Can You Diagnose This Sleep Disorder?

Author:
Joseph A. Diamond, MD
Mount Sinai West/St. Luke's

A 48-year-old healthy man presents to your office reporting that he has been having “sleep problems, maybe insomnia” for the past 3 months. These problems began shortly after his work shift was changed from the daytime shift (7 AM to 3 PM) to the late shift (3 PM to 11 PM) at his request, because he was finding it too difficult to get to work on time as a result of helping his children get ready for school (they awake at 6 AM each school day). He previously went to bed at 10 PM and fell asleep without difficulty, awakening at 5:45 AM.

He works as a computer programmer and, other than prior intermittent tardiness, has an exemplary work record. Since his schedule change, he has noted that he will “lie awake in bed for 15 minutes, tossing and turning,” and he says, “I just don’t feel tired when I’m first trying to sleep, so I get out of bed,” usually attempting sleep in bed when he gets home at 11:45 PM and not falling asleep until 1 AM. This causes him to feel fatigued later in the day, since he still has to initially awake at 6 AM when his children arise, but then he can go back to bed later for an additional 1 to 2 hours, work and home duties permitting. He exercises later in the day and drinks extra caffeine to offset this feeling of fatigue but worries his work and family performance may be “slipping.”

He falls asleep around 1 AM no matter whether he is reading an engaging book or listening to music and regardless of which room he is in. On the weekends, when his children do not have school, he sleeps from 1 AM until 8:30 AM and wakes up feeling more refreshed.

Joseph A. Diamond, MD, DABPN, DABSM, is an assistant professor of neurology at the Icahn School of Medicine at Mount Sinai; Neurology Clerkship Site Director at Mount Sinai West/St. Luke's; and Neurohospitalist at Mount Sinai West/St. Luke's in New York, New York.

Do you know the etiology of this patient's condition? >>

Now that you have diagnosed this patient, it is important to understand the diagnosis' etiology.

Joseph A. Diamond, MD, DABPN, DABSM, is an assistant professor of neurology at the Icahn School of Medicine at Mount Sinai; Neurology Clerkship Site Director at Mount Sinai West/St. Luke's; and Neurohospitalist at Mount Sinai West/St. Luke's in New York, New York.