Everyone has days when they simply can’t seem to stay awake. Whether you slept poorly the night before, got up earlier than usual, or simply haven’t had your daily dose of caffeine, some days you feel excessively tired until you finally make it to bed at night.
Excessive daytime sleepiness or hypersomnia is one of the most common symptoms reported by patients with sleep disorders. This condition affects roughly 20% of the population and, for many people, it is severe enough to affect daily activities and may even increase the risk for motor vehicle accidents and work-related injuries.
In this article, we’ll explore the subject of excessive daytime sleepiness including what it is, which sleep disorders are known to cause it, and how it can be diagnosed and treated.
What is Excessive Daytime Sleepiness?
Technically speaking, excessive daytime sleepiness (EDS) is not a disorder in itself but a symptom of several different sleep disorders.
This symptom is thought to affect as much as 20% of the population to such a degree that it interferes with work, school, and other daytime activities.
It is the most common symptom reported by patients who visit sleep clinics for the diagnosis of a sleep disorder, and it is most common in young adults, older adults, and shift workers.
The true prevalence of excessive daytime sleepiness is difficult to determine for a number of reasons.
For one thing, the nature of the symptom itself is subjective – a level of daytime sleepiness one patient might consider excessive may be mild or moderate to another patient.
There are also inconsistencies in terminology and a lack of consensus among medical professionals in regard to methods of assessment and diagnosis.
Though the terms used to describe this problem may vary, they all point to a common problem – a level of daytime sleepiness that interferes with daily activity.
What Are the Symptoms of Excessive Daytime Sleepiness?
The primary symptom of hypersomnia is, of course, a chronic feeling of sleepiness that occurs despite being well-rested. People who experience EDS experience a constant and overwhelming feeling of tiredness throughout the day, on most days, even if they got an adequate or above-adequate amount of sleep the night before.
Other symptoms of EDS may include the following:
- Difficulty waking in the morning
- General lack of energy during the day
- Dozing off at inappropriate times
- Still feeling tired after a nap
- Anxiety or irritability
- Difficulty concentrating and focusing
- Lapses in attention
- Changes in appetite
- Poor performance at work or in school
It is important to differentiate between excessive daytime sleepiness and fatigue. Fatigue is a level of extreme tiredness that results from mental or physical exertion or from illness. For example, if you normally work an 8-hour day but one day worked a double shift, you might feel fatigued afterward due to the increased level of physical and mental exertion. Excessive daytime sleepiness, on the other hand, can happen even when you are well-rested. You might struggle to stay awake during the day or still feel drowsy after taking regular naps.
Not only is excessive daytime sleepiness different from fatigue, but some would argue that it is more dangerous.
While fatigue can be relieved with rest, EDS can become chronic, and you may not always have the luxury of being able to take a nap – you may be forced to work through it which only makes things more dangerous.
According to the National Transportation Safety Board, over 50% of single-vehicle crashes involving heavy trucks are related to fatigue, and over 17% involve the driver falling asleep at the wheel.
Daytime sleepiness has even been linked to lower academic performance and poor health.
Adolescents who suffer from EDS have increased school tardiness, lower levels of academic performance, and lower graduation rates than healthy students.
It can even impede job performance which may affect the patient’s ability to gain or maintain employment.
What Causes Excessive Daytime Sleepiness?
Excessive daytime sleepiness is not a condition in itself but a symptom of several common sleep disorders. The top three sleep disorders in which EDS is a common symptom are:
- Obstructive Sleep Apnea (OSA)
- Narcolepsy
- Restless Leg Syndrome
Now, let’s take a closer look at each of these three sleep disorders.
- Obstructive Sleep Apnea (OSA)
Hypersomnia or excessive daytime sleepiness is the most commonly reported symptom of obstructive sleep apnea (OSA), the most common sleep disorder which affects over 20 million American adults.
This sleep disorder is characterized by periodic cessations in breathing during sleep and can last up to 20 seconds at a time and may occur hundreds of times per night.
OSA is caused by a blockage in the upper airway during sleep. This blockage may be the result of anatomical abnormalities such as enlarged tonsils, or it could be the result of the tongue or throat muscles collapsing into the airway.
If the cessation in breathing is long enough, it triggers the brain to wake itself up to resume breathing.
Depending how often it happens during the night, these events can cause a serious disturbance in the quality of the patient’s sleep which can lead to excessive daytime sleepiness.
- Narcolepsy
A sleep disorder affecting roughly 1 in 2,000 people, narcolepsy is technically a chronic neurological disorder that affects the brain’s ability to control the sleep/wake cycle.
People who have regular sleep patterns typically enter REM sleep after 60 to 90 minutes, but people with narcolepsy enter REM sleep within 15 minutes of falling asleep and may also experience REM sleep involuntarily during the day.
Every person who has narcolepsy experiences EDS, though only 10% to 20% will experience other symptoms such as sudden loss of muscle tone (cataplexy), sleep paralysis, hallucinations, insomnia, and automatic behaviors.
- Restless Leg Syndrome
Another neurological disorder, restless leg syndrome (RLS), is characterized by the uncontrollable urge to move the legs caused by an uncomfortable or painful sensation in the legs.
Symptoms of RLS typically develop in the afternoon and evening or during periods of rest, particularly when trying to fall asleep. Because this condition can make it difficult to fall or stay asleep, it may contribute to excessive daytime sleepiness.
While these three disorders are some of the most common causes of chronic hypersomnia, there are other potential contributing factors. Sleep deprivation, the use of certain medications, and various psychiatric conditions can all play a role.
Sleep deprivation is one of the most common causes of excessive daytime sleepiness, and it is not always caused by a sleep disorder like restless leg syndrome or sleep apnea. In many cases, sleep deprivation is intentional.
For example, you might stay up late to finish watching a movie or to prepare for a presentation at work the next day.
You may not realize it, but even mild sleep restriction can lead to negative symptoms like excessive daytime sleepiness.
In fact, a study published in the journal Sleep showed that healthy adults restricted to six hours of sleep a night for 14 consecutive nights showed significant impairment of neurobiological functions.
Excessive daytime sleepiness is also a common complaint related to certain medications – particularly those that act on the central nervous system. Some of the drugs most likely to interfere with the sleep/wake cycle and contribute to daytime sleepiness include the following:
- Anticonvulsants
- Antidepressants
- Antihistamines
- Antipsychotics
- Antispasmodics
- Barbiturates
- Benzodiazepines
- Muscle relaxants
- Opiate agonists
Hypersomnia has also been reported as a symptom secondary to medical conditions such as head trauma, inflammatory conditions, stroke, encephalitis, and neurodegenerative disease. Certain psychiatric conditions like depression can trigger excessive daytime sleepiness, and other sleep disorders like circadian rhythm disorder or periodic limb movement disorder may contribute as well.
How is Excessive Daytime Sleepiness Diagnosed?
If you are concerned about the severity of your daytime sleepiness or its effect on your ability to complete daily tasks, talk to your doctor. Your doctor will perform a thorough clinical exam in addition to taking a medical history and a review of your symptoms.
In addition to these things, your doctor will also use a tool called the Epworth Sleepiness Scale to determine the severity of your daytime sleepiness based on your responses to a series of short questions.
The Epworth Sleepiness Scale will require you to answer questions about your likelihood of falling asleep during certain activities rated on a scale from 0 to 3.
A response of 0 is equated with zero chance of falling asleep while a response of 3 is the highest chance of falling asleep.
If your doctor still needs more information about your sleep habits, he may use additional assessments such as the Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT).
These tests are often performed in conjunction with polysomnography or a sleep test. This test may also be used to diagnose a concurrent sleep disorder like OSA, narcolepsy, or restless leg syndrome.
Additional testing may be required to confirm a diagnosis for other conditions that may be contributing to your excessive daytime sleepiness such as neurological problems, psychiatric disorders, etc.
What Are the Treatment Options for Excessive Daytime Sleepiness?
When it comes to treatment options for excessive daytime sleepiness, it depends on the underlying cause for the problem. If the underlying cause of your EDS is a sleep disorder like obstructive sleep apnea, narcolepsy, or restless leg syndrome, treatment will be catered to treating the disorder.
Here is an overview of treatment options for these three conditions:
- Obstructive Sleep Apnea – The most common treatment for OSA is a continuous positive airway pressure (CPAP) machine. This consists of a mask that fits over your nose and delivers gently pressurized air to keep the airway open during sleep. Oral devices that hold the tongue in place or which pull the lower jaw forward may also help. In some cases in which CPAP therapy is inadequate, treatment with modafinil may be beneficial.
- Narcolepsy – The most common treatment options for narcolepsy include modafinil, stimulants, antidepressants, sodium oxybate, and lifestyle changes. Modafinil is a central nervous system stimulant which has fewer side effects than other stimulants like amphetamines. Antidepressants may help control cataplexy in narcolepsy patients, and sodium oxybate may be beneficial as well, though it is much stronger.
- Restless Leg Syndrome – In cases where restless leg syndrome is secondary to another condition (like Parkinson’s disease, iron deficiency, diabetes, or kidney problems), treatment of that condition may improve symptoms like EDS. Other treatments may include sedatives to promote sleep, narcotics to relieve pain, anti-inflammatory drugs, and improved sleep habits.
If excessive daytime sleepiness is not related to another sleep disorder, treatment may not be as straightforward.
In some cases, lifestyle changes may be beneficial such as improving sleep hygiene, sticking to a regular sleep schedule, and addressing any psychiatric disorders.
Sleep hygiene, according to the National Sleep Foundation, is a set of practices and habits necessary to have a good nighttime sleep quality and full daytime alertness.
Here are some simple tips for improving sleep hygiene to help you get a better night’s sleep:
- Try to stick to the same bedtime and wake times each day, so your body develops a regular sleep/wake cycle.
- Exercise for at least 10 minutes per day but avoid strenuous exercise within a few hours of bedtime.
- Limit your daytime naps to no more than 30 minutes to improve alertness and focus.
- Avoid stimulants like caffeine and nicotine within a few hours of bedtime – some recommend that you stop drinking caffeine after 2pm.
- Make sure you have adequate exposure to natural light during the day to support your internal circadian rhythm.
- Avoid rich, heavy, and fatty foods as well as spicy foods, citrus, and carbonated beverages right before sleep because they can trigger indigestion or heartburn that interferes with sleep.
- Keep your bedroom cool, quiet, and dark to improve the quality of your sleep.
- Only use your bedroom for sleeping and sexual activity – if you perform other activities in bed (like watching TV), you may find it more difficult to fall asleep at night.
Unfortunately, the best treatment plan for excessive daytime sleepiness is not always obvious, even if your doctor is able to diagnose you with a specific sleep disorder.
When it comes to pharmaceutical treatments, some drugs have side effects which can make your sleep problems worse, or they may cause the opposite of the original problem, insomnia rather than sleepiness.
Work closely with your doctor and be as open and honest as you can about your symptoms to gain the best chance of finding an effective treatment for your excessive daytime sleepiness.
Disclaimer: The information on this website is not intended to be used as a substitute for professional medical advice, clinical diagnosis, or treatment.
Always seek the advice of your personal physician or another qualified health provider with any questions you may have regarding a medical condition.
