A 22-year-old university student was evaluated for fatigue and disturbed sleep experienced over an interval of eight months. The participant reported bedtime of 12:30-1 am with 15 to 90 minute intervals of sleep onset latency. The patient reported wake time of 6:30 am that was absolute due to her school and work schedule. She denied napping. The patient reported an average of two awakenings per night for approximately ten to sixty minutes. The patient denied snoring, restless legs, morning headache, nightmares, depression and anxiety. Her BMI was 30; appetite was appropriate to two meals per day plus snacks. The patient recent physical examination labs requested for her job was within normal limits (1-7). The patient does not use alcohol, nicotine, caffeine of recreational drugs. She is a recovered addict to a three-year history of cocaine and amphetamine abuse. The patient is not pregnant. The Epworth Sleepiness Inventory score of 15/24 indicated severe fatigue and sleepiness (Table 1).
The patient received a clinical intervention and completed the Beck Depression Inventory (BDI=2). Symptoms of ???, crying spells, physiological irregularities of energy, panic attacks, phobic states, excessive worry, were inconsistent with the patient’s history. The patient experienced a sense of overwhelming worry (emotional fatigue to maintaining her work and academic schedule successfully. The physical fatigue is experienced by this patient secondary to the poor sleep (Figure 1).
Assessment, CBTi x 4 with FU 3m later
Administer Beck Depression Inventory, Fatigue Scales. Use Symptom Checklists in assessment and sessions to evaluate for Depression and Anxiety Disorder.
Guide and reinforce skill development for patient skills to: self-regulate to relaxation, become aware of sleepiness versus physical fatigue symptoms, application of sleep hygiene, stimulus control with wake-up occurences and use of energizing practices of movement/sufficient bright light/nutrition/hydration.
In reviewing the findings of the patient's improvements in sleep efficiency it becomes paramount to explore the within the sessions, the patients circumstances related to the fatigue. The assessment and ongoing monitoring of the patient's fatigue level is essential to discerning the course of clincial treatment for fatigue and to rule out psychiatric conditions such as Depression/A/Persistent Depressive Disorder.
- need to do differential dx to R/O MDD