Excessive Daytime Sleepiness: Why Management Is Necessary

There is a normal tendency to blame excessive daytime sleepiness to lifestyle. Too many late nights causing sleep deprivation, losing sleep over work or domestic problems etc are normal self-diagnosed reasons for losing alertness during the day. Not many realize though that excessive daytime sleepiness is one of the most common sleep disorders affecting close to 20% of the population.

Going beyond feeling too sleepy 

Excessive daytime sleepiness is not about feeling droopy and lousy during the day. It can severely impact mood, relationships as well as personal safety and quality of life. Look what it is doing to fellow Americans:

–          36% fall asleep while driving

–          29% become sleepy at work

–          20% lose interest in sex

–          14%  miss family functions and leisure activities

What causes one to be over sleepy during the day? 

The most common causes are sleep deprivation, sleep disorders like narcolepsy and obstructive sleep apnea, certain medical and psychiatric conditions and sedating medications.  Some other common causes are:

–          Voluntary sleep deprivation (not allowing sufficient time for sleep)

–          Medical conditions that cause chronic pain, frequent urination, and muscle cramps

–          Disturbances in the circadian rhythm (jet lag, changes in work shift may cause disturbed or fragmented sleep)

–          Toxic metabolic disorders

–          Medical conditions including head trauma, stroke, cancer, inflammatory conditions, encephalitis, neurodegenerative conditions

–          Depression

–          Medications including Alpha-adrenergic blocking agents, Anticonvulsants, Antidepressants, Anti-diarrhea agents, Anti-emetics, etc.

Is it possible to quantify excessive daytime sleepiness? 

The Epworth Sleepiness Scale is a tool that subjectively measures daytime sleepiness. This involves rating on a 0 to 3 scale the likelihood of falling asleep in 8 different situations like watching TV etc. While scores higher than 10 is regarded as extreme sleepiness. Patients suffering from narcolepsy, sleep apnea, etc score high. On the other hand chronic insomnia patients score low because of their innate inability to fall asleep.

The Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT) are used for physiologic measurement of sleepiness. They assess the time taken to fall asleep (sleep latency) during a series of waking nap periods.  MSLT is an objective diagnostic tool that tests sleep onset rapid eye movement sleep periods (SOREMPS), useful for diagnosing narcolepsy.  According to the American Academy of Sleep Medicine (AASM), MSLT is considered to be the de facto standard for the objective measurement of sleepiness.

How is excessive daytime sleepiness treated? 

Treatment modality is decided by the cause of the condition. For example if the individual is experiencing excessive sleepiness because of sleep apnea, then doctors may prescribe Continuous Positive Airway Pressure (CPAP) therapy for making breathing easier. However if the sleepiness is due to poor sleep habits or sleep deprivation is self-created then the treatment measures include adopting behavioral measures.

Steps that can be taken to reduce daytime sleepiness and increase alertness are:

–          Keeping a strict bedtime schedule

–          Developing a relaxing bedtime routine

–          Improving sleep and bedroom environment

–          Avoiding coffee and other stimulants

–          Quitting alcohol

Leave A Response

* Denotes Required Field