As a doctor, my challenge is to distinguish true cases of hypersomnia from the chronic, low-level fatigue and tiredness that sometimes afflict people who, while basically normal, may be bored, restless, or otherwise unhappy. I must also sort out those patients who are simply unaware that they are not getting enough sleep to meet their daytime needs. Often these are people who hold two jobs, or who cram their days so full of activities that they do not allow sufficient time for sleep. Yet another type of patient excluded from the DOES category is the “healthy hypersomniac,” the person who simply needs more sleep than other people—possibly as many as fourteen hours. These long sleepers may not complain of excessive sleepiness, but, like their short-sleeping counterparts discussed in the previous chapter, they may experience some kind of psychological fallout if they think of themselves as abnormal or experience social isolation as a result of their sleep patterns.

Among the questions I might ask you to determine if DOES is a problem in your case: is your feeling of sleepiness constant, or does it appear only at certain times? When do episodes of sleepiness occur? In what ways does the sleepiness affect you: do you take naps, for example, or struggle constantly to stay awake? How well do you function generally during the day? I would also conduct a number of clinical tests in order to rule out such causes of excessive sleepiness as hypothyroidism, hypoglycemia, drug abuse, metabolic disorders, even brain tumor. If none of these pathologies could be identified, then I would be reasonably certain you had a true disorder of excessive sleepiness.

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