Excessive daytime sleepiness
Encyclopedia
Excessive daytime sleepiness (EDS) is characterized by persistent sleepiness, and often a general lack of energy, even after apparently adequate night time sleep. EDS is a symptom of one of the two forms of the sleep disorder
hypersomnia
, the other being prolonged nighttime sleep.
Some persons with EDS, including those with narcolepsy
, 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.
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.
EDS can affect the ability to function in family, social, occupational, or other settings. A proper diagnosis, and treatment, of the underlying cause can help mitigate such complications. It can be difficult to accept that EDS is beyond a person's control; the unaffected may see sleepiness as an insult, a rejection, or as evidence for lack of interest. 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; this lends credence to an observer's assertions that the alertness is simply a matter of self control
and that EDS can be 'willed away'.
The prescription medications, Provigil (modafinil
) and Xyrem
(sodium oxybate) oral solution, have been approved as a first-line treatment for EDS symptoms in the U.S., and have been proven extremely effective in the treatment of most symptoms. While there is declining usage of other drugs such as methylphenidate
(Ritalin), dextroamphetamine
(Dexedrine), amphetamine
(Adderall), methamphetamine
(Desoxyn), and pemoline
(Cylert), these psychostimulants still provide additive assistance under varying circumstances. http://www.narcolepsynetwork.org/?page_id=9.
Sleep disorder
A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning...
hypersomnia
Hypersomnia
Hypersomnia is a disorder characterized by excessive amounts of sleepiness.There are two main categories of hypersomnia: primary hypersomnia and recurrent hypersomnia...
, the other being prolonged nighttime sleep.
Some persons with EDS, including those with narcolepsy
Narcolepsy
Narcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive sleepiness and sleep attacks at inappropriate times, such as while at work. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which often is confused with insomnia...
, 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.
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
Epworth Sleepiness Scale
The Epworth Sleepiness Scale 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...
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
Sleep medicine
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 and answered many questions about sleep-wake functioning. The rapidly evolving field has...
for further evaluation. A self test is available at the author's website.
Another tool is the Multiple Sleep Latency Test
Multiple Sleep Latency Test
The Multiple Sleep Latency Test 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...
(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
EDS can be a symptom of a number of factors and disorders. Specialists in sleep medicine are trained to diagnose them. Some are:- Insufficient quality or quantity of night time sleep.
- Misalignments of the body's circadian pacemaker with the environment (e.g. jet lagJet lagJet lag, medically referred to as desynchronosis, is a physiological condition which results from alterations to the body's circadian rhythms; it is classified as one of the circadian rhythm sleep disorders...
, shift workShift workShift work is an employment practice designed to make use of the 24 hours of the clock. The term "shift work" includes both long-term night shifts and work schedules in which employees change or rotate shifts....
or other circadian rhythm sleep disorderCircadian rhythm sleep disorderCircadian rhythm sleep disorders are a family of sleep disorders affecting, among other things, the timing of sleep. People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs. They are generally able to get enough sleep...
s). - An underlying sleep disorder, such as narcolepsyNarcolepsyNarcolepsy is a chronic sleep disorder, or dyssomnia, characterized by excessive sleepiness and sleep attacks at inappropriate times, such as while at work. People with narcolepsy often experience disturbed nocturnal sleep and an abnormal daytime sleep pattern, which often is confused with insomnia...
, sleep apneaSleep apneaSleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...
, hypersomniaHypersomniaHypersomnia is a disorder characterized by excessive amounts of sleepiness.There are two main categories of hypersomnia: primary hypersomnia and recurrent hypersomnia...
or restless legs syndromeRestless legs syndromeRestless legs syndrome or Willis-Ekbom disease is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can affect the arms, torso, and even phantom limbs...
. - Disorders such as clinical depressionClinical depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
or atypical depressionAtypical depressionAtypical depression is a subtype of dysthymia and major depression, sharing many of the symptoms of both, but also being characterized by mood reactivity—being able to experience improved mood in response to positive events. In contrast, sufferers of "melancholic" depression generally cannot...
. - Tumors, head trauma, anemia, kidney failure, hypothyroidism or an injury to the central nervous system.
- Drug abuse.
- Genetic predisposition.
Coping
EDS is often the manifestation of a disorder, and not a sign of a willful lack of effort. Without firm and knowledgeable counseling on the part of the physician, family members, educators, and employers can easily fail to accept EDS as part of an illness.EDS can affect the ability to function in family, social, occupational, or other settings. A proper diagnosis, and treatment, of the underlying cause can help mitigate such complications. It can be difficult to accept that EDS is beyond a person's control; the unaffected may see sleepiness as an insult, a rejection, or as evidence for lack of interest. 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; this lends credence to an observer's assertions that the alertness is simply a matter of self control
Self control
Self control is the ability to control one's emotions, behavior and desires in order to obtain some reward later. In psychology it is sometimes called self-regulation...
and that EDS can be 'willed away'.
The prescription medications, Provigil (modafinil
Modafinil
Modafinil is an analeptic drug manufactured by Cephalon, and is approved by the U.S. Food and Drug Administration for the treatment of narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea...
) and Xyrem
Xyrem
Xyrem is a prescription medication manufactured by Jazz Pharmaceuticals, and is approved by the U.S. Food and Drug Administration for the treatment of cataplexy associated with narcolepsy and Excessive Daytime Sleepiness associated with narcolepsy...
(sodium oxybate) oral solution, have been approved as a first-line treatment for EDS symptoms in the U.S., and have been proven extremely effective in the treatment of most symptoms. While there is declining usage of other drugs such as methylphenidate
Methylphenidate
Methylphenidate is a psychostimulant drug approved for treatment of attention-deficit hyperactivity disorder, postural orthostatic tachycardia syndrome and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neural insult and obesity...
(Ritalin), dextroamphetamine
Dextroamphetamine
Dextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus as well as decreased fatigue and decreased appetite....
(Dexedrine), amphetamine
Amphetamine
Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
(Adderall), methamphetamine
Methamphetamine
Methamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...
(Desoxyn), and pemoline
Pemoline
Pemoline was first synthesized in 1913 but it's activity was not discovered until the 1930s. Under the names it was used as a medication used to treat attention-deficit hyperactivity disorder and narcolepsy. Under the Convention on Psychotropic Substances, it is a Schedule IV drug...
(Cylert), these psychostimulants still provide additive assistance under varying circumstances. http://www.narcolepsynetwork.org/?page_id=9.