Maintaining Sleep Diary or Sleep Log
This technique is the best and convenient way to gather sleep details. The physician provides sleep diary to the patient. Generally, patients have to fill the sleep logs for two consecutive weeks. The captured data provides more understanding of patients sleep troubles.-
The time when the patient went to bed
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Actual sleep time
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Any disturbance to start the sleep
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Any discomfort to start the sleep
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Awakening time
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Any sleep disturbance
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Reason for in-between sleep disturbance
Sleep Rating Scale: Epworth Sleepiness Scale
We are describing the method below for our readers only for their information purpose. Kindly note that we do not use this scale (or any other such tool) for Online Homoeopathy Consultation.
Interested readers should approach for the detail information about this scale on ESS official site.
The ESS is self-administered questionnaire with 8 questions. The patient has to rate chances of his dozing off while engaged in 8 different activities. The questionnaire uses 4 point scale i.e. 0-3. The ESS score can range from 0-24. The higher score denotes the higher propensity of an individual towards dozing off.
The ESS Scale:
- 0: No chances of dozing
- 1: Slight chances of dozing
- 2: Moderate chances of dozing; and
- 3: High chances of dozing.
This scale, in particular, measures daytime sleepiness. The short questionnaire administered to assess sleep problems. The patient rates the probability of falling asleep during daily activities. The resultant value used for diagnosing narcolepsy or like other sleep disorders.
Below is general interpretation of ESS score as published on the official website
- 0-5:- Lower Normal Daytime Sleepiness
- 6-10:- Higher Normal Daytime Sleepiness
- 11-12:- Mild Excessive Daytime Sleepiness
- 13-15:- Moderate Excessive Daytime Sleepiness
- 16-24:- Severe Excessive Daytime Sleepiness
Physical Examination to diagnose Chronic Insomnia
It is important to realize that there is no definitive physical sign to mark insomnia. Generally, the physician has to correlate medical history, symptoms and sleep data. Additionally, a physician may examine signs of co-morbid disorders. Below is the list of some co-morbid disorders which can be examined.
- Asthma
- Chronic Obstructive Pulmonary Disorder (COPD)
- Restless leg syndrome
- Pain disorders like arthritis, back pain etc.
- Hyperthyroidism
Laboratory Investigations to diagnose Chronic Insomnia
Blood Examination
It is important to realize that there is no definite laboratory blood marker for insomnia. The physician may decide which laboratory investigations to be carried out. In fact, factors like patient age, the presence of co-morbid disorders, patient past and family history etc. help him to prescribe the lab tests.
Generally, the physician has to correlate patient history, symptoms and sleep data with laboratory results of co-morbid disorders. Blood examination helps to rule out iron deficiency, vitamin B12 deficiency or thyroid levels.
Polysomnography (PSG)
This is the multi-parametric test. The test is intended for diagnosing narcolepsy and similar sleep disorders. It is abbreviated as PSG. The study records bio-physiological changes that occur during sleep. This test is usually performed during the night. However, in the case of shift workers, it can be carried away during the daytime.
This is the non-invasive and painless test for diagnosing narcolepsy.
PSG procedure
The PSG includes EEG study for the brain. It also includes EOG test for measuring eye movements. The testing includes muscle activities (EMG) and heart rhythm (ECG) are records. Along with diagnosing narcolepsy, this test rules out other sleep disorders also.
The person appears in the sleep lab in the early evening. It usually takes 1-2 hours to wired him up. Multiple channel data being recorded after he falls asleep. Such sleep labs are set in hospitals. However, some medical offices or even hotels provide such facility. The sleep physician attends and monitors the test. The patient can be discharged in the early morning.
Analysis
Nowadays one can conduct the test in his home. This adds to the patient comfort value.
The scorer reviews test data. The resultant information details the sleep onset, sleep efficiency and sleep stages.
The study also records breathing irregularities, cardiac rhythm abnormalities, leg movements, body positions while sleeping and oxygen saturation.
Only the sleep physician can interpret the data accurately. Ideally, medical history details and other relevant details help in diagnosing narcolepsy and rule out other sleep disorders.
Actigraphy
This non-invasive technique monitors the patient rest and activity cycles. A portable device worn on wrist records the patient data. Generally, the device is worn on the non-dominant arm. It records the patient movements and sometimes light exposure. The device helps to track sleep-wake behavior by notifying patient movements.
Unlike Polysomnography, Actigraphy allows the regular day to day activities. Additionally, sleep actigraphs are more affordable compared to polysomnography. Generally, the device can store a couple of weeks data. The comparison of actigraphy results with polysomnography provides more valuable information.
It is important to realize that diagnosis of chronic insomnia is a subjective procedure. Investigation results may not correlate with patients insomnia status. Hence, patients, actual sleeping difficulties must play role in deciding the treatment plan.
