Tiredness is one of the most common complaints that confront the clinician. Yet the nature of the symptom and its implications for sleep-related disorders is poorly understood. This review provides the clinician with an understanding of the difficulties inherent in assessing the tired patient. The complaint of tiredness is commonly an expression of sleepiness and fatigue that arises as the result of sleep-wake–related disorders. Behavioural and physiological procedures are described in the assessment and management of sleepiness and fatigue in primary sleep disorders and sleep-related medical and psychiatric disorders. Improvement in the diagnosis and management of the fatigued or sleepy patient requires that residents in psychiatry and neurology be exposed to the behavioural and physiological techniques of sleep medicine as part of their post-graduate training programs.
MitlerMMCarskadonMACzeislerCADementWCDingesDFGraeberRC. Catastrophes, sleep, and public policy: Consensus report. Sleep1988;11:100–9.
2.
RosenRCRosekindMRosevearCColeWEDementWC. Physician education in sleep and sleep disorders – a national survey of United States medical schools. Sleep1993;16:249–54.
3.
SuttonDABadleyEMMoldofskyH. Prevalence and independent distribution of insomnia, unrefreshing sleep, sleepiness and short sleep duration in the Canadian population. Sleep Res1997;26:514.
4.
SuttonDABadleyEMMoldofskyH. Pain, chronic physical health conditions, and psychosocial stress are major determinants of insomnia and unrefreshing sleep in the Canadian population. Sleep Res1997;26:596.
5.
MalowBA. Waking up to the importance of sleep in neurologic disorders. Neurology1999;52:1732–3.
6.
PhillipsBCollopNGoldbergR. Sleep medicine practices, training, and attitudes–A wake-up call for pulmonologists. Chest2000;117:1603–7.
7.
PriceRKNorthCSWesselySFraserVJ. Estimating the prevalence of chronic fatigue syndrome and associated symptoms in the community. Public Health Reports1992;107:514–22.
8.
MoldofskyH. Evaluation of daytime sleepiness. Clin Chest Med1992;13:417–25.
9.
RushAJArmitageRGillinJYonkersKAWinokurA, Moldofsky H, and others. Comparative effects of nefazodone and fluoxetine on sleep in outpatients with major depressive disorder. Biol Psychiatry1998;44:3–14.
10.
Salin-PascualRJGalicia-PoloLDruckerCR. Sleep changes after 4 consecutive days of venlafaxine administration in normal volunteers. J Clin Psychiatry1997;58:348–50.
11.
MarkkulaJLauermaH. Mianserin and restless legs. Int Clin Psychopharmacol1997;12:53–8.
12.
ZulleyJCrönleinTHellWLangwiederK. Fatal highway accidents mainly caused by falling asleep. In: ÅkerstedtTKecklundG, editors. Work hours, sleepiness and accidents. Stockholm: Karolinska Institute; 1994. p 104.
13.
KecklundGÅkerstedtT. Time of day and Swedish road accidents. In: ÅkerstedtTKecklundG, editors. Work hours, sleepiness and accidents. Stockholm: Karolinska Institute1994. p 100.
14.
YoshitakeH. Three characteristic patterns of subjective fatigue symptoms. Ergonomics1978;1:231–3.
15.
SchwartzJEJandorfLKruppLB. The measurement of fatigue: A new instrument. J Psychosom Res1993;37:753–62.
16.
HoddesEZarconeVSmytheHPhillipsRDementWC. Quantification of sleepiness: A new approach. Psychophysiology1973;10:431–6.
17.
JohnMW. A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep1991;14:540–5.
18.
HoughtonWilkinson RT. Portable four-choice reaction time test with magnetic tape memory. Behav Res Methods1975;7:441–6.
19.
HorneJAReynerLA. Sleep related vehicle accidents. BMJ1995;310:565–7.
20.
MitlerMMMillerJCLipsitzJJWalshJKWylieCD. The sleep of long-haul drivers. N Engl J Med1997;337:755–61
21.
AldrichMS. Automobile accidents in patients with sleep disorders. Sleep1989;12:487–94.
22.
RichardsonGSCarskadonMAFlaggWVan den HoedJDementWCMitlerMM. Excessive daytime sleepiness in man: Multiple sleep latency measurement in narcoleptic and control participants. Electroencephalogr Clin Neurophysiol1978;45:621–7.
23.
DoghramjiKMitlerMMSangalRBShapiroCTaylorSWalslebenJBelsileCErmanMKHaydukRHosnRO'MalleyEBSangalJMSchutteSLYouakimJM. A normative study of the Maintenance of Wakefulness Test (MWT). Electroencephalogr Clin Neurophysiol1997;103:554–62.
