Evaluations of Daytime Sleepiness

The two most commonly performed objective evaluations to assess daytime sleepiness are the MSLT and the maintenance of wakefulness test (MWT). During the MSLT, the patient attempts to take a 20-minute nap every 2 hours during the day beginning 2 hours after morning awakening (following a normal night's sleep) to evaluate physiologic sleepiness. The patient is instructed not to resist the urge to fall asleep. Sleep latency of less than 5 or 6 minutes is considered pathologically sleepy. The occurrence of an REM onset period during two naps is indicative of a diagnosis of narcolepsy. The MWT is performed to assess a patient's ability to avoid succumbing to sleepiness (manifest sleepiness). Similar nap opportunities are set up for the MWT, with the exception that the patient is instructed to lie down in bed and attempt to stay awake. A subjective assessment of sleepiness can be completed using the Epworth Sleepiness Scale (ESS). The ESS is a validated questionnaire that is easy to use and reliably predicts subjective sleepiness. The maximum score is 24, and any patient with a score greater than 10 is considered sleepy.

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