Excessive Daytime Sleepiness


Introduction

Excessive daytime sleepiness is a prevalent condition in over 5% of the global population. It is characterized by frequent naps, low energy, and short attention spans during the day. An individual with the disorder feels excessively drowsy during the day even after having sufficient sleep during the night. This condition significantly lowers one’s quality of life by affecting their ability to work, socialize, and perform normal activities.

It is common in other sleep disorder cases, including sleep apnea, narcolepsy, and hypersomnia. It is also associated with other health conditions such as Parkinson’s disease, dementia, and depression. Excessive daytime sleepiness is concerning because the individuals can harm themselves or others if they fall asleep when performing tasks that require alertness, such as driving.

The condition can be resolved by treating the underlying health condition or controlled using medications that stimulate alertness and practices that can lead to sufficient night time sleep.

Symptoms

Excessive daytime sleepiness is characterized by persistent drowsiness during the day. A person suffering from the condition needs frequent naps or tends to fall asleep during inappropriate times during the day. The excessive sleepiness can persist even when one has had sufficient uninterrupted sleep during the night. In such cases, taking frequent naps does not help in reducing daytime sleepiness as the individual still feels sleepy after a short while.

Apart from obvious daytime lethargy, other symptoms associated with excessive daytime sleepiness include:

  • Low energy
  • Poor concentration
  • Poor memory
  • Irritability

Causes of excessive daytime sleepiness

Excessive daytime sleepiness mainly occurs as a symptom of other sleep disorders. The common sleep disorders associated with excessive daytime sleepiness are:

1. Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is commonly cited as a major cause of excessive daytime sleepiness because it affects an individual’s ability to breathe when asleep. A person who has this condition experiences obstruction in the upper airways while asleep. Consequently, their breathing is interrupted severally causing them to frequently lose sleep. These sleep interruptions lower a person’s sleep quality at night and lead to excessive sleepiness during the day.

2. Narcolepsy

This is a chronic sleeping disorder that is characterized by excessive sleepiness, which is usually overwhelming and uncontrollable. An individual with the disorder falls asleep abruptly and commonly experiences sleep hallucinations. Further, narcolepsy affects sleep-wake cycles and, therefore, causes one to feel sleepy during wakeful episodes. The disorder is normally an exaggerated form of excessive daytime sleepiness.

3. Restless leg syndrome

This disorder is characterized by uncomfortable leg sensations causing uncontrollable urges to move legs frequently. The restless leg syndrome commonly occurs at night; thus, it often disrupts one’s sleep. The sleep disturbances caused by this condition lead to sleepiness during the day.

 

Other causes of Excessive Daytime Sleepiness

Excessive daytime sleepiness can also be caused by underlying health conditions and one’s lifestyle. Thus, the other potential causes of excessive daytime sleepiness are:

1. Depression

Depression can cause insomnia or restless sleep with frequent interruptions. It may also cause one to stay for long periods before falling asleep when in bed and wake up several times during the night. Eventually, one ends up feeling sleepy during the day because of insufficient night time sleep. Consequently, excessive daytime sleepiness is a commonly referred symptom in the diagnosis of clinical depression.

2. Anxiety disorders

Anxiety disorders cause an individual to be in a constant state of worry and fear. These feelings can affect one’s sleep as they induce restlessness that makes it hard for one to fall asleep. As a result, the quality of sleep in people with anxiety disorders is significantly low. Ultimately, they end up having excessive daytime sleepiness and requiring to take frequent naps to offset their sleep deficiencies.

3. Obesity

The risk of sleep disorders is higher in individuals who are overweight. Studies show that obesity causes sleep disturbances by affecting one’s breathing. Obesity is also commonly associated with sleep apnea, which causes blockage in the airway several times at night. Obese people often get poor quality sleep and, therefore, require to nap frequently during the day.

4. Medication

Excessive daytime sleepiness can be a side effect of non-prescription and prescription medication. Certain drugs, such as sedatives, can inhibit the function of neurotransmitters, like dopamine and serotonin. These neurotransmitters induce alertness during the day; thus, their frequent inhibition can lead to excessive daytime sleepiness. Examples of medications that can cause excessive daytime drowsiness are:

  • Antidepressants
  • Muscle relaxants
  • Antipsychotics
  • Sedative-hypnotics
  • Parkinson’s disease medications

Medications that are used to increase alertness, such as amphetamines, can also cause drowsiness when their effects wear out.

5. Chronic sleep deprivation

Excessive daytime sleepiness commonly occurs because of a lack of sufficient sleep. It is common and normal for one to feel tired and sleepy during the day if they do not get sufficient night time sleep; but, the feeling fades after a lengthy sleeping episode. However, when one has chronic sleep deprivation, they continually feel drowsy and do not become refreshed after sufficient night time sleep. Hence, they get stuck in an ever-present state of low energy level, poor concentration, sleepiness, and tiredness. Underlying health conditions, such as sleep apnea, Parkinson’s disease, anxiety disorders, and depression can cause chronic sleep deprivation. Nonetheless, the deprivation is manifested through excessive daytime sleepiness.

6. Poor sleep hygiene

Good sleep hygiene involves preparing for night time sleep and eliminating sleep impediments such as light, noise, and other possible sources of disturbances in a sleeping space. Some practices that ensure a good night’s sleep include avoiding stimulants and alcohol before going to sleep, keeping the bedroom dark and quiet at night, and not performing other tasks while in bed. People with poor sleep hygiene often do not get sufficient sleep at night. Over time, they feel sleepier during the day, which often ends up becoming an excessive daytime sleepiness disorder.

7. Irregular sleep routine

A regular sleep routine prepares the body to sleep at a specific time of the night and wake up in the morning. Further, the body’s internal clock becomes attuned to keep one alert throughout the day and induce sleep at night. However, the lack of a regular sleep routine disturbs the body’s internal clock and can cause poor night time sleep and excessive daytime sleepiness.

8. Unhealthy lifestyles

Lifestyle habits can affect sleep patterns and lead to excessive daytime sleepiness. Smoking, for example, affects one’s breathing and is known to increase the risk of developing sleep apnea. Similarly, the lack of exercise can cause obesity, which can lead to poor night time sleep. Therefore, unhealthy lifestyles can lead to excessive daytime sleepiness in the long term.

Diagnosis

Physicians use information about a patient’s sleep habits to confirm and determine the seriousness of an excessive daytime sleepiness case. Identifying the underlying causes of the condition is usually the main goal since the disorder is commonly caused by other health problems. The following are some of the methods that doctors can use to diagnose excessive daytime sleepiness.

1. Polysomnography

Individuals with excessive daytime sleepiness symptoms require overnight evaluation, especially if they complain of snoring when asleep. Snoring can be an indicator of obstructive sleep apnea, which affects one’s breathing when asleep. The polysomnography study examines a person’s brain activity, blood oxygen levels, heart rate, eye movements, and respiratory rate when asleep. It can, therefore, provide details that can help in the confirmation of the condition.

2. Epworth sleepiness scale

The Epworth sleepiness scale is used to rate excessive daytime sleepiness by using questions to find out about the individual’s sleepiness during the day. The questions probe the possibility of a person falling asleep in different situations during the day. The doctor uses the information from the questionnaire as a guide to determine the seriousness of the condition.

3. Multiple sleep latency test

This is a common test used to measure the time taken by an individual to fall asleep.  It involves five scheduled naps with two-hour breaks. The patient lies in bed in a dark and quiet environment and the time they take to fall asleep is measured and recorded. The individual is woken up after sleeping for 15 minutes and if they do not fall asleep again within 20 minutes, the test is ended. At the end of the test, the average latency to sleep onset over the five naps is calculated. A mean sleep latency of 8 minutes or lower gives a positive diagnosis for narcolepsy, which is a causal disorder for excessive daytime sleepiness.

4. Sleep diary

The doctor asks a patient to keep a sleep diary for up to two weeks to assess their sleep patterns. The diary is used to record one’s sleep and wake times that the doctor uses to find patterns that can confirm excessive daytime sleepiness.

5. Physical exam

The doctor can diagnose excessive daytime sleepiness by observing the patient’s physical characteristics. Common physical characteristics that can be used to diagnose excessive daytime sleepiness are weight, crowded oropharyngeal airway, and signs of other linked sleep disorders.

Treatment

The treatment for excessive daytime sleepiness is mainly based on the underlying issues that may be causing it. Hence, doctors will identify and prescribe medicine for those specific conditions. For example, excessive sleepiness caused by obstructive sleep apnea can be treated using continuous positive airway pressure (CPAP) or surgery to ensure that the airway remains open when one is asleep. The other treatment options are methods that can be used to control the condition in cases where the specific cause of excessive daytime sleepiness has not been identified. They include:

1. Central Nervous System Stimulants

Stimulants have wake-promoting agents that stimulate the central nervous system, thus increasing one’s alertness. When taken, they help the individual stay awake for longer. They also improve one’s mood and concentration. Stimulants work by either increasing the neuronal activity or inhibiting influences that block the excitation of neuronal activity. Common OTC and prescribed stimulants used to treat excessive daytime sleepiness include modafinil and methylphenidate.

Some antidepressants that have stimulant properties are also prescribed for excessive daytime sleepiness. They include fluoxetine, paroxetine, sertraline, and citalopram. Most of the prescribed stimulants inhibit the reuptake of dopamine, which, as a result, increases its presence in the brain. Dopamine plays a significant role in ensuring wakefulness, concentration, and regulating emotional responses. Taking these stimulants during appropriate times, therefore, helps the individual stay awake and carry out their normal activities without falling asleep. Other stimulants, which are often sold over the counter, include ephedrine, caffeine, and pseudoephedrine. They can be taken to control one’s sleepiness when working. It is, however, important to take stimulants responsibly because they can be addictive if abused.

2. Energy supplements

Excessive daytime sleepiness is usually associated with low energy levels. Therefore, supplements can be used to increase one’s energy and help the individual stay alert for longer. Iron supplements are useful in combating low energy because they reduce tiredness. They are sold over the counter in the form of Ferrous Bisglycine and Ferrous oxide capsules. The various forms of vitamin B are also useful in fighting fatigue and are commonly sold as a complex. Vitamin B1 regulates mood, vitamin B2 reduces oxidative stress, Vitamin B3 supports brain functions, and vitamin B5 supports neurotransmitters.

3. Lifestyle changes

Unhealthy lifestyle habits are a major cause of excessive daytime sleepiness. Changing one’s lifestyle habits can significantly improve the condition. Quitting smoking can help reduce excessive daytime sleepiness significantly. Smoking affects one’s breathing ability and can contribute to sleep apnea, which causes sleep disturbances. When one quits smoking, their breathing ability improves thus resulting in uninterrupted night time sleep. Additionally, exercising regularly makes a person fit and reduces the risk of health problems that cause sleep disorders.

4. Weight loss

Losing weight can significantly alleviate excessive daytime sleepiness. Obese people often report feeling drowsy during inappropriate times. They also have low energy levels, reduced concentration during the day, and sleeping problems at night. Losing weight resolves these problems naturally allowing one to get adequate night sleep and remain alert during the day.

5. Sleep hygiene

Having proper sleep hygiene greatly contributes to high-quality night time sleep, which resolves excessive daytime sleepiness. Sleep deprivation is a common cause of excessive daytime sleepiness; thus, having good sleep hygiene helps in treating the condition.

6. Self-care

Excessive daytime sleepiness poses a major threat to the individual and those around them. They can cause accidents at work or even on the road if they fall asleep while driving. One should take care of themselves by avoiding tasks that require alertness if they have the condition. Alternatively, they can take stimulants such as caffeine to stay alert when performing some tasks.

Conclusion

Excessive daytime sleepiness is a condition common in many sleep disorders that cause individuals to feel excessively drowsy during the day. It is mostly caused by other underlying health conditions such as obesity, Parkinson’s disease, depression, and anxiety disorders. Other sleep disorders that cause sleep interruptions at night can also cause excessive daytime sleepiness. This condition is, therefore, commonly treated by resolving the underlying health complications that may be causing it.

At times, the disorder occurs as a solitary ailment mainly due to sleep deprivation. In such cases, several treatment options can resolve or alleviate it. Central Nervous System stimulants can be used to control the sleepiness by inducing alertness. Likewise, energy supplements can help one remain active during the day. Further, practicing good sleep hygiene can improve night time sleep and reduce sleepiness during the day. Nevertheless, taking care of oneself is crucial to prevent bodily harm when performing tasks that require alertness.

 

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