Fatigue Case Study Essay

Thank you very much for referring Callie along for her lifelong issues of fatigue, lethargy and excessive daytime sleepiness. As you are aware, she dates this back to her late teenage years and the symptoms do not seem to correlate with her diabetes. She has always woken unrefreshed and currently she is sleeping for 8-8.5 hours very well and wakes unrefreshed with headaches in the morning. She has significant lethargy and fatigue throughout the day and some excessive daytime sleepiness is passive situations with an Epworth Sleepiness Score of 13/24.

She lives alone and is uncertain as to whether or not she snores, but of note her past partner never reported any snoring and she has had no episodes of nocturnal choking. She only very intermittently

Her other symptom is that of a reduced exercise tolerance. She finds that when she walks up the stairs at work, she has some muscle pain in her quad and significant fatigue that she does to attribute to shortness of breath on exertion. It is not associated with any chest pain, palpitations or dizziness.

On examination, she is well looking, she was saturating at 98% on room air and her lung fields were clear. Her cardiovascular was unremarkable.

Impression/Management:

The lifelong history of excessive daytime sleepiness alongside the sleep paralysis and possible hypnogogic hallucinations in the absence of any significant snoring or restless legs symptoms to suggest a possible underlying narcolepsy and in order to investigate this, I have organised a diagnostic sleep study with MSLT at the Austin Hospital next week.

With regards to he muscle aches and pains whilst walking, I have organised a CK level to complete the serological workup for her symptoms and also an autoimmune screen.

I will then see her following the sleep study to discuss the results and ongoing management.

Kind