Excessive daytime sleepiness

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daytime hypersomnia
Classification and external resources
ICD-10F51.1, G47.1
ICD-9291.82, 292.85, 307.43-307.44, 327.1, 780.53-780.54
eMedicinemed/3129
MeSHD006970
 
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daytime hypersomnia
Classification and external resources
ICD-10F51.1, G47.1
ICD-9291.82, 292.85, 307.43-307.44, 327.1, 780.53-780.54
eMedicinemed/3129
MeSHD006970

Excessive daytime sleepiness (EDS) is characterized by persistent sleepiness, and often a general lack of energy, even after apparently adequate or even prolonged night time 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, sleep apnoea or a circadian rhythm disorder.

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. A proper diagnosis of the underlying cause and ultimately treatment of symptoms and/or the underlying cause can help mitigate such complications.[1]

Diagnosis[edit]

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. 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. A self test is available at the author's website.

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. The test is based on the idea that the sleepier people are, the faster they will fall asleep.

Causes[edit]

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

Treatment[edit]

Treatment of EDS relies on identifying and treating the underlying disorder which may cure the person from the EDS. Drugs like modafinil,[2] Armodafinil,[3] 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 have several adverse effects and addictive properties.[4]


References[edit]

  1. ^ Guilleminault, C; Brooks, SN (2001 Aug). "Excessive daytime sleepiness: a challenge for the practising neurologist.". Brain : a journal of neurology 124 (Pt 8): 1482–91. PMID 11459741. 
  2. ^ Valentino, RM; Foldvary-Schaefer, N (2007 Aug). "Modafinil in the treatment of excessive daytime sleepiness.". Cleveland Clinic journal of medicine 74 (8): 561–6, 568–71. PMID 17708127. 
  3. ^ Nishino, S; Okuro, M (2008 Jun). "Armodafinil for excessive daytime sleepiness.". Drugs of today (Barcelona, Spain : 1998) 44 (6): 395–414. PMID 18596995. 
  4. ^ Harris, SF; Monderer, RS; Thorpy, M (2012 Nov). "Hypersomnias of central origin.". Neurologic clinics 30 (4): 1027–44. PMID 23099128.