Joshua Olham Joshua Olham is a 40-year-old male seen in the medical clinic, who is complaining of severe fatigue during the day. Joshua also reports waking up frequently throughout the night. He states that he has a new baby at home and a new job, which requires a daily commute of 1 hour each way to and from work. He almost fell asleep while driving home last week, and this is making him afraid to drive.


Sleep disorders are a common issue that can significantly impact an individual’s daily functioning, productivity, and overall well-being. In this case, Joshua Olham, a 40-year-old male, presents to the medical clinic with complaints of severe fatigue during the day and frequent nighttime awakenings. This paper aims to discuss the potential causes, assessment, and management options for Joshua’s symptoms.


Fatigue and sleep disturbances can be caused by a variety of factors, including lifestyle choices, medical conditions, medication side effects, and sleep disorders. Joshua’s symptoms of daytime fatigue and frequent awakenings are characteristic of a sleep disorder known as obstructive sleep apnea (OSA).

Obstructive sleep apnea is a common sleep disorder characterized by frequent interruptions in breathing during sleep due to the collapse of the upper airway. This results in oxygen desaturation, disrupted sleep architecture, and excessive daytime sleepiness. Risk factors for OSA include obesity, male gender, older age, smoking, and alcohol consumption.


Joshua’s symptoms and risk factors suggest a high likelihood of obstructive sleep apnea. The presence of a new baby at home and a new job with a long daily commute may have contributed to the development or exacerbation of his symptoms. Sleep disturbances are common in individuals with young children and can result in insufficient sleep duration and disrupted sleep structure.

The excessive daytime sleepiness reported by Joshua, which almost led to an accident while driving, is a serious concern. It highlights the potential dangers of untreated obstructive sleep apnea, as individuals with this condition are at an increased risk of motor vehicle accidents due to impaired alertness and attention.


The assessment of Joshua’s symptoms should be comprehensive and involve a thorough history, physical examination, and potentially diagnostic tests. The history should focus on the duration and severity of symptoms, associated factors (such as alcohol consumption or use of sedative medications), and any comorbid medical conditions that may contribute to sleep disturbances.

Given Joshua’s history of excessive daytime sleepiness and the potential risk it poses while driving, a subjective measure of sleepiness, such as the Epworth Sleepiness Scale, can be administered. This scale quantifies an individual’s likelihood of falling asleep in different situations and can provide insight into the severity of daytime sleepiness.

Additionally, further objective assessments may be warranted, such as a overnight sleep study or polysomnography. This test measures different physiological parameters during sleep, including brain waves, eye movements, heart rate, and respiratory patterns. It can help diagnose obstructive sleep apnea by identifying the presence of apneas and hypopneas (partial blockages) during sleep.


The management of obstructive sleep apnea typically involves a combination of lifestyle modifications, continuous positive airway pressure (CPAP) therapy, and, in some cases, surgical interventions.

Lifestyle modifications may include weight loss, avoiding alcohol and sedative medications, and improving sleep hygiene practices. Weight loss is particularly important for individuals with obesity-related sleep apnea, as excess weight contributes to the collapse of the upper airway.

CPAP therapy is considered the gold standard treatment for obstructive sleep apnea and involves wearing a mask during sleep that delivers a constant flow of air to keep the airway open. This reduces the occurrence of apneas and hypopneas, improves oxygenation, and promotes restful sleep. Compliance with CPAP therapy is crucial for its effectiveness, and education and support are essential to ensure successful long-term use.

In some cases, surgical interventions may be considered to address anatomical abnormalities contributing to the obstruction of the upper airway. These procedures may involve removing excess tissue, repositioning the jaw, or opening up the airway in other ways. Surgical interventions are typically reserved for cases of severe sleep apnea or when CPAP therapy is ineffective or not tolerated.


In conclusion, Joshua Olham’s symptoms of severe fatigue during the day and frequent nighttime awakenings suggest a possible diagnosis of obstructive sleep apnea. Given the potential risks associated with untreated sleep apnea, a comprehensive assessment, including a detailed history, physical examination, and potentially a sleep study, is warranted. Management options for obstructive sleep apnea may include lifestyle modifications, CPAP therapy, and surgical interventions, depending on the severity and response to treatment. Prompt diagnosis and appropriate management are essential for improving Joshua’s symptoms, ensuring his safety, and enhancing his overall quality of life.