General Flashcards
Undifferentiated Tiredness
History: Maintenance/Initation, Shift worker, Sleep walking/night terrors, Restless limbs, Snoring/apnoea, Falling asleep while driving/performing tasks, Distressed by symptoms/impacting function (Diagnostic criteria for insomnia), Impaired concentration or memory/irritibability), Low mood/anhedonia, weight gain/cold intolerance/constipation (Thyroid), Coffee/stimulant intake at night, Screen-time around bed.
Differentials: Poor sleep hygiene/stimulant use, insufficient sleep, Insomnia, Depression, OSA, Narcolepsy, Thyroid dysfunction, delayed sleep phase disorder, anaemia, antihistamine use
Ex: HTN, Increased BMI/neck circ/abdo circ, blunted affect, signs of thyroid disease (Reflexes, brittle nails, dry hair), signs of illcit substance use ie injecting site/pinpoint pupils, signs of anaemia, tonsilar size (OSA)
Mx: Avoid laying in bed/get up after 20min, stop late night computer use, encourage relaxation techniques, ambient light, warm drink before bed, avoid daytime naps, avoid stressful rumination before bed, consistent wake up time, no electronics in bedroom
