Excessive daytime sleepiness explained

Daytime hypersomnia
Synonyms:EDS
Speciality: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.

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 excessive daytime sleepiness.[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; 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.[10] [11] [12]

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.[13] [14]

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.[15] [16]

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.[16] Moreover, power characteristics in the alpha-band of resting-state EEG readings, correlating with somnolence, also showed a correlation with the presence of EDS.[17] [18] [19]

Treatment

Treatment of EDS relies on identifying and treating the underlying disorder which may cure the person from the EDS. Drugs like modafinil,[20] armodafinil,[21] 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.[22]

See also

Notes and References

  1. Web site: How to Manage Excessive Sleepiness During the Day . Health . 29 June 2024 . en.
  2. Hein . Matthieu . Mungo . Anais . Hubain . Philippe . Loas . Gwenolé . Excessive daytime sleepiness in adolescents: current treatment strategies . Sleep Science . 2020 . 13 . 2 . 157–171 . 10.5935/1984-0063.20190143 . 1 July 2024 . 32742588 . 7384526 . 1984-0659.
  3. Guilleminault. C. Brooks, SN. Excessive daytime sleepiness: a challenge for the practising neurologist.. Brain: A Journal of Neurology. August 2001. 124. Pt 8. 1482–91. 11459741. 10.1093/brain/124.8.1482. free.
  4. Web site: 2020-12-03. Do I Have Excessive Sleepiness?. 2021-11-16. National Sleep Foundation. en-US.
  5. Diagnosis and treatment of sleep disorders: a brief review for clinicians. Dialogues in Clinical Neuroscience. 2003. en. 5. 4. 371–388. 10.31887/DCNS.2003.5.4/vabad. 3181779. 22033666. Abad. V. C.. Guilleminault. C..
  6. Web site: How to Stop Snoring. Sleep Apnea. 15 August 2015. https://web.archive.org/web/20160304070701/http://www.howtostopsnoringpro.com/exercises-to-stop-snoring/. 4 March 2016. dead.
  7. Arnold. Ria. Issar. Tushar. Krishnan. Arun V. Pussell. Bruce A. Neurological complications in chronic kidney disease. JRSM Cardiovascular Disease. 2016. en. 5. 204800401667768. 10.1177/2048004016677687. 2048-0040. 5102165. 27867500.
  8. 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 . 2019-08-13 . Genome-wide association analysis of self-reported daytime sleepiness identifies 42 loci that suggest biological subtypes . Nature Communications . en . 10 . 1 . 3503 . 10.1038/s41467-019-11456-7 . 31409809 . 6692391 . 2041-1723. free . 2019NatCo..10.3503W .
  9. Clinical Case Reports. Narcolepsy following COVID-19: A case report and review of potential mechanisms. 2023 . en. 10.1002/ccr3.7370. free. 10213711 . Roya . Yazdani . Farzaneh . Barzkar . Mostafa . Almasi-Dooghaee . Mahsa . Shojaie . Babak . Zamani . 11 . 6 . e7370 . 37251741 .
  10. Johns . Murray W. . A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale . Sleep . November 1991 . 14 . 6 . 540–545 . 10.1093/sleep/14.6.540 . 1798888 . 14 March 2021. free .
  11. Johns . Murray W. . Reliability and Factor Analysis of the Epworth Sleepiness Scale . Sleep . July 1992 . 15 . 4 . 376–381 . 10.1093/sleep/15.4.376 . 1519015 . 14 March 2021. free .
  12. Kendzerska . Tetyana B. . Smith . Peter M. . Brignardello-Petersen . Romina . Leung . Richard S. . Tomlinson . George A. . Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review . Sleep Medicine Reviews . August 2014 . 18 . 4 . 321–331 . 10.1016/j.smrv.2013.08.002 . 24135493 . 14 March 2021.
  13. Carskadon . Mary A. . Guidelines for the Multiple Sleep Latency Test (MSLT): A Standard Measure of Sleepiness . Sleep . December 1986 . 9 . 4 . 519–524 . 10.1093/sleep/9.4.519 . 1798888 . 14 March 2021. free .
  14. 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 . Practice Parameters for Clinical Use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test . Sleep . January 2005 . 28 . 1 . 113–121 . 10.1093/sleep/28.1.113 . 15700727 . 14 March 2021. free .
  15. Mitler . Merrill M. . Gujavarty . Krishnareddy S. . Browman . Carl P. . Maintenance of wakefulness test: A polysomnographic technique for evaluating treatment efficacy in patients with excessive somnolence . Electroencephalography and Clinical Neurophysiology . June 1982 . 53 . 6 . 658–661 . 10.1016/0013-4694(82)90142-0 . 6177511 . 2480525 .
  16. Arand . Donna . Bonnet . Michael . Hurwitz . Thomas . Mitler . Merrill . Rosa . Roger . Sangal . R. Bart . The Clinical Use of the MSLT and MWT . Sleep . January 2005 . 28 . 1 . 123–144 . 10.1093/sleep/28.1.123 . 15700728 . 14 March 2021. subscription .
  17. Breitenbach . Johannes . Baumgartl . Hermann . Buettner . Ricardo . 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 . August 2020 . Salt Lake City . 1–10 . 14 March 2021.
  18. Kalauzi . Aleksandar . Vuckovic . Aleksandra . Bojić . Tijana . EEG alpha phase shifts during transition from wakefulness to drowsiness . International Journal of Psychophysiology . December 2012 . 86 . 3 . 195–205 . 10.1016/j.ijpsycho.2012.04.012 . 22580156 . 14 March 2021.
  19. Lin . Chin-Teng . Wu . Ruei-Cheng . Liang . Sheng-Fu . Chao . Wen-Hung . Chen . Yu-Jie . Jung . Tzyy-Ping . EEG-based drowsiness estimation for safety driving using independent component analysis . IEEE Transactions on Circuits and Systems I: Regular Papers . December 2005 . 52 . 12 . 2726–2738 . 10.1109/TCSI.2005.857555 . 12252030 . 14 March 2021.
  20. Valentino. RM. Foldvary-Schaefer, N. Modafinil in the treatment of excessive daytime sleepiness.. Cleveland Clinic Journal of Medicine. August 2007. 74. 8. 561–6, 568–71. 17708127. 10.3949/ccjm.74.8.561.
  21. Nishino. S. Okuro, M. Armodafinil for excessive daytime sleepiness.. Drugs of Today. June 2008. 44. 6. 395–414. 18596995. 10.1358/dot.2008.44.6.1223892.
  22. Harris. SF. Monderer, RS . Thorpy, M . Hypersomnias of central origin.. Neurologic Clinics. November 2012. 30. 4. 1027–44. 23099128. 10.1016/j.ncl.2012.08.002.

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