Differential Diagnosis for Sleep Disturbances in a Pregnant Woman

• Single most likely diagnosis
  • Normal sleep in pregnancy: This is the most likely cause of her symptoms. Sleep disturbances are common during pregnancy, especially in the third trimester, due to discomfort, fetal movement, and other pregnancy-related factors. The patient's symptoms of waking up more frequently and feeling tired during the day are consistent with normal sleep changes in pregnancy.
• Other Likely diagnoses
  • Poor sleep hygiene: Although the patient does not report any specific poor sleep habits, it is possible that her sleep environment or habits have changed during pregnancy, contributing to her sleep disturbances.
  • Chronic insomnia disorder: The patient's report of waking up more frequently and having difficulty sleeping could be indicative of chronic insomnia disorder, although her ability to function during the day and take naps suggests that it may not be as severe.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Sleep apnea: Although the patient denies snoring or pauses in breathing, sleep apnea can still occur, especially during pregnancy. It is essential to consider this diagnosis due to its potential risks to both the mother and the fetus.
  • Restless leg syndrome: The patient denies abnormal movements or discomfort in her limbs, but restless leg syndrome can still be a possibility, especially during pregnancy. This condition can significantly impact sleep quality and should not be missed.
• Rare diagnoses
  • Adjustment disorder: While the patient is experiencing sleep disturbances, there is no clear indication of an adjustment disorder, which typically involves significant emotional or psychological distress in response to a stressor.
  • Other sleep disorders: Other sleep disorders, such as narcolepsy or periodic limb movement disorder, are less likely given the patient's symptoms and pregnancy status. However, they should still be considered in the differential diagnosis if other symptoms or risk factors are present.