Office evaluation of the "tired" or "sleepy" patient

In an outpatient neurologic practice, the patient complaint of being "tired" is frequently encountered yet often not specifically addressed. Clarifying the symptoms and determining whether the tiredness is the result of excessive daytime sleepiness versus fatigue or weakness is the first step in diagnosing and treating the patient. A detailed neurologic and sleep history and exam can often distinguish among these different symptoms, establish the potential causes of excessive sleepiness, and decide on the additional ancillary tests that may be helpful to determine the underlying etiology. Understanding the etiology of patient's symptoms is necessary to initiate appropriate treatment.