Understanding Sleep Disorders: Part 1

Welcome to our series on sleep disorders with Dr Joseph A. Diamond from the Icahn School of Medicine at Mount Sinai. Read this case, and send your feedback to neurologyeditor@consultant360.com. Then listen to next week's podcast with Dr Diamond for the answer!

A 46-year-old man with a medical history significant for episodic common migraines, hypertension, and depression presents to your office with fatigue throughout the day, which has been affecting his work and marriage. He denies any overt symptoms of depression but says he usually feels “blue” and has trouble sleeping during the winter months.

He is taking venlafaxine and lisinopril. He tried an over-the-counter remedy (he thinks it was valerian) without benefit. Upon further questioning, he denies other problems but does have occasional headaches, usually in the morning. His total sleep time every night is 5.5 to 6 hours (range, 3.5-7), usually related to problems falling asleep.

He denies any other abnormal sleep behaviors or problems. Screening for sleep disordered breathing is positive for occasional snoring and dry mouth, Epworth Sleepiness Scale score is 8 out of 24 (an upper limit of normal), Insomnia Severity Index score shows moderate insomnia, and Fatigue Severity Scale is 37 out of 63 (mildly elevated). How many sleep disorders does he likely have?