Treatment for Excessive Sleepiness

 

Excessive daytime sleepiness (EDS) is the tendency to fall asleep during the daytime1 when one is expected to be awake. EDS can impact alertness, concentration, attention, and overall health. This health concern affects up to 18% of the U.S. population2. EDS is not a sleep disorder in itself; instead, it is a symptom of other sleep-related disorders.

What Are Common Causes of Excessive Daytime Sleepiness?

The following sleep disorders commonly cause excessive daytime sleepiness:

·         Sleep apnea and other sleep-related breathing disorders

·         Narcolepsy with or without cataplexy

·         Insomnia disorders, particularly in adolescents

·         Circadian rhythm disorders such as delayed sleep phase

·         Restless leg syndrome (RLS) and periodic limb movement disorder

·         Insufficient sleep

Some psychiatric disorders—especially those that affect mood (anxiety, depression) or psychosis (schizophrenia) —can also impact sleep and can cause EDS. Heart failure, renal failure, liver failure, and obesity are medical conditions that can contribute to EDS. Neurological disorders including Parkinson’s, stroke, multiple sclerosis, and epilepsy also can affect EDS.

Other causes of EDS are inadequate sleep hygiene, excessive use of caffeine or other stimulants, chronic drug and alcohol use, and insufficient sleep. Sleep deprivation that leads to EDS is often a consequence of altered sleep patterns, like those that occur due to jet lag or shift work.

Sleep Hygiene and Excessive Daytime Sleepiness

A broad, nonpharmacologic step everyone with EDS can take is improving sleep hygiene. Proper sleep hygiene can lessen the effects of sleep-related disorders and promote overall health and wellbeing. To improve sleep hygiene:

·         Ensure the sleep environment is dark, cool, and quiet

·         Use the bed only for sex and sleep

·         Exercise regularly during daytime hours

·         Reduce consumption of alcohol, caffeine, and drugs

·         Establish a consistent and relaxing bedtime routine, free from electronics whose bright screens emit light which includes the blue wavelengths

·         If you cannot sleep after 20 minutes of lying in bed, get out of bed and find a quiet, relaxing activity until you are sleepy

What Are Treatments for Disorders That Cause Excessive Daytime Sleepiness?

Other appropriate treatments for EDS depend on the underlying disorder. Work with your physician to accurately identify the cause of your EDS rather than making assumptions. As the disorders or causes are addressed—often using a combination of treatments—daytime sleepiness improves.

When it comes to treating EDS, physicians commonly identify one or more of the following underlying disorders and recommend the corresponding treatments:

Sleep apnea. One of the most common treatments for sleep apnea of all severities is positive airway pressure (PAP)6. This is applied through the nose, mouth, or both through a machine, such as a continuous (CPAP) or bi-level (BPAP) machine.

Narcolepsy is managed through behavioral therapy, timed short naps, and proper sleep hygiene. Wake-promoting medications, such as modafinil in combination with sodium oxybate, can also be used to help with staying awake during the day.

Insomnia treatments vary. For both adolescents and adults, cognitive-behavioral therapy (CBT) is typically the first treatment approach. Pharmacological treatment is a secondary, short-term treatment to be pursued along with CBT. Prescribed drugs for insomnia include benzodiazepines, atypical antidepressants, antihistamines, and melatonin.

Circadian rhythm disorders, such as sleep phase delay in adolescents, can be treated with a combination of light therapy in the morning and melatonin in the evening. Note that for adolescents, a prescription for melatonin may need to be written off-label. Other types of circadian rhythm disorders caused by jet lag and shift work can be treated by altering the sleep schedule ahead of travel and scheduling napping.

Restless leg syndrome treatments, in addition to good sleep hygiene, include replacing iron determined to be deficient, other medications, pneumatic pressure therapy7, and regular exercise.

What Medications Are Available For People With Excessive Sleepiness?

Although there are many medications available for people with excessive sleepiness, they are often recommended along with other types of treatments, therapies, and behavior modifications. The following are commonly prescribed medications for patients with EDS:

Modafinil (Provigil) is used to treat excessive sleepiness in patients with narcolepsy and residual sleepiness in certain cases of sleep apnea. Scientists believe the drug affects the sleep-wake centers in the brain. The most common side effect is a headache. More serious side effects can be the development of insomnia or nervousness, though these are uncommon.

Armodafinil (Nuvigil) is similar to modafinil in that it is a wake-promoting agency used to treat sleepiness in patients who have narcolepsy or sleep apnea8. Mild side effects are headache and dizziness. More serious side effects can include difficulty breathing or swallowing, depression, or thoughts of self-harm.

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