Sleep Disorders

Overview of the Medical Evaluation

The police physician should be consulted if an LEO is observed to be somnolent, has an episode of sudden incapacitation, or manifests erratic job performance (see Appendix C – Early Warning Systems).

The primary care physician or police physician should be able to perform the initial clinical evaluation of the LEO who may have a sleep disorder. The definitive diagnostic workup and therapy may involve the assistance of formally credentialed specialists in sleep medicine, neurology, pulmonary medicine, dentistry, and other disciplines.

The initial evaluation for sleep disorder consists of: 1) a directed history and physical examination; 2) review of past medical history; 3) review of psychological comorbidities; 4) occupational history5; 5) a review of medications currently taken on a chronic or episodic basis; 6) laboratory studies to rule out medically correctable conditions associated with somnolence such as renal disease, diabetes, hypothyroidism; and 7) screening tests. Further diagnostic testing such as the polysomnogram (sleep study) may be indicated based upon the findings of the initial evaluation. This chapter will focus on the five most commonly encountered sleep disordersa – obstructive sleep apnea, narcolepsy, shift work disorder, restless leg syndrome, and idiopathic hypersomnia.