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] A proper diagnosis of the underlying cause and ultimately treatment of symptoms and/or the underlying cause can help mitigate such complications. [2] According to the National Sleep Foundation, around 20 percent of people experience excessive daytime sleepiness. [3]

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. [9] [10] [11]

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. [12] [13]

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. [14] [15]

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. [15] Moreover, power characteristics in the alpha-band of resting-state EEG readings, correlating with somnolence, also showed a correlation with the presence of EDS. [16] [17] [18]

Treatment

Treatment of EDS relies on identifying and treating the underlying disorder which may cure the person from the EDS. Drugs like modafinil, [19] armodafinil, [20] 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. [21]

See also

Related Research Articles

<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), a type of sleep study, is a multi-parameter study of sleep 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 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.

<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 that involves an excessive urge to sleep and other neurological features

Narcolepsy is a chronic neurological disorder that involves a decreased ability to regulate sleep–wake cycles. Symptoms often include periods of excessive daytime sleepiness and brief involuntary sleep episodes. Narcolepsy paired with cataplexy is evidenced to be an autoimmune disorder. These experiences of cataplexy can be brought on by strong emotions. Less commonly, there may be vivid hallucinations or an inability to move while falling asleep or waking up. People with narcolepsy tend to sleep about the same number of hours per day as people without it, but the quality of sleep tends to be lessened.

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.

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

Eugeroics, also known as wakefulness-promoting agents and wakefulness-promoting drugs, are a class of drugs that promote wakefulness and alertness. They are medically indicated for the treatment of certain sleep disorders including excessive daytime sleepiness (EDS) in narcolepsy or obstructive sleep apnea (OSA). Eugeroics are also often prescribed off-label for the treatment of EDS in idiopathic hypersomnia. In contrast to classical psychostimulants, such as methylphenidate and amphetamine, which are also used in the treatment of these disorders, eugeroics typically do not produce marked euphoria, and, consequently, have a lower addictive potential.

Idiopathic hypersomnia(IH) is a neurological disorder which is characterized primarily by excessive sleep and excessive daytime sleepiness (EDS). 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 oral solution of calcium, magnesium, potassium, and sodium oxybates; in addition to several off-label treatments (primarily FDA-approved narcolepsy medications).

Sleep state misperception (SSM) is a term in the International Classification of Sleep Disorders (ICSD) most commonly used for people who mistakenly perceive their sleep as wakefulness, though it has been proposed that it be applied to those who severely overestimate their sleep time as well. While most sleepers with this condition will report not having slept in the previous night at all or having slept very little, clinical recordings generally show normal sleep patterns. Though the sleep patterns found in those with SSM have long been considered indistinguishable from those without, some preliminary research suggest there may be subtle differences.

<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.

<span class="mw-page-title-main">Behavioral sleep medicine</span>

Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.

Pediatric narcolepsy refers to conditions of narcolepsy during childhood and adolescence. In a pediatric setting, people with narcolepsy still exhibit the classical tetrad symptoms of narcolepsy, and thus is possible for both type 1 and type 2 narcolepsy to develop in adolescence.

References

  1. ↑ Palomo-Toucedo, Inmaculada C.; Leon-Larios, Fatima; Reina-Bueno, María; Vázquez-Bautista, María del Carmen; Munuera-Martínez, Pedro V.; Domínguez-Maldonado, Gabriel (3 September 2020). "Psychosocial Influence of Ehlers–Danlos Syndrome in Daily Life of Patients: A Qualitative Study". International Journal of Environmental Research and Public Health. 17 (17): 6425. doi: 10.3390/ijerph17176425 . ISSN   1660-4601. PMC   7503231 . PMID   32899328.
  2. ↑ 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.
  3. ↑ "Do I Have Excessive Sleepiness?". National Sleep Foundation. 3 December 2020. Retrieved 16 November 2021.
  4. ↑ Abad, V. C.; 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.
  5. ↑ "How to Stop Snoring". Sleep Apnea. Archived from the original on 4 March 2016. Retrieved 15 August 2015.
  6. ↑ 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.
  7. ↑ Wang, Heming; Lane, Jacqueline M.; Jones, Samuel E.; Dashti, Hassan S.; Ollila, Hanna M.; Wood, Andrew R.; van Hees, Vincent T.; Brumpton, Ben; Winsvold, Bendik S.; Kantojärvi, Katri; Palviainen, Teemu; Cade, Brian E.; Sofer, Tamar; Song, Yanwei; Patel, Krunal (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.
  8. ↑ Roya, Yazdani; Farzaneh, Barzkar; Mostafa, Almasi-Dooghaee; Mahsa, Shojaie; Babak, Zamani (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.
  9. ↑ 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.
  10. ↑ Johns, Murray W. (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 . Retrieved 14 March 2021.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ Mitler, Merrill M.; Gujavarty, Krishnareddy S.; Browman, Carl P. (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.
  15. 1 2 Arand, Donna; Bonnet, Michael; Hurwitz, Thomas; Mitler, Merrill; Rosa, Roger; Sangal, R. Bart (January 2005). "The Clinical Use of the MSLT and MWT" . Sleep. 28 (1): 123–144. doi:10.1093/sleep/28.1.123. PMID   15700728 . Retrieved 14 March 2021.
  16. ↑ Breitenbach, Johannes; Baumgartl, Hermann; Buettner, Ricardo (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. Retrieved 14 March 2021.
  17. ↑ Kalauzi, Aleksandar; Vuckovic, Aleksandra; Bojić, Tijana (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 . Retrieved 14 March 2021.
  18. ↑ Lin, Chin-Teng; Wu, Ruei-Cheng; Liang, Sheng-Fu; Chao, Wen-Hung; Chen, Yu-Jie; Jung, Tzyy-Ping (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. doi:10.1109/TCSI.2005.857555. S2CID   12252030 . Retrieved 14 March 2021.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
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.