Case 3: A 46-Year-Old Male Hotel Night Manager With Hypertension Who Feels Chronically Tired and Run Down.

Case 2: A 52-Year-Old Male Security Guard Who Falls Asleep on the Early Morning Shift. Shift work disorder may affect any person who works a job with nonconventional hours, leading to excessive sleepiness and impaired functioning. This case illustrates the impact of shift work disorder on patient performance and quality of life and how appropriate assessment can aid in the differential diagnosis and treatment recommendations.

Case 1: A 37-Year-Old, Female 911 Operator Who Works the Night Shift and Complains of Insomnia and Depression. Shift work disorder has a significant impact on relationships, mood, and performance as well as on the hallmark symptoms of insomnia and daytime sleepiness. Symptoms of shift work disorder and depression may appear to be similar but may have subtle differences.

Recognizing and Managing Shift Work Disorder, an Underdiagnosed Condition: Improving Quality of Life. Nearly 18% of the U.S. labor force works alternative hours that place individuals at risk for shift work disorder (SWD). Although SWD poses serious risks to the patient’s functioning, health, safety, and quality of life, it is one of the sleep/wake disorders that is largely undiagnosed and undertreated.

Chronic Migraine: Making the Diagnosis. The diagnosis of "chronic migraine” is a newly established diagnosis. Although descriptors of chronic migraine have been reported in medical literature for decades, it recently (2004; 2006) has become a codeable diagnosis rather than an adjective to describe “really bad migraine.” A genetically linked primary headache disorder, chronic migraine causes more disability and negative effects on the sufferer’s quality of life than does episodic migraine.

The Diagnosis, Treatment, and Management of Acute Migraine. Migraine is a highly prevalent disease characterized by recurrent episodes of disabling headache, associated nausea, and sensory hypersensitivity. Migraine attacks generally begin early in life and continue over many decades of a person’s life. The significant disability associated with migraine is observed during an acute episode, but is more aptly understood through the accumulated disability of recurrent attacks over time.

When You Can’t Fall Asleep, Maybe it’s Your Clock That’s Broken. Delayed sleep phase disorder is the most common circadian rhythm sleep disorder and may be present in as many as 10% of adolescence though the numbers decline in older cohorts. It is under recognized, misdiagnosed as insomnia, and too often mistreated resulting in excessive daytime sleepiness, social, work, and scholastic dysfunction, and even depression.

Best Practices in Recognition, Diagnosis, and Treatment of Circadian Rhythm Disorders: An Online Activity for Primary Care Clinicians. Underlying human physiology and behavior are rhythms which wax and wane with 24-hour periodicity, regulating core body temperature, insulin secretion, alertness, mood, and other biologic parameters. To ensure homeostatic balance these and other circadian rhythms must be synchronized by various timekeepers, particularly the environmental light/dark cycle.