Excessive daytime sleepiness

Last updated

Excessive daytime sleepiness
Other namesHypersomnolence
Specialty Psychiatry, Neurology
Symptoms Persistent sleepiness during the day despite adequate nighttime sleep
Causes Narcolepsy, idiopathic hypersomnia, circadian rhythm sleep disorder, sleep apnea, others

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] A proper diagnosis of the underlying cause and ultimately treatment of symptoms and/or the underlying cause can help mitigate such complications. [3] According to the National Sleep Foundation, around 20 percent of people experience EDS. [4]

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 (EDS); however, it is important to distinguish between occasional daytime sleepiness and EDS, which is chronic.

A number of tools for screening for EDS have been developed. One is the Epworth Sleepiness Scale (ESS) 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. [12] [13] [14]

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. [15] [16]

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. [17] [18]

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. [18] Moreover, power characteristics in the alpha-band of resting-state EEG readings, correlating with somnolence, also showed a correlation with the presence of EDS. [19] [20] [21]

Treatment

Treatment of excessive daytime sleepiness (EDS) relies on identifying and treating the underlying disorder which may cure the person from the EDS. Drugs like modafinil, [22] armodafinil, [23] pitolisant [24] (Wakix), sodium oxybate (Xyrem) oral solution, have been approved as treatment for EDS symptoms in the United States. There is declining usage of other drugs such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine), amphetamine, lisdexamfetamine (Vyvanse), methamphetamine (Desoxyn), and pemoline (Cylert), as these stimulants may have several adverse effects. [25]

If EDS is caused by obstructive sleep apnea (OSA), it is recommended that people with OSA use continuous positive airway pressure (CPAP) therapy, that is a sleep breathing apparatus to prevent OSA, before starting intake of wake-promoting agents such as modafinil. [26] [7] [6]

See also

Related Research Articles

<span class="mw-page-title-main">Modafinil</span> Eugeroic medication

Modafinil, sold under the brand name Provigil among others, is a wakefulness-promoting medication used primarily to treat narcolepsy, a sleep disorder characterized by excessive daytime sleepiness and sudden sleep attacks. Modafinil is also approved for stimulating wakefulness in people with sleep apnea and shift work sleep disorder. It is taken by mouth. Modafinil is not approved by the US Food and Drug Administration (FDA) for use in people under 17 years old.

<span class="mw-page-title-main">Sleep disorder</span> Medical disorder of a persons sleep patterns

A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.

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.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

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.

<span class="mw-page-title-main">Somnology</span> Scientific study of sleep

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 is the first symptom to appear in about 10% of cases of narcolepsy, 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.

<span class="mw-page-title-main">Armodafinil</span> Eugeroic medication

Armodafinil, sold under the brand name Nuvigil, is a wakefulness-promoting medication which is used to treat excessive daytime sleepiness associated with obstructive sleep apnea, narcolepsy, and shift work disorder. It is also used off-label for certain other indications. The drug is taken by mouth.

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.

<span class="mw-page-title-main">Sleep medicine</span> Medical specialty devoted to the diagnosis and therapy of sleep disturbances and disorders

Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions about, sleep–wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.

The sleep–wake activity inventory (SWAI) is a subjective multidimensional questionnaire intended to measure sleepiness.

<span class="mw-page-title-main">Sleep study</span> Sleep Medicine

A sleep study is a test that records the activity of the body during sleep. There are five main types of sleep studies that use different methods to test for different sleep characteristics and disorders. These include simple sleep studies, polysomnography, multiple sleep latency tests (MSLTs), maintenance of wakefulness tests (MWTs), and home sleep tests (HSTs). In medicine, sleep studies have been useful in identifying and ruling out various sleep disorders. Sleep studies have also been valuable to psychology, in which they have provided insight into brain activity and the other physiological factors of both sleep disorders and normal sleep. This has allowed further research to be done on the relationship between sleep and behavioral and psychological factors.

<span class="mw-page-title-main">Narcolepsy</span> Human sleep disorder

Narcolepsy is a chronic neurological disorder that impairs the ability to regulate sleep–wake cycles, and specifically impacts REM sleep. The pentad symptoms of narcolepsy include excessive daytime sleepiness (EDS), sleep-related hallucinations, sleep paralysis, disturbed nocturnal sleep (DNS), and cataplexy. People with narcolepsy tend to sleep about the same number of hours per day as people without it, but the quality of sleep is typically compromised.

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 an inverse agonist of the histamine 3 (H3) receptor (an antihistamine drug specific to that kind of receptors). It represents the first commercially available medication in its class, so that the U.S. 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.

<span class="mw-page-title-main">Eugeroic</span> Drug for wakefulness and alertness

A eugeroic, or eugregoric, also known as a vigilance-promoting agent, is a type of drug that increases vigilance. The term has been used inconsistently and in multiple ways in the scientific literature, either to refer specifically to modafinil-type wakefulness-promoting agents or to refer to wakefulness-promoting agents generally. It was first introduced in the French literature in 1987 as a descriptor for modafinil-like wakefulness-promoting drugs and for purposes of distinguishing such drugs from psychostimulants. However, the term "eugeroic" has not been widely adopted in the literature, and instead the term "wakefulness-promoting agent" has been more widely used, both for modafinil-type drugs and other agents.

Idiopathic hypersomnia(IH) is a neurological disorder which is characterized primarily by excessive sleep and excessive daytime sleepiness (EDS). Idiopathic hypersomnia was first described by Bedrich Roth in 1976, and it can be divided into two forms: polysymptomatic and monosymptomatic. The condition typically becomes evident in early adulthood and most patients diagnosed with IH will have had the disorder for many years prior to their diagnosis. As of August 2021, an FDA-approved medication exists for IH called Xywav, which is an oral solution of calcium, magnesium, potassium, and sodium oxybates; in addition to several off-label treatments (primarily FDA-approved narcolepsy medications).

<span class="mw-page-title-main">Flmodafinil</span> Wakefulness-promoting drug/Dopamine reuptake inhibitor

Flmodafinil, also known as bisfluoromodafinil and lauflumide, is a wakefulness-promoting agent related to modafinil which has been developed for treatment of a variety of different medical conditions. These include chronic fatigue syndrome, idiopathic hypersomnia, narcolepsy, attention deficit hyperactivity disorder (ADHD), and Alzheimer's disease. Aside its development as a potential pharmaceutical drug, flmodafinil is sold online and used non-medically as a nootropic.

<span class="mw-page-title-main">Solriamfetol</span> Medication used for the treatment of excessive sleepiness

Solriamfetol, sold under the brand name Sunosi, is a wakefulness-promoting medication used in the treatment of excessive sleepiness related to narcolepsy and sleep apnea. It is taken by mouth.

References

  1. ↑ "How to Manage Excessive Sleepiness During the Day". Health. Archived from the original on 29 June 2024. Retrieved 29 June 2024.
  2. ↑ Hein M, Mungo A, Hubain P, Loas G (2020). "Excessive daytime sleepiness in adolescents: current treatment strategies". Sleep Science. 13 (2): 157–171. doi:10.5935/1984-0063.20190143 (inactive 1 November 2024). ISSN   1984-0659. PMC   7384526 . PMID   32742588.{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)
  3. ↑ Guilleminault C, Brooks, SN (August 2001). "Excessive daytime sleepiness: a challenge for the practising neurologist". Brain: A Journal of Neurology. 124 (Pt 8): 1482–91. doi: 10.1093/brain/124.8.1482 . PMID   11459741.
  4. ↑ "Do I Have Excessive Sleepiness?". National Sleep Foundation. 3 December 2020. Archived from the original on 16 November 2021. Retrieved 16 November 2021.
  5. ↑ Abad VC, Guilleminault C (2003). "Diagnosis and treatment of sleep disorders: a brief review for clinicians". Dialogues in Clinical Neuroscience. 5 (4): 371–388. doi:10.31887/DCNS.2003.5.4/vabad. PMC   3181779 . PMID   22033666.
  6. 1 2 Wang Y, Zhang W, Ye H, Xiao Y (August 2024). "Excessive daytime sleepiness in obstructive sleep apnea: Indirect treatment comparison of wake-promoting agents in patients adherent/nonadherent to primary OSA therapy". Sleep Med Rev. 78: 101997. doi: 10.1016/j.smrv.2024.101997 . PMID   39243682.
  7. 1 2 Morgenthaler TI, Lee-Chiong T, Alessi C, Friedman L, Aurora RN, Boehlecke B, et al. (November 2007). "Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report". Sleep. 30 (11): 1445–1459. doi:10.1093/sleep/30.11.1445. PMC   2082098 . PMID   18041479.
  8. ↑ "How to Stop Snoring". Sleep Apnea. Archived from the original on 4 March 2016. Retrieved 15 August 2015.
  9. ↑ Arnold R, Issar T, Krishnan AV, Pussell BA (2016). "Neurological complications in chronic kidney disease". JRSM Cardiovascular Disease. 5: 204800401667768. doi:10.1177/2048004016677687. ISSN   2048-0040. PMC   5102165 . PMID   27867500.
  10. ↑ Wang H, Lane JM, Jones SE, Dashti HS, Ollila HM, Wood AR, et al. (13 August 2019). "Genome-wide association analysis of self-reported daytime sleepiness identifies 42 loci that suggest biological subtypes". Nature Communications. 10 (1): 3503. Bibcode:2019NatCo..10.3503W. doi: 10.1038/s41467-019-11456-7 . ISSN   2041-1723. PMC   6692391 . PMID   31409809.
  11. ↑ Roya Y, Farzaneh B, Mostafa AD, Mahsa S, Babak Z (2023). "Narcolepsy following COVID-19: A case report and review of potential mechanisms". Clinical Case Reports. 11 (6): e7370. doi: 10.1002/ccr3.7370 . PMC   10213711 . PMID   37251741.
  12. ↑ Johns MW (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.
  13. ↑ Johns MW (July 1992). "Reliability and Factor Analysis of the Epworth Sleepiness Scale". Sleep. 15 (4): 376–381. doi: 10.1093/sleep/15.4.376 . PMID   1519015. Archived from the original on 13 March 2022. Retrieved 14 March 2021.
  14. ↑ Kendzerska TB, Smith PM, Brignardello-Petersen R, Leung RS, Tomlinson GA (August 2014). "Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review" (PDF). Sleep Medicine Reviews. 18 (4): 321–331. doi:10.1016/j.smrv.2013.08.002. PMID   24135493 . Retrieved 14 March 2021.
  15. ↑ Carskadon MA (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. Archived from the original on 25 May 2021. Retrieved 14 March 2021.
  16. ↑ Littner MR, Kushida C, Wise M, Davila DG, Morgenthaler T, Lee-Chiong T, et al. (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. Archived from the original on 13 August 2021. Retrieved 14 March 2021.
  17. ↑ Mitler MM, Gujavarty KS, Browman CP (June 1982). "Maintenance of wakefulness test: A polysomnographic technique for evaluating treatment efficacy in patients with excessive somnolence". Electroencephalography and Clinical Neurophysiology. 53 (6): 658–661. doi:10.1016/0013-4694(82)90142-0. PMC   2480525 . PMID   6177511.
  18. 1 2 Arand D, Bonnet M, Hurwitz T, Mitler M, Rosa R, Sangal RB (January 2005). "The Clinical Use of the MSLT and MWT" . Sleep. 28 (1): 123–144. doi:10.1093/sleep/28.1.123. PMID   15700728. Archived from the original on 3 August 2022. Retrieved 14 March 2021.
  19. ↑ Breitenbach J, Baumgartl H, Buettner R (August 2020). Detection of Excessive Daytime Sleepiness in Resting-State EEG Recordings: A Novel Machine Learning Approach Using Specific EEG Sub-Bands and Channels. AMCIS 2020 Proceedings. Salt Lake City. pp. 1–10. Archived from the original on 19 September 2020. Retrieved 14 March 2021.
  20. ↑ Kalauzi A, Vuckovic A, Bojić T (December 2012). "EEG alpha phase shifts during transition from wakefulness to drowsiness" . International Journal of Psychophysiology. 86 (3): 195–205. doi:10.1016/j.ijpsycho.2012.04.012. PMID   22580156. Archived from the original on 9 May 2021. Retrieved 14 March 2021.
  21. ↑ Lin CT, Wu RC, Liang SF, Chao WH, Chen YJ, Jung TP (December 2005). "EEG-based drowsiness estimation for safety driving using independent component analysis". IEEE Transactions on Circuits and Systems I: Regular Papers. 52 (12): 2726–2738. CiteSeerX   10.1.1.145.2320 . doi:10.1109/TCSI.2005.857555. S2CID   12252030. Archived from the original on 9 October 2021. Retrieved 14 March 2021.
  22. ↑ Valentino RM, Foldvary-Schaefer, N (August 2007). "Modafinil in the treatment of excessive daytime sleepiness". Cleveland Clinic Journal of Medicine. 74 (8): 561–6, 568–71. doi:10.3949/ccjm.74.8.561. PMID   17708127.
  23. ↑ Nishino S, Okuro, M (June 2008). "Armodafinil for excessive daytime sleepiness". Drugs of Today. 44 (6): 395–414. doi:10.1358/dot.2008.44.6.1223892. PMID   18596995.
  24. ↑ Zhan S, Ye H, Li N, Zhang Y, Cheng Y, Wang Y, et al. (2023). "Comparative Efficacy and Safety of Multiple Wake-Promoting Agents for the Treatment of Excessive Daytime Sleepiness in Narcolepsy: A Network Meta-Analysis". Nat Sci Sleep. 15: 217–230. doi: 10.2147/NSS.S404113 . PMC   10112483 . PMID   37082610.
  25. ↑ 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.
  26. ↑ Hashemian SM, Farhadi T (2020). "A review on modafinil: the characteristics, function, and use in critical care". Journal of Drug Assessment. 9 (1): 82–86. doi:10.1080/21556660.2020.1745209. PMC   7170336 . PMID   32341841.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.