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Excessive Daytime SleepinessWakefulness and daytime fatigue -
Polysomnography is now commonly done in the home to diagnose obstructive sleep apnea, but not any other sleep disorders. A multiple sleep latency test is done to distinguish between physical fatigue and excessive daytime sleepiness and to check for narcolepsy.
People spend the day in a sleep laboratory. They are given the opportunity to take five naps at 2-hour intervals. They lie in a darkened room and are asked to take a nap.
Polysomnography is used as part of this test to assess how quickly people fall asleep. It detects when people fall asleep and is used to monitor the stages of sleep during the naps. The maintenance of wakefulness test is used to determine how well people can remain awake while sitting in a quiet room.
This test helps determine how severe daytime sleepiness is and whether people can safely do their usual daily activities such as driving a car. Tests to evaluate the heart, lungs, and liver may be done in people with excessive daytime sleepiness if symptoms or results from the physical examination suggest that another disorder is the cause.
Treatment of insomnia depends on its cause and severity but typically involves a combination of the following:. If insomnia results from another disorder, that disorder is treated. Such treatment may improve sleep. For example, if people have insomnia and depression, treating the depression often relieves the insomnia.
Some antidepressant drugs also have sedative effects that help with sleep when the drugs are given before bed. However, these drugs may also cause daytime sleepiness, particularly in older people. Good sleep hygiene Sleep hygiene The most commonly reported sleep-related problems are insomnia and excessive daytime sleepiness.
read more is important whatever the cause and is often the only treatment patients with mild problems need. But if daytime sleepiness and fatigue develop, especially if they interfere with daytime functioning, additional treatment is warranted, mainly counseling cognitive-behavioral therapy Cognitive-behavioral therapy The most commonly reported sleep-related problems are insomnia and excessive daytime sleepiness.
read more and sometimes prescription sleep aids Prescription sleep aids The most commonly reported sleep-related problems are insomnia and excessive daytime sleepiness. read more or over-the-counter sleep aids Over-the-counter sleep aids The most commonly reported sleep-related problems are insomnia and excessive daytime sleepiness.
If people are considering taking an over-the-counter sleep aid, they should first talk to their doctor because these drugs can have significant side effects. Alcohol is not an appropriate sleep aid and may actually interfere with sleep.
It produces an unrefreshing sleep with many awakenings during the night. Sleep hygiene focuses on changes in behavior to help improve sleep. Limiting the amount of time spent in bed is intended to help eliminate long periods of being awake in the middle of the night.
Cognitive-behavioral therapy, done by a trained sleep therapist, may help people when insomnia interferes with daily activities and when changes in behavior to help improve sleep good sleep hygiene alone are ineffective. Cognitive-behavioral therapy is typically done in four to eight individual or group sessions but can be done remotely through the Internet or by telephone.
The effects of this therapy last a long time after therapy ends. The therapist helps people change their behavior to improve sleep. The therapist asks people to keep a sleep diary. In the diary, people record how well and how long they sleep as well as any behavior that might interfere with sleep such as eating or exercising late at night, consuming alcohol or caffeine , feeling anxious, or being unable to stop thinking when trying to sleep.
Therapists may recommend limiting the amount of time spent in bed so that people spend less time lying in bed and trying unsuccessfully to sleep. This therapy also includes relaxation training, which may involve techniques such as visual imagery, progressive muscle relaxation, and breathing exercises.
When a sleep disorder interferes with normal activities and a sense of well-being, occasionally taking prescription sleep aids also called hypnotics or sleeping pills for up to a few weeks may help. Using prescription Loss of effectiveness: Once people become accustomed to a sleep aid, it may become ineffective.
This effect is called tolerance. Withdrawal symptoms: If a sleep aid is taken for more than a few days, stopping it suddenly can make the original sleep problem worse causing rebound insomnia and can increase anxiety. Thus, doctors recommend reducing the dose slowly over a period of several weeks until the drug is stopped.
Habit-forming or addiction potential: If people use certain sleep aids for more than a few days, they may feel that they cannot sleep without them. Stopping the drug makes them anxious, nervous, and irritable or causes disturbing dreams.
Potential for overdose: If taken in higher than recommended doses, some of the older sleep aids can cause confusion, delirium, dangerously slow breathing, a weak pulse, blue fingernails and lips, and even death.
Serious side effects: Most sleep aids, even when taken at recommended doses, are particularly risky for older people and for people with breathing problems because sleep aids tend to suppress areas of the brain that control breathing.
Some can reduce daytime alertness, making driving or operating machinery hazardous. Sleep aids are especially dangerous when taken with other drugs that can cause daytime drowsiness and suppress breathing, such as alcohol, opioids narcotics , antihistamines, or antidepressants.
The combined effects are more dangerous. Rarely, especially if taken at higher than recommended doses or with alcohol, sleep aids have been known to cause people to walk or even drive during sleep and to cause severe allergic reactions. Sleep aids also increase the risk of falls at night.
Benzodiazepines are the most commonly used sleep aids. Some benzodiazepines such as flurazepam are longer acting than others such as temazepam and triazolam. Doctors try to avoid prescribing long-acting benzodiazepines for older people. Older people cannot metabolize and excrete drugs as well as younger people.
Thus for them, taking these drugs may be more likely to cause daytime drowsiness, slurred speech, falls, and occasionally confusion. Other useful sleep aids are not benzodiazepines but affect the same areas of the brain as benzodiazepines. These drugs eszopiclone , zaleplon , and zolpidem are shorter acting than most benzodiazepines and are less likely to lead to daytime drowsiness.
Zolpidem also comes in a longer-acting extended-release, or ER form and a very short acting low-dose form. Ramelteon , a newer sleep aid, has the same advantages as these shorter-acting drugs. In addition, it can be used longer than benzodiazepines without losing its effectiveness or causing withdrawal symptoms.
It is not habit-forming and does not appear to have overdose potential. However, it is not effective in many people. Ramelteon affects the same area of the brain as melatonin a hormone that helps promote sleep and is thus called a melatonin receptor agonist.
Three relatively new drugs daridorexant , lemborexant , and suvorexant can be used to treat insomnia. They help people fall asleep and help them stay asleep. These drugs block orexin receptors in the brain that are involved in controlling sleep.
Thus, they are called orexin receptor blockers antagonists. They are taken by mouth once a day shortly before going to bed. However, these drugs are not overly effective for treating insomnia. The most common side effect is drowsiness. Some sleep aids that are available without a prescription over-the-counter, or OTC contain antihistamines such as doxylamine and diphenhydramine.
Antihistamines Allergic reactions hypersensitivity reactions are inappropriate responses of the immune system to a normally harmless substance.
Usually, allergies cause sneezing, watery and itchy eyes, a read more However, the drugs that contain antihistamines should not be taken to treat insomnia.
Antihistamines may have significant side effects, such as daytime drowsiness or sometimes nervousness, agitation, difficulty urinating, falls, and confusion, especially in older people.
Melatonin Melatonin Melatonin, a hormone produced by the pineal gland located in the middle of the brain , regulates the sleep-wake cycle. Melatonin used in supplements can be derived from animals, but most is read more is a hormone that helps promote sleep and that regulates the sleep-wake cycle.
It can be used to treat insomnia. It may be effective when sleep problems are caused by consistently going to sleep and waking up late for example, going to sleep at 3 AM and waking up at 10 AM or later —called delayed sleep phase disorder.
To be effective, melatonin should be taken when the body normally produces melatonin the early evening for most people. Use of melatonin for insomnia is controversial, but because it has few side effects, it is safe to use.
Side effects include headache, dizziness, nausea, and drowsiness. Melatonin can be effective for short-term use up to a few weeks , but the effects of using it for a long time are unknown.
Also, melatonin products are unregulated, and thus purity and content cannot be confirmed. A doctor should supervise the use of melatonin.
Marijuana Marijuana Marijuana cannabis is a drug made from the plants Cannabis sativa and Cannabis indica that contain a psychoactive chemical called deltatetrahydrocannabinol THC. read more cannabis contains many chemicals, such as.
CBD cannabidiol , which causes drowsiness but no euphoria. THC tetrahydrocannabinol , which causes euphoria, reduces pain and nausea, and affects sleep stages. Dronabinol Marijuana, Synthetic Cannabis is a term for marijuana. Tetrahydrocannabinol THC is the main active ingredient in marijuana.
Synthetic cannabinoids are man-made drugs that are similar to THC. They are usually sprayed read more is a synthetic version that is used to treat nausea and vomiting associated with cancer chemotherapy and to enhance appetite in AIDS patients.
Many other medicinal herbs and dietary supplements, such as skullcap and valerian , are available in health food stores, but their effects on sleep and their side effects are not well-understood.
Some antidepressants Medications for Treatment of Depression Several types of medications can be used to treat depression: Selective serotonin reuptake inhibitors SSRIs Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine read more such as paroxetine , trazodone , and trimipramine can relieve insomnia and prevent early morning awakening when they are given in lower doses than those used to treat depression.
These drugs may be used in the rare instances when people who are not depressed cannot tolerate other sleep aids. However, side effects, such as daytime sleepiness, can be a problem, especially for older people. Doxepin , used as an antidepressant when given in high doses, may be an effective sleep aid when given in very low doses.
Because sleep patterns deteriorate as people age, older people are more likely to report insomnia than younger people. As people age, they tend to sleep less and to awaken more often during the night and to feel sleepier and to nap during the day.
The periods of the deep sleep that are most refreshing become shorter and eventually disappear. Usually, these changes alone do not indicate a sleep disorder in older people.
Many older people with insomnia do not need to take sleep aids. But if they do, they should keep in mind that these drugs can cause problems. For example, sleep aids can cause confusion and reduce daytime alertness, making driving hazardous.
Thus, caution is required. Poor sleep habits, stress, and conditions that disrupt people's internal sleep-wake schedule such as shift work cause many cases of insomnia and excessive daytime sleepiness. However, sometimes the cause is a disorder, such as obstructive sleep apnea or a mental disorder.
Polysomnography done in a sleep laboratory or at home is usually recommended when doctors suspect the cause is obstructive sleep apnea or another sleep disorder, when the diagnosis is uncertain, or when general measures do not help.
If insomnia is mild, changes in behavior good sleep hygiene , such as following a regular sleep schedule, may be all that is needed.
If changes in behavior are ineffective, cognitive-behavioral therapy is usually the next step, and, if needed, short-term use of a sleep aid up to a few weeks may be considered.
Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Brought to you by About Merck Merck Careers Research Worldwide. Disclaimer Privacy Terms of use Contact Us Veterinary Edition. IN THIS TOPIC. OTHER TOPICS IN THIS CHAPTER. Periodic Limb Movement Disorder PLMD and Restless Legs Syndrome RLS.
Insomnia and Excessive Daytime Sleepiness EDS By Richard J. GET THE QUICK FACTS. Causes Evaluation Treatment Essentials for Older People: Insomnia and EDS Key Points. Did You Know Almost half of people have insomnia at one time or another.
Insomnia is most often caused by. Mental health disorders, particularly depression, anxiety, and substance abuse disorders. Certain symptoms are cause for concern:. Falling asleep while driving or during other potentially dangerous situations.
Stopping breathing during sleep or waking up with gasping or choking reported by a bed partner. The doctor asks people about the following:. Their sleep patterns.
You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest. The Basics " and "Patient education: Sleep insufficiency The Basics ". It is distinguished from fatigue, which refers to a subjective lack of physical or mental energy.
See 'Definitions' above. See 'Causes' above. The Epworth Sleepiness Scale ESS is a standardized measure of subjective sleepiness that is not diagnostic but can be useful in clinical practice.
Additional objective testing in the sleep laboratory can also be helpful. See 'Initial evaluation' above. See 'Polysomnography' above. A home sleep apnea test may be an appropriate alternative to polysomnography in a sleep laboratory when a patient's history and physical exam suggest high pretest probability for moderate to severe OSA.
See 'Home sleep apnea testing' above. When an assessment of ability to remain alert is the main question, a variant of the MSLT, the maintenance of wakefulness test MWT , may be appropriate.
See 'Multiple sleep latency test' above. Does your problem bother you more if you sit to read for an hour or if you go out shopping for an hour? Which of the following is the single most important problem for you: sleepiness, tiredness, fatigue, or lack of energy?
Which of the following most interferes with your ability to accomplish what you would like to: sleepiness, tiredness, fatigue, or lack of energy? How many caffeinated drinks coffee, tea, soda, energy drinks did you have?
Did you take any over-the-counter or prescription medication s to help you sleep? Contributor disclosures are reviewed for conflicts of interest by the editorial group.
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Find in topic Formulary Print Share. Official reprint from UpToDate ® www. com © UpToDate, Inc. All Rights Reserved. Author: Ronald D Chervin, MD, MS Section Editor: Thomas E Scammell, MD Deputy Editor: April F Eichler, MD, MPH.
All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Sep 20, Polysomnography will be abnormal in a variety of sleep disorders.
International Classification of Sleep Disorders, 3rd ed, text revision, American Academy of Sleep Medicine, Markowitz AJ, Rabow MW. Palliative management of fatigue at the close of life: "it feels like my body is just worn out". JAMA ; Chervin RD.
Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest ; Chotinaiwattarakul W, O'Brien LM, Fan L, Chervin RD. Fatigue, tiredness, and lack of energy improve with treatment for OSA. J Clin Sleep Med ; Young TB. Epidemiology of daytime sleepiness: definitions, symptomatology, and prevalence.
J Clin Psychiatry ; 65 Suppl Hublin C, Kaprio J, Partinen M, et al. Daytime sleepiness in an adult, Finnish population. J Intern Med ; Baldwin CM, Kapur VK, Holberg CJ, et al. Associations between gender and measures of daytime somnolence in the Sleep Heart Health Study.
Sleep ; Hara C, Lopes Rocha F, Lima-Costa MF. Prevalence of excessive daytime sleepiness and associated factors in a Brazilian community: the Bambuí study. Sleep Med ; Theorell-Haglöw J, Åkerstedt T, Schwarz J, Lindberg E. Predictors for Development of Excessive Daytime Sleepiness in Women: A Population-Based Year Follow-Up.
Chesson AL Jr, Ferber RA, Fry JM, et al. The indications for polysomnography and related procedures. Use of clinical tools and tests in sleep medicine. In: Principles and Practice of Sleep Medicine, Kryger MH, Roth T, Dement WC Eds , Elsevier Saunders, St Louis Bodkin CL, Manchanda S.
Office evaluation of the "tired" or "sleepy" patient. Semin Neurol ; Carney CE, Buysse DJ, Ancoli-Israel S, et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale.
Richardson GS, Carskadon MA, Flagg W, et al. Excessive daytime sleepiness in man: multiple sleep latency measurement in narcoleptic and control subjects. Electroencephalogr Clin Neurophysiol ; Littner MR, Kushida C, Wise M, et al.
Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Krahn LE, Arand DL, Avidan AY, et al. Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine.
Drake C, Roehrs T, Breslau N, et al. The year risk of verified motor vehicle crashes in relation to physiologic sleepiness. Philip P, Guichard K, Strauss M, et al. Maintenance of wakefulness test: how does it predict accident risk in patients with sleep disorders?
Schreier DR, Banks C, Mathis J. Driving simulators in the clinical assessment of fitness to drive in sleepy individuals: A systematic review.
Sleep Med Rev ; Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient.
It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications.
This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc.
and its affiliates disclaim any warranty or liability relating to this information or the use thereof. All rights reserved. GRAPHICS Differential diagnosis of excessive daytime sleepiness. Key questions in evaluating the tired patient. Key questions in the evaluation of a patient who complains of sleepiness, tiredness, fatigue, or low energy Questions about sleepiness Do you feel sleepy during the day?
Is daytime sleepiness a problem for you? Is it difficult to keep your eyes open at times during the day? Do you struggle to stay awake during the day? Do you take naps?
How often and how long do you nap during the day? Do you fall asleep at times you do not want to ie, watching a movie, reading a book, or on long drives?
Questions about tiredness, fatigue, and low energy Do you lack the energy to go about your daily activities? Do you tire easily, or sooner than others, when you are active? Do you feel physically or mentally exhausted? Questions to differentiate sleepiness from related complaints Does your problem bother you more if you sit to read for an hour or if you go out shopping for an hour?
Which of the following is the one problem you would most like to address effectively: sleepiness, tiredness, fatigue, or lack of energy? Adapted from: Bodkin CL, Manchanda S. Consensus Sleep Diary. Questions 1 through 10 are to be completed within one hour of getting out of bed in the morning.
Questions 11 through 15 are to be completed before bed. Reproduced with permission from: Camey CE, Buysse DJ, Ancoli-Israel S, et al. The Consensus Sleep Diary: Standardizing prospective sleep self-monitoring.
Copyright © American Academy of Sleep Medicine. Consensus Sleep Diary instructions. General instructions What is a sleep diary?
A sleep diary is designed to gather information about your daily sleep pattern. How often and when do I fill out the sleep diary? It is necessary for you to complete your sleep diary every day.
If possible, the sleep diary should be completed within one hour of getting out of bed in the morning. What should I do if I miss a day? If you forget to fill in the diary or are unable to finish it, leave the diary blank for that day. What if something unusual affects my sleep or how I feel in the daytime?
If your sleep or daytime functioning is affected by some unusual event such as an illness or an emergency , you may make brief notes on your diary.
What do the words "bed" and "day" mean on the diary? This diary can be used for people who are awake or asleep at unusual times.
In the sleep diary, the word "day" is the time when you choose or are required to be awake. The term "bed" means the place where you usually sleep.
Will answering these questions about my sleep keep me awake? This is not usually a problem. You should not worry about giving exact times, and you should not watch the clock.
Just give your best estimate. Sleep diary item instructions Use the guide below to clarify what is being asked for each item of the sleep diary. Date: Write the date of the morning you are filling out the diary. What time did you get into bed? Write the time that you got into bed.
This may not be the time you began "trying" to fall asleep. What time did you try to go to sleep? Record the time that you began "trying" to fall asleep.
How long did it take you to fall asleep? Beginning at the time you wrote in question 2, how long did it take you to fall asleep? How many times did you wake up, not counting your final awakening?
How many times did you wake up between the time you first fell asleep and your final awakening? In total, how long did these awakenings last?
What was the total time you were awake between the time you first fell asleep and your final awakening? What time was your final awakening? Record the last time you woke up in the morning. After your final awakening, how long did you spend in bed trying to sleep?
After the last time you woke up item 6a , how many minutes did you spend in bed trying to sleep? For example, if you woke up at AM but continued to try and sleep until AM, record 1 hour.
Did you wake up earlier than you planned? If you woke up or were awakened earlier than you planned, check yes. If you woke up at your planned time, check no.
If yes, how much earlier? If you answered "yes" to question 6c, write the number of minutes you woke up earlier than you had planned on waking up. For example, if you woke up 15 minutes before the alarm went off, record 15 minutes here.
What time did you get out of bed for the day? What time did you get out of bed with no further attempt at sleeping? This may be different from your final awakening time eg, you may have woken up at AM but did not get out of bed to start your day until AM.
In total, how long did you sleep? This should just be your best estimate, based on when you went to bed and woke up, how long it took you to fall asleep, and how long you were awake. You do not need to calculate this by adding and subtracting; just give your best estimate.
How would you rate the quality of your sleep? How restful or refreshed did you feel when you woke up for the day? This refers to how you felt after you were done sleeping for the night, during the first few minutes that you were awake.
How many times did you nap or doze? A nap is a time you decided to sleep during the day, whether in bed or not in bed. Count all the times you napped or dozed at any time from when you first got out of bed in the morning until you got into bed again at night. In total, how long did you nap or doze?
Estimate the total amount of time you spent napping or dozing, in hours and minutes. For instance, if you napped twice, once for 30 minutes and once for 60 minutes, and dozed for 10 minutes, you would answer "1 hour 40 minutes.
How many drinks containing alcohol did you have? Enter the number of alcoholic drinks you had where 1 drink is defined as one 12 oz beer can , 5 oz wine, or 1.
Almost half of all people in the US daytiem sleep-related problems. Disordered sleep can cause emotional disturbance, memory wakefulness and daytime fatigue, poor Assessing water content skills, decreased dwytime efficiency, and increased High protein foods of traffic accidents. Fstigue can even contribute to cardiovascular disorders and mortality. See also Sleep Apnea Obstructive Sleep Apnea OSA Obstructive sleep apnea OSA consists of multiple episodes of partial or complete closure of the upper airway that occur during sleep and lead to breathing cessation defined as a period of read more and Sleep Problems in Children Sleep Problems in Children For most children, sleep problems are intermittent or temporary and often do not require treatment.
Dayti,e read Belly fat reduction motivation Disclaimer at the end of this Natural remedies for back pain. Complaints of EDS, or wakefulnezs Assessing water content such adn tiredness, fatigue, and lack of Assessing water content, constitute dayitme of the most common daytimr presented to clinicians. EDS is important wakefulneas recognize because it can signal an undiagnosed sleep disorder or other treatable condition. In addition, EDS can have negative impacts on a broad range of activities and raise safety risks while driving or operating other machinery. This topic provides a general overview of the epidemiology, etiology, clinical features, and diagnosis of disorders that cause excessive daytime sleepiness. Classification of sleep disorders, sleep deprivation, and quantification of sleepiness are discussed separately. See "Classification of sleep disorders" and "Insufficient sleep: Definition, epidemiology, and adverse outcomes" and "Quantifying sleepiness". Wakefulness and daytime fatigue -
Van Dongen H, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation [published correction appears in Sleep.
Pagel JF. Sleep disorders in primary care: evidence-based clinical practice. Medications that induce sleepiness. In: Lee-Chiong TL, ed. Sleep: A Comprehensive Handbook. Hoboken, N. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia.
An Amerrican Academy of Sleep Medicine review. Verster JC, Volkerts ER. Antihistamines and driving ability: evidence from on-the-road driving studies during normal traffic [published corrections appear in Ann Allergy Asthma Immunol. Ann Allergy Asthma Immunol. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women.
Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. World Health Organization. Obesity and overweight.
Fact sheet September Accessed October 27, Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome.
Findley LJ, Levinson MP, Bonnie RJ. Driving performance and automobile accidents in patients with sleep apnea. Clin Chest Med.
Lindberg E, Carter N, Gislason T, Janson C. Role of snoring and daytime sleepiness in occupational accidents. Thorpy MJ. Cataplexy associated with narcolepsy: epidemiology, pathophysiology and management. CNS Drugs. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.
Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for Centers for Medicare and Medicaid Services. Medicare Coverage Database.
Polysomnography and sleep studies. Accessed December 9, Roehrs T, Carskadon MA, Dement WC, Roth T. Daytime sleepiness and alertness.
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Kreiger J. Clinical approach to excessive daytime sleepiness. Findley L, Smith C, Hooper J, Dineen M, Suratt PM. Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea.
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Kushida CA, Morgenthaler TI, Littner MR, et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for Sundaram S, Bridgman SA, Lim J, Lasserson TJ.
Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev. McClellan KJ, Spencer CM. Modafinil: a review of its pharmacology and clinical efficacy in the management of narcolepsy. Chervin RD.
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search close. PREV Mar 1, NEXT. B 29 , 31 , 35 Modafinil Provigil improves symptoms of persistent sleepiness in patients with OSA who are already being treated with CPAP. It also improves daytime sleepiness in patients with shift work disorder. Causes of Excessive Daytime Sleepiness.
Evaluating and Screening for Excessive Daytime Sleepiness. Quantifying Excessive Daytime Sleepiness. Treating Excessive Daytime Sleepiness. Medical and Legal Considerations.
PAGEL, MD, MS, is an associate clinical professor of family practice at the Southern Colorado family medicine residency program of the University of Colorado School of Medicine, Pueblo, and director of the Rocky Mountain Sleep Disorders Center, Pueblo and Colorado Springs, Colo.
Pagel received his medical degree from the University of Alabama at Birmingham, and completed his family medicine residency at St. Pagel, MD, MS, Rocky Mountain Sleep Disorders Center, N. Greenwood St.
Pagel was a consultant to Cephalon, Inc. Wilens TE, Biederman J. The stimulants. Psychiatr Clin North Am. Continue Reading. More in AFP. More in Pubmed. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians. All Rights Reserved. Treatment of OSA with CPAP therapy leads to a decline in daytime sleepiness and a lower risk for motor vehicle incidents.
Modafinil Provigil improves symptoms of persistent sleepiness in patients with OSA who are already being treated with CPAP. Excessive daytime sleepiness secondary to obstructive sleep apnea general population prevalence is 2 percent of women and 4 percent of men.
Seek advice from your doctor or sleep disorder clinic if you still feel excessively sleepy. The characteristics of hypersomnia vary from one person to the next, depending on their age, lifestyle and any underlying causes.
In extreme cases, a person with hypersomnia might sleep soundly at night for 12 hours or more, but still feel the need to nap during the day. Sleeping and napping may not help, and the mind may remain foggy with drowsiness.
It is possible that a person with hypersomnia may have very disturbed sleep but not be aware of it. Some of the sleep disorders that may contribute to or cause excessive daytime sleepiness include:. Identifying the causes of excessive sleepiness may involve investigations into lifestyle habits, medications, physical health and emotional state.
Sleep disorders need to be diagnosed and treated at a sleep disorders clinic. The treatment depends on the disorder. Hypersomnia can be helped in many cases with lifestyle adjustments to improve sleep quality, so called good sleep hygiene.
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Excessive sleepiness. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. About excessive sleepiness Characteristics of hypersomnia Symptoms of hypersomnia Causes of hypersomnia Sleep disorders Diagnosis and treatment of hypersomnia Self-help strategies Where to get help.
About excessive sleepiness Hypersomnia means excessive sleepiness. Characteristics of hypersomnia The characteristics of hypersomnia vary from one person to the next, depending on their age, lifestyle and any underlying causes.
Causes of hypersomnia Excessive daytime sleepiness can be caused by a wide range of events and conditions, including: Insufficient or inadequate sleep — long working hours and overtime can be tolerated for months or years before the symptoms of sleepiness take effect.
Teenagers who stay out until the early hours of the morning on weekends may be tired during the week. Environmental factors — broken sleep can be caused by a variety of things such as a snoring partner, a baby that wakes , noisy neighbours, heat and cold, or sleeping on an uncomfortable mattress.
Shiftwork — it is very difficult to get good sleep while working shiftwork , especially night shift. Mental states — anxiety can keep a person awake at night, which makes them prone to sleepiness during the day. Depression saps energy. Medications — such as alcohol , caffeinated drinks , tranquillisers, sleeping pills and antihistamines can disrupt sleeping patterns.
Medical conditions — like hypothyroidism underactive thyroid gland , oesophageal reflux , nocturnal asthma and chronic painful conditions can disrupt sleep. Changes to time zone — such as jet lag can affect the internal biological clock, which regulates sleep.
This clock responds to light.
Assessing water content epidemiological study anr hypersomnia Plant-based caffeine source is still in its infancy; most epidemiological surveys on this Assessing water content were published in the last decade. More than fatugue dozen representative wakefulmess studies can be Assessing water content. These studies fatiuge two aspects of hypersomnia: excessive quantity of sleep and sleep propensity during wakefulness excessive daytime sleepiness. Excessive daytime sleepiness has been mostly investigated in terms of frequency or severity; duration of the symptom has rarely been investigated. In most studies, men and women are equally affected. In the International Classification of Sleep Disorders, hypersomnia symptoms are the essential feature of three disorders: insufficient sleep syndrome, hypersomnia idiopathic, recurrent or posttraumatic and narcolepsy. Insufficient sleep syndrome and hypersomnia diagnoses are poorly documented.
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