Dialogue:
Doctor: How's everything going on? 
Patient: I'm having this weird feeling where I feel that my face is going to twitch and I start doing these grimacing actions on my face, mouth, and then it kind of suppresses it, but I'm not sure what's happening. I'm still having a fear of feeling of pressure in the backside of my head and it comes approximately like once each week. 
Doctor: What exactly does this pressure feels like? 
Patient: It feels like pins and needles in my head and a lot of pressure and often it feels like water is running down my hair. 
Doctor: How frequent are these feelings? Is anything helping you? Are you taking any medications or anything else for it? 
Patient: It is like I said before, like once a week maybe. It has decreased from before. I am taking Aleve and it is kind of helping me. 
Doctor: Is anything else going on? 
Patient: Oh yeah, I'm still suffering from that problem of daydreaming at work and have noticed that I fall asleep when I'm sitting in front of my desk or in front of my television. I just fall asleep in non stimulating environments. It seems like I'm always tired and I cannot get enough amount of sleep no matter what I do. 
Doctor: It feels like insomnia to me, but what are your working hours? 
Patient: I work from four to midnight, and then after getting home I just, I cannot sleep. It takes me around two hours and then I wake up at nine each morning. So, it's just like I'm not getting to sleep more than five to six hours ever. Usually, it is like five hours of sleep for me.
Doctor: How is the quality of your sleep? Do you wake up many times or have sound sleep for those five hours?
Patient: It is good, I just need to get up and go to the bathroom. I think I snore, but I do not know exactly. 
Doctor: Have you ever lost your sleep to catch your breath? 
Patient: Not that I remember.

Clinical note section (GENHX):
The patient had several episodes where she felt like her face was going to twitch, which she could suppress it with grimacing movements of her mouth and face.  She reports she is still having right posterior head pressure like sensations approximately one time per week.  These still are characterized by a tingling, pressure like sensation that often has a feeling as though water is running down on her hair.  This has also decreased in frequency occurring approximately one time per week and seems to respond to over-the-counter analgesics such as Aleve.  Lastly during conversation today, she brought again the problem of daydreaming at work and noted that she occasionally falls asleep when sitting in non-stimulating environments or in front of the television.  She states that she feels fatigued all the time and does not get good sleep.  She describes it as insomnia, but upon questioning she works from 4 till mid night and then gets home and cannot go to sleep for approximately two hours and wakes up reliably by 9.00 a.m. each morning and sleeps no more than five to six hours ever, but usually five hours.  Her sleep is relatively uninterrupted except for the need to get up and go to the bathroom.  She thinks she may snore, but she is not sure.  She does not recall any events of awakening and gasping for breath.