One study estimated that 93 percent of women and 82 percent of men with moderate to severe OSA are undiagnosed. Because increasing age and obesity are significant risk factors for OSA, the prevalence of OSA is set to increase rapidly.
Persons with OSA have an increased risk of motor vehicle incidents because of their impaired vigilance. Many medical conditions can cause secondary excessive daytime sleepiness, including head trauma, stroke, tumors, inflammatory conditions, encephalitis, and genetic and neurodegenerative diseases.
Psychiatric conditions, especially depression, can also result in excessive daytime sleepiness. Sleep disorders such as circadian rhythm disorders e. Narcolepsy, the most common of the primary hypersomnias, is reported to affect 0. Approximately 25 to 30 percent of patients with narcolepsy have associated cataplexy i. Although some patients present with the symptom of daytime sleepiness, most are far sleepier than they realize. Questionnaires such as the Stanford Sleepiness Scale and the Epworth Sleepiness Scale Figure 1 24 are validated, patient-completed assessments of daytime sleepiness that can be used as screening tests.
A test score in excess of 12 on the Epworth Sleepiness Scale or a patient history of falling asleep while driving are clear indications that further evaluation and work-up are required. Patient questionnaire for rating excessive daytime sleepiness using the Epworth Sleepiness Scale. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. A targeted medical history, physical examination, and laboratory assessment should be used to evaluate patients at risk of medical or psychological causes of secondary excessive daytime sleepiness.
The medication history must address use of all prescription and nonprescription medications, and drugs of abuse. Sometimes treatment of excessive daytime sleepiness can be as simple as discontinuing or modifying the use of such agents. Information about sleep patterns should identify behavioral sleep deprivation. This is most common in adolescents and shift workers, and it can result in significant excessive daytime sleepiness if not addressed. Information about sleep patterns from the patient and his or her bed partner, if applicable, may indicate restless legs syndrome or OSA, the latter of which may occur even in persons who are not obese or who do not have the common comorbidities of hypertension, diabetes, and coronary disease.
In most cases, overnight polysomnography is required to confirm the diagnosis of OSA and to determine the appropriate pressure levels for treatment using continuous positive airway pressure CPAP or a similar system. Home sleep testing must only be performed by a physician with board certification in sleep medicine or a physician who is an active staff member of a sleep laboratory or clinic accredited by the American Academy of Sleep Medicine or the Joint Commission.
CPAP is initially limited to a week period, with coverage extended for persons whose symptoms improve based on follow-up physician re-evaluation and with objective evidence of CPAP utilization. Algorithm for the diagnosis and treatment of conditions that cause excessive daytime sleepiness. Subjective assessment of symptoms using questionnaires and clinical assessment of behavioral impact may not accurately reflect the degree of physiologic sleepiness.
Both of these tests use modified polysomnography to assess sleep onset latency i. To diagnose narcolepsy without cataplexy, the MSLT must demonstrate hypersomnolence and early onset of rapid eye movement sleep. The MWT can be used to assess improvements in waking performance after treatment in persons with excessive daytime sleepiness who could potentially be dangerous to self and others, such as commercial drivers and airplane pilots.
Addressing the underlying cause is the mainstay of treatment of excessive daytime sleepiness. In OSA—the most dangerous and physiologically disruptive cause of excessive daytime sleepiness—treatment with positive pressure devices e. Modafinil Provigil is considered to be the first-line activating agent for the treatment of excessive daytime sleepiness. It is indicated for the treatment of persistent sleepiness associated with OSA in patients already being treated with CPAP, and for the treatment of daytime sleepiness in patients with shift work disorder.
Other medications that must be used with caution to induce alertness in somnolent patients include the amphetamines dextroamphetamine [Dexedrine], methylphenidate [Ritalin] and pemoline Cylert, not available in the United States. The amphetamines are Schedule II prescription drugs and are considered to have a high potential for abuse.
Side effects of amphetamines include personality changes, tremor, hypertension, headaches, and gastroesophageal reflux. The use of activating agents is inappropriate in hypersomnolent patients with untreated OSA—although daytime sleepiness may be improved with these agents, the patient remains at risk from the pathophysiologic consequences of untreated OSA. Legal requirements for reporting excessive daytime sleepiness that may impair driving vary from state to state. A physician should report patients who fail to comply with treatment, particularly high-risk persons such as airline pilots, truck, bus, and occupational drivers, and those with a history of recent sleepiness-associated incidents.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Pagel received his medical degree from the University of Alabama at Birmingham, and completed his family medicine residency at St. Address correspondence to J. Greenwood St. Reprints are not available from the authors.
Pagel was a consultant to Cephalon, Inc. Johnson EO. Sleep in America: Accessed October 28, Friedman NS. Determinants and measurements of daytime sleepiness. Totowa, N. Treatment usually involves stimulant medications, which help the person stay awake.
Antidepressant medications may help control hallucinations and episodes of sleep paralysis. Doctors may also recommend that people take a few good naps throughout the day, as this can improve narcolepsy symptoms. Depression may contribute to sleep issues, including excessive daytime sleepiness, as well as oversleeping, or sleep that is not restful. Likewise, sleep issues may contribute to symptoms of depression. General fatigue and daytime tiredness are common among people with depression.
Other symptoms of depression include:. Several different types of antidepressant medication are available. A person can talk to their doctor about which medication would be most appropriate for them. Common psychotherapies for depression include cognitive behavioral therapy CBT and interpersonal therapy. According to the Anxiety and Depression Association of America , these therapies appear to be particularly effective in treating depression.
It is important to discuss the side effects of any medication with a doctor. If side effects such as sleepiness are too difficult to deal with, the doctor may recommend a change in medication or dosage. Excessive sleepiness is not a disorder in itself but a symptom of insufficient sleep or an underlying health condition.
A person may experience additional symptoms if their excessive sleepiness is the result of an underlying health condition. Correctly diagnosing the underlying cause of excessive sleepiness is important for establishing the best treatment. The doctor may also ask questions relating to mental health. Most healthcare professionals will not want to prescribe highly addictive drugs to assist with sleep, and people who receive a prescription for sleep medications should not take them every day.
These include:. You may have excessive sleepiness, and it may be time to talk to your doctor. Losing sleep can increase reaction times, impacting performance, productivity, and safety.
Our guide explores the connection between sleep deprivation and…. Excessive daytime sleepiness can occur for different reasons. For many people, feelings of tiredness can be attributed to not getting…. Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
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The Sleep Foundation editorial team is dedicated to providing content that meets the highest standards for accuracy and objectivity. Our editors and medical experts rigorously evaluate every article and guide to ensure the information is factual, up-to-date, and free of bias.
Updated February 18, Written by Danielle Pacheco. Medically Reviewed by Dr. Anis Rehman. What Causes Excessive Sleepiness? When to Talk To Your Doctor. What Is Excessive Daytime Sleepiness? Related Reading. Sign up below for your free gift. Your privacy is important to us. Was this article helpful? Yes No. Anis Rehman Endocrinologist MD. Wang, H.
Genome-wide association analysis of self-reported daytime sleepiness identifies 42 loci that suggest biological subtypes. Nature Communications, 10 1 , Ford, E. Trends in insomnia and excessive daytime sleepiness among U. Sleep Medicine, 16 3 , — Chervin, R.
Many experts define EDS as distinct from fatigue , which involves strong feelings of physical exhaustion, but the two conditions may overlap. Recent research points to excessive sleepiness being a significant problem. The Sleep in America Poll for by the National Sleep Foundation found that nearly half of Americans report feeling sleepy between three and seven days per week. Forty percent of adults said that their drowsiness interferes with daily activities at least occasionally.
Some resources refer to EDS as hypersomnia, which describes disorders of excess sleep. However, hypersomnia is a broader term that includes issues like sleeping too much at night that are distinct from extreme drowsiness during the day or in situations when alertness is required. Excessive daytime sleepiness is not a condition in itself; instead, it is a symptom caused by an underlying problem.
Lack of sleep is widely considered to be the most common cause of excessive sleepiness. Sleep deprivation may be short-term or chronic and can itself be caused by numerous sleep disorders and other medical conditions :. A lack of sleep is not the only potential cause of excessive sleepiness. Medications , especially sedatives, can make a person drowsy and disoriented during the day.
Antidepressants, pain medications, and over-the-counter antihistamines are just a few of the other types of medications that can cause sleepiness. In addition, withdrawal from some drugs may provoke drowsiness.
Mental health disorders can frequently cause drowsiness. Bipolar disorder , post-traumatic stress disorder PTSD , and general anxiety disorder are associated with sleeping problems that may give rise to bouts of excessive sleepiness. Several brain conditions can cause excessive daytime sleepiness. Narcolepsy is a prominent example as it is a neurological condition in which the brain cannot properly regulate the sleep-wake cycle. Narcolepsy affects around one in every 2, people and makes them prone to falling asleep rapidly, including at inopportune times.
Traumatic brain injury TBI and concussions commonly cause sleeping problems , and brain tumors or lesions may provoke excessive sleepiness. Infections, including meningitis and those that cause encephalitis swelling of the brain , can also lead to EDS. Other health problems beyond brain conditions can make a person sleepy during the day. Metabolic problems, including diabetes and hypothyroidism, can be risk factors for drowsiness.
Medical conditions like anemia, abnormal blood sodium levels, and electrolyte imbalances can also provoke excessive sleepiness. Relief is possible for most people with excessive sleepiness. The optimal treatment is tailored to each person based on the specific cause or contributing factors.
Because EDS can be caused by both poor sleep habits and medical and brain conditions, there are a diverse range of approaches to resolving it. A doctor is in the best position to identify and tailor optimal treatment pathways for individuals. If drowsiness is derived from sleep deprivation, various steps can be taken to improve sleep quality and quantity.
If EDS is tied to another medical problem, treatment typically focuses on resolving that underlying issue. Sleep hygiene improvements may be encouraged along with other treatments to help people incorporate healthy sleep tips into their daily routines. Eric Suni has over a decade of experience as a science writer and was previously an information specialist for the National Cancer Institute. His research and clinical practice focuses on the entire myriad of sleep disorders.
Terminology about sleep can be confusing.
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