Daytime Sleepiness

What are the symptoms of daytime sleepiness? Patients may doze off when inactive, and may even doze off when driving or at traffic signals. Other patients may find it hard to stay awake, although they are able to. They may feel tired all the time. Severe daytime sleepiness leads to a seven-fold increase in the rate of auto accidents. Milder sleepiness may present as tiredness, fatigue and lack of energy, and may interfere with attention, memory, and routine tasks.

How is it diagnosed? Monitoring of sleepiness or wakefulness through the day establishes the presence and severity of daytime sleepiness. Sleep testing may also show the cause. Sleep apnea is the most common cause. Narcolepsy and idiopathic hypersomnia are familial disorders, with sleepiness beginning early in life and persisting through life. Muscle weakness when emotional (cataplexy), vivid dreams while still half-awake, and brief paralysis on awakening, also may occur in narcolepsy, but not in idiopathic hypersomnia. Other causes include not getting enough time in bed, delayed sleep phase disorder and mood disorder. In delayed sleep phase syndrome, the body clock is delayed, so that the preferred bedtime and rise-time are later than desirable, with difficulty falling asleep and difficulty waking up.

 How is it treated? Accurate diagnosis allows effective treatment. Sleep apnea is best treated with CPAP. Narcolepsy and idiopathic hypersomnia are treated with stimulant medicines that generally work on the brain chemical dopamine. Sleepiness with mood disorder can be treated with medicines that work on other brain chemicals including serotonin and norepinephrine. Delayed sleep phase disorder can be treated behaviorally and with bright light, but requires a commitment to go to bed and get up at the desired times everyday. It is also important to get enough time in bed. People spending just five to six hours in bed are likely to be sleepy as a result. Average need for sleep is seven to eight hours a night.

When should I seek help? If sleepiness interferes with daily routine, or causes impaired alertness or sleep episodes when driving.

Key Benefits of Treatment

• Treatment improves sleepiness, increases energy levels
• This improves school and work performance
• Controlling sleepiness can decrease risk of accidents