Differentials

Travel-related fatigue

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Usually symptoms are of shorter duration than jet lag and resolve after a normal night’s sleep.[4]

INVESTIGATIONS

Diagnosis is clinical.

Short-term insomnia disorder

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

To be considered if symptoms persist beyond the episode of jet lag but last less than three months.[1]

INVESTIGATIONS

Sleep history.[1]

Insomnia

Chronic insomnia disorder

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

To be considered if symptoms persist beyond the episode of jet lag and last more than three months.[1]

INVESTIGATIONS

Sleep history.[1]

Dyssomnias in children

Delayed sleep-wake phase disorder

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

To be considered if symptoms persist beyond the episode of jet lag and last more than three months.[1]​ Typically occurs in adolescence, or in extreme "owls" on the lark-owl scale ("night people").[1]​​

INVESTIGATIONS

Sleep logs confirm delayed pattern of the habitual sleep period.[1]​​

Actigraphy confirms diagnosis.[1]​​

Dyssomnias in children

Shift-work disorder

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

History of work schedule that coincides with the normal sleep period (generally, nighttime).

INVESTIGATIONS

Sleep logs confirm a disturbed sleep-wake pattern.[1]

Actigraphy confirms diagnosis.[1][5]​​

Advanced sleep-wake phase disorder

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

To be considered if symptoms persist beyond the episode of jet lag and last more than three months.[1]

INVESTIGATIONS

Sleep logs confirm a stable advance in timing of the sleep period.[1]

Actigraphy confirms diagnosis.[1]​​

Non-24-hour sleep-wake rhythm disorder

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

To be considered if symptoms persist beyond the episode of jet lag and last more than three months.[1]​ There may be a history of blindness.

INVESTIGATIONS

Sleep logs confirm pattern of daily progressive change in primary sleep episode.[1]

Actigraphy confirms diagnosis.[1]

Irregular sleep-wake rhythm disorder

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

To be considered if symptoms persist beyond the episode of jet lag and last more than three months.[1]​ There may be a history of neurodegenerative disorders, such as dementia; or in children, developmental disorders.

INVESTIGATIONS

Sleep logs confirm pattern of at least three irregular bouts of sleep with no major sleep period.[1]

Actigraphy confirms diagnosis.[1]

Obstructive sleep apnea

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Consider if there are symptoms of excessive daytime sleepiness and unrefreshing sleep predating travel. Patients with obstructive sleep apnea (or their bed partners) may also report loud snoring, gasping during sleep, and apneas.

INVESTIGATIONS

Polysomnography (including electroencephalogram, electro-oculographic recording, air flow assessment, electromyogram, capnography, esophageal manometry, ECG, and pulse oximetry) demonstrates five or more obstructive respiratory events per hour of sleep.[1]

Obstructive sleep apnea in adults

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