Excessive Daytime Sleepiness

What is excessive daytime sleepiness?

Excessive Daytime Sleepiness (EDS) is defined by having an increased pressure to fall asleep during typical wake hours. It is a common complaint of many adults and children. It is the most common symptoms of people with sleep disorders. EDS is a leading cause of fatalities from motor vehicle accident.

Sleep deprivation has also been associated with the Chernobyl nuclear power plant meltdown, Exxon Valdez oil spill, and the space shuttle, Challenger, explosion.

See Hypersomnia for more information on EDS.

Excessive Daytime Sleepiness is a non-specific symptom. There are several potential causes of EDS. EDS is difficult to assess objectively. There are several questionnaires available to assess EDS. One of the most popular questionnaires is the Epworth Sleepiness Scale (ESS). This scale uses eight questions composed of eight scenarios. The user rates the likelihood of falling asleep from 0 -3 points per scenario. The total is tallied up to a highest sleepiness score of 24.

feel tired and feel sleepy
Feel tired and feeling sleepy

Excessive daytime sleepiness (EDS) is usually a symptom of a condition.

Tests used to assess excessive daytime sleepiness

There are several tests that can be done to diagnose sleepiness, which will determine whether the individual has primary (originating in the brain) or secondary (originating as a result of another disease) sleepiness.  First, the physician will look for other obvious sleep disorders that could be causing the excessive sleepiness, with the primary goal being to determine if there are treatable medical conditions present.  These tests could include polysomnography, subjective scales such as the Epworth Sleepiness Scale and the Stanford Sleepiness Scale, as well as objective tests like the multiple sleep latency test.  The physician will usually make the diagnosis when symptoms have been present for three consecutive months and there are no other underlying diseases.

Primary sleepiness is less common than secondary sleepiness, affecting less than 1% of the population and usually associated with a more widely known diagnosis.  Primary sleepiness include diagnoses of sleep disorders like narcolepsy, sleep apnea, restless leg syndrome, and insomnia

Secondary sleepiness is much more prevalent.  The excessive sleepiness can be a result of other conditions such as depression, obesity, epilepsy, or multiple sclerosis.  It is common in those with upper airway resistance syndrome, restless leg syndrome, sleep deprivation, and substance abuse.  Some people may be genetically predisposed to the condition as well.

There are a host of conditions that could lead to sleepiness; however, one of the most common cause is sleep apnea, affecting approximately 4% of the population. 

sleeping person 04 (5)Treatments for excessive daytime sleepiness

Treatment will depend greatly on the underlying cause of sleepiness and whether it is a primary or secondary concern.  Sometimes, catching up on sleep will alleviate the excessive sleepiness; however, more often than not, it is more appropriate to treat the underlying cause than it is to treat the symptom.  Most common treatments include the use of stimulant medications like amphetamines to help the individual stay awake throughout the day.  In addition, behavioral therapy, sleep hygiene, and education are usually added to a treatment regimen.

There are two sleep study tests that are used to assess excessive daytime sleepiness. The Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) are tests that are performed in a sleep center. The patient is instructed to try to fall asleep (MSLT) or try to stay awake (MWT). These tests are usually performed during the daytime after a nighttime sleep study. They usually consist of 4 or 5 nap time tests.

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