone.

I wanna lay down in that bed right now."

Saima, you know, one of the things I heard in Kathy's response there is kind of a range of somnolence or kind of a spectrum of somnolence, if you will.

If I said to you that some aspects of somnolence are normal, would you say I'm crazy?

No, I wouldn't think you're crazy.

But I would try to understand, just like Kathy defined, the, the need, the, the urge and the necessity to sleep, where is that coming from? Um, y- you shouldn't, if you're sleeping well and enough hours, you shouldn't have such a desirable need to sleep unless there's a sleep disorder present, in my opinion.

But there's a lot of weeding out of habits, behaviors, patterns, medications, et cetera, that need to be identified before we really label something as hypersomnolence, somnolence, very tired, fatigued, rundown.

There's so much that goes into it.

So I would never think anyone's crazy.

Just like Kathy said, a complaint is a complaint because it's happening.

But what is driving that complaint is very important.

I think there's something to be said about normalizing episodes of occasional sleepiness, right, as well.

So I get a lot of patients, for example, with insomnia, that are like, "I'm not doing well because after lunch

lunchI feel sleepy.

Um, but then I'm like, "Well, let's think about it throughout the day." Is it this one...

I, I think about circadian timing and when is there a dip-

Yeah

... that tends to happen, and are the-- is that lining up there? And that's when I'll have a talk about, with the patient about circadian timing, what's considered normal.

So when I hear those terms and when I'm considering those terms in my evaluation of a patient, I'm really thinking about somebody who is fighting the urge to fall asleep, who they feel sleepy.

Now, for example, in our clinic, we use the clinic rooms at night for our sleep studies, so they have a bed in them.

And oftentimes one of the things I'll ask patients to get at this symptom, because a lot of people will come to us saying, "I feel tired." And tired can mean a thousand different things.

And so what I say is, "See that bed right there? If I were to leave this room and let you take a nap in that bed, do you think you could fall asleep? Would you be happy about that?" And there's people that are like, "No, no.

It's not that.

I just feel exhausted." And then there's the people that say, "Absolutely.

If you could do that right now [laughs] that would be fantastic, 'cause I'm about to fall asleep." And it's that second group that when we're r- and again, all types of tiredness are important because they are pointing to a problem typically.

But when I think about hypersomnolence, it's those individuals that say, "Leave me alone.

I wanna lay down in that bed right now."

Saima, you know, one of the things I heard in Kathy's response there is kind of a range of somnolence or kind of a spectrum of somnolence, if you will.

If I said to you that some aspects of somnolence are normal, would you say I'm crazy?

No, I wouldn't think you're crazy.

But I would try to understand, just like Kathy defined, the, the need, the, the urge and the necessity to sleep, where is that coming from? Um, y- you shouldn't, if you're sleeping well and enough hours, you shouldn't have such a desirable need to sleep unless there's a sleep disorder present, in my opinion.

But there's a lot of weeding out of habits, behaviors, patterns, medications, et cetera, that need to be identified before we really label something as hypersomnolence, somnolence, very tired, fatigued, rundown.

There's so much that goes into it.

So I would never think anyone's crazy.

Just like Kathy said, a complaint is a complaint because it's happening.

But what is driving that complaint is very important.

I think there's something to be said about normalizing episodes of occasional sleepiness, right, as well.

So I get a lot of patients, for example, with insomnia, that are like, "I'm not doing well because after lunch

lunchI feel sleepy.

Um, but then I'm like, "Well, let's think about it throughout the day." Is it this one...

I, I think about circadian timing and when is there a dip-

Yeah

... that tends to happen, and are the-- is that lining up there? And that's when I'll have a talk about, with the patient about circadian timing, what's considered normal.