Excessive daytime sleepiness

Last updated

Daytime hypersomnia
Other namesEDS
Specialty Psychiatry, neurology

Excessive daytime sleepiness (EDS) is characterized by persistent sleepiness and often a general lack of energy, even during the day after apparently adequate or even prolonged nighttime sleep. EDS can be considered as a broad condition encompassing several sleep disorders where increased sleep is a symptom, or as a symptom of another underlying disorder like narcolepsy, circadian rhythm sleep disorder, sleep apnea or idiopathic hypersomnia.

Contents

Some persons with EDS, including those with hypersomnias like narcolepsy and idiopathic hypersomnia, are compelled to nap repeatedly during the day; fighting off increasingly strong urges to sleep during inappropriate times such as while driving, while at work, during a meal, or in conversations. As the compulsion to sleep intensifies, the ability to complete tasks sharply diminishes, often mimicking the appearance of intoxication. During occasional unique and/or stimulating circumstances, a person with EDS can sometimes remain animated, awake and alert, for brief or extended periods of time. EDS can affect the ability to function in family, social, occupational, or other settings. [1] [2] [3] A proper diagnosis of the underlying cause and ultimately treatment of symptoms and/or the underlying cause can help mitigate such complications. [4] According to the National Sleep Foundation, around 20 percent of people experience excessive daytime sleepiness. [5]

Causes

EDS can be a symptom of a number of factors and disorders. Specialists in sleep medicine are trained to diagnose them. Some are:

Diagnosis

An adult who is compelled to nap repeatedly during the day may have excessive daytime sleepiness; however, it is important to distinguish between occasional daytime sleepiness and excessive daytime sleepiness, which is chronic.

A number of tools for screening for EDS have been developed. One is the Epworth Sleepiness Scale which grades the results of a questionnaire with eight questions referring to situations encountered in daily life. The ESS generates a numerical score from zero (0) to 24 where a score of ten [10] or higher may indicate that the person should consult a specialist in sleep medicine for further evaluation. [11] [12] [13]

Another tool is the Multiple Sleep Latency Test (MSLT), which has been used since the 1970s. It is used to measure the time it takes from the start of a daytime nap period to the first signs of sleep, called sleep latency. Subjects undergo a series of five 20-minute sleeping opportunities with an absence of alerting factors at 2-hour intervals on one day. The test is based on the idea that the sleepier people are, the faster they will fall asleep. [14] [15]

The Maintenance of Wakefulness Test (MWT) is also used to quantitatively assess daytime sleepiness. This test is performed in a sleep diagnostic center. The test is similar to the MSLT as it also relies on a measurement of initial sleep latency. However, during this test, the patient is instructed to try to stay awake under soporific conditions for a defined time. [16] [17]

The use of Electroencephalography (EEG) readings is essential for the objective diagnosis of EDS. The initial sleep latency employed in the MSLT and the MWT is mainly derived from EEG recordings. [17] Moreover, power characteristics in the alpha-band of resting-state EEG readings, correlating with somnolence, also showed a correlation with the presence of EDS. [18] [19] [20]

Treatment

Treatment of EDS relies on identifying and treating the underlying disorder which may cure the person from the EDS. Drugs like modafinil, [21] armodafinil, [22] Xyrem (sodium oxybate) oral solution, have been approved as treatment for EDS symptoms in the U.S. There is declining usage of other drugs such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine), amphetamine (Adderall), lisdexamfetamine (Vyvanse), methamphetamine (Desoxyn), and pemoline (Cylert), as these psychostimulants may have several adverse effects. [23]

See also

Related Research Articles

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Somnolence is a state of strong desire for sleep, or sleeping for unusually long periods. It has distinct meanings and causes. It can refer to the usual state preceding falling asleep, the condition of being in a drowsy state due to circadian rhythm disorders, or a symptom of other health problems. It can be accompanied by lethargy, weakness and lack of mental agility.

Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.

A microsleep is a sudden temporary episode of sleep or drowsiness which may last for a few seconds where an individual fails to respond to some arbitrary sensory input and becomes unconscious. Episodes of microsleep occur when an individual loses and regains awareness after a brief lapse in consciousness, often without warning, or when there are sudden shifts between states of wakefulness and sleep. In behavioural terms, MSs may manifest as droopy eyes, slow eyelid-closure, and head nodding. In electrical terms, microsleeps are often classified as a shift in electroencephalography (EEG) during which 4–7 Hz activity replaces the waking 8–13 Hz background rhythm.

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Polysomnography (PSG) is a multi-parameter type of sleep study and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

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Somnology is the scientific study of sleep. It includes clinical study and treatment of sleep disorders and irregularities. Sleep medicine is a subset of somnology.

Cataplexy is a sudden and transient episode of muscle weakness accompanied by full conscious awareness, typically triggered by emotions such as laughing, crying, or terror. Cataplexy affects approximately 20% of people who have narcolepsy, and is caused by an autoimmune destruction of hypothalamic neurons that produce the neuropeptide hypocretin, which regulates arousal and has a role in stabilization of the transition between wake and sleep states. Cataplexy without narcolepsy is rare and the cause is unknown.

The Multiple Sleep Latency Test (MSLT) is a sleep disorder diagnostic tool. It is used to measure the time elapsed from the start of a daytime nap period to the first signs of sleep, called sleep latency. The test is based on the idea that the sleepier people are, the faster they will fall asleep.

The Epworth Sleepiness Scale (ESS) is a scale intended to measure daytime sleepiness that is measured by use of a very short questionnaire. This can be helpful in diagnosing sleep disorders. It was introduced in 1991 by Dr Murray Johns of Epworth Hospital in Melbourne, Australia.

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Pitolisant, sold under the brand name Wakix among others, is a medication used for the treatment of excessive daytime sleepiness in adults with narcolepsy. It is a histamine 3 (H3) receptor antagonist/inverse agonist (an antihistamine drug specific to that kind of receptors). It represents the first commercially available medication in its class, so that the US Food and Drug Administration (FDA) declares it a first-in-class medication. Pitolisant enhances the activity of histaminergic neurons in the brain that function to improve a person's wakefulness. It was approved by the European Medicines Agency (EMA) in March 2016 for narcolepsy with or without cataplexy, and for excessive daytime sleepiness by the FDA in August 2019. The most common side effects include difficulty sleeping, nausea, and feeling worried.

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References

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  2. ↑ Hein, Matthieu; Mungo, Anais; Hubain, Philippe; Loas, Gwenolé (2020). "Excessive daytime sleepiness in adolescents: current treatment strategies". Sleep Science. 13 (2): 157–171. doi:10.5935/1984-0063.20190143 (inactive 1 July 2024). ISSN   1984-0659. PMC   7384526 . PMID   32742588.{{cite journal}}: CS1 maint: DOI inactive as of July 2024 (link)
  3. ↑ Gharibi, Vahid; Mokarami, Hamidreza; Cousins, Rosanna; Jahangiri, Mehdi; Eskandari, Davood (31 March 2020). "Excessive Daytime Sleepiness and Safety Performance: Comparing Proactive and Reactive Approaches". The International Journal of Occupational and Environmental Medicine. 11 (2): 95–107. doi:10.34172/ijoem.2020.1872. PMC   7205513 . PMID   32218557.
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  5. ↑ "Do I Have Excessive Sleepiness?". National Sleep Foundation. 3 December 2020. Retrieved 16 November 2021.
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  8. ↑ Arnold, Ria; Issar, Tushar; Krishnan, Arun V; Pussell, Bruce A (2016). "Neurological complications in chronic kidney disease". JRSM Cardiovascular Disease. 5: 204800401667768. doi:10.1177/2048004016677687. ISSN   2048-0040. PMC   5102165 . PMID   27867500.
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  11. ↑ Johns, Murray W. (November 1991). "A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale". Sleep. 14 (6): 540–545. doi: 10.1093/sleep/14.6.540 . PMID   1798888 . Retrieved 14 March 2021.
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  13. ↑ Kendzerska, Tetyana B.; Smith, Peter M.; Brignardello-Petersen, Romina; Leung, Richard S.; Tomlinson, George A. (August 2014). "Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review". Sleep Medicine Reviews. 18 (4): 321–331. doi:10.1016/j.smrv.2013.08.002. PMID   24135493 . Retrieved 14 March 2021.
  14. ↑ Carskadon, Mary A. (December 1986). "Guidelines for the Multiple Sleep Latency Test (MSLT): A Standard Measure of Sleepiness". Sleep. 9 (4): 519–524. doi: 10.1093/sleep/9.4.519 . PMID   1798888 . Retrieved 14 March 2021.
  15. ↑ Littner, Michael R.; Kushida, Clete; Wise, Merrill; Davila, David G.; Morgenthaler, Timothy; Lee-Chiong, Teofilo; Hirshkowitz, Max; Loube, Daniel L.; Bailey, Dennis; Berry, Richard B.; Kapen, Sheldon; Kramer, Milton (January 2005). "Practice Parameters for Clinical Use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test". Sleep. 28 (1): 113–121. doi: 10.1093/sleep/28.1.113 . PMID   15700727 . Retrieved 14 March 2021.
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  23. ↑ Harris, SF; Monderer, RS; Thorpy, M (November 2012). "Hypersomnias of central origin". Neurologic Clinics. 30 (4): 1027–44. doi:10.1016/j.ncl.2012.08.002. PMID   23099128.
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