Excessive daytime sleepiness can sound like a made-up problem created to scare gullible people into buying medication they don’t need. It seems like a part of simple everyday life, and one we’ve all experienced more than once. However, there is more to EDS than you’d think – it acts as a symptom of many if not all sleeping disorders, and the exhaustion you feel prevents you from enjoying various activities to their fullest, or from being productive at work or energetic and positive at home. If you’re a driver, excessive daytime sleepiness can spell disaster due to the risks of drowsy driving.
It’s important to know what causes EDS and what its effects on people and consequences are. Once you understand the seriousness of the issue, we will go over treatment methods that have been proven effective in the past. Remember that if you’re constantly sleepy during the day, or you interpret what we’re about to explain as a chance that you have excessive daytime sleepiness – it’s best to consult your doctor. They will be able to provide an accurate and helpful diagnosis and suggest solutions. Let’s examine this issue together, first.
Methods of Diagnosing Excessive Daytime Sleepiness
A common way people dismiss EDS as a non-issue is by claiming that it’s subjective. How can you tell if someone is sleepier during the day than they should be? A test being subjective doesn’t immediately discredit the method. While it’s hard to quantify how sleepy someone feels, subjective tests have historically been useful enough to help doctors reach a precise diagnosis, when coupled with blood tests, urine tests, and other lab examinations. We will list a few diagnosis methods that are used to determine whether a patient is dealing with excessive daytime sleepiness. All of them are commonly used, and while subjective, they provide enough insight to steer the tests and examinations towards uncovering specific sleep disorders, which can result in a very accurate diagnosis.
Epworth Sleeping Scale (ESS)
The Epworth Sleeping Scale (or ESS for short) was developed by Dr. Murray Johns at the Epworth Hospital in Melbourne, Australia. The way it works is, the patient is given a questionnaire to fill. There are eight questions in total, each having four possible answer options. These answers give 0-3 points based on which option you selected, and the points are added up in the end. If the patient has 10 or more points after completing all the questions honestly, it indicates the presence of a sleeping disorder. Scores of 11-15 generally hint towards moderate or mild sleep apnea. A score of 16 points or more could point towards narcolepsy or a more severe case of sleep apnea.
In general, the ESS has been primarily used to detect and diagnose obstructive sleep apnea. However, doctors have had success using this method to find narcolepsy and idiopathic hypersomnia. As a rule, the patient will repeat the questionnaire after treatment methods have been applied, to measure their progress and check for improvements.
Pittsburg Sleep Quality Index (PSQI)
This very accessible questionnaire helps track a patient’s sleep quality over the course of a month. It takes roughly 5-10 minutes to complete and produces seven components that combine to create one global score. It was developed at the University of Pittsburg as an easy-to-use, accessible diagnosis method for clinicians to use with various demographics. While it has since been used in research (specifically in studies trying to connect sleep with problems like bipolar disorder or depression), the main application has been the diagnosis of sleep disorders. As a whole, the PSQI is particularly effective when it comes to detecting depression-related sleeping problems and self-reported issues.
The main downside is the same as most other subjective diagnosis methods. It’s very easy for a patient to exaggerate or misremember things, which creates unintentional false answers and muddies the issue further, potentially leading to inaccurate diagnosis. However, its ease of use and accessibility have resulted in it seeing use in clinical practice, as well as for research purposes, primarily focusing on patients who have at least hit adolescence.
Multiple Sleep Latency Test (MSLT)
This test is a much more complex diagnostic method than the questionnaires we’ve covered thus far and takes quite a bit more time. The purpose of the MSLT is to measure how long it takes for the patient to fall asleep during predetermined daytime nap periods. It is commonly used to test for narcolepsy and to differentiate between excessive daytime sleepiness and simple physical exhaustion. This method has also seen niche use in assessing the effectiveness of breathing disorder treatment. The test consists of 4-5 nap windows, each lasting 20 minutes with a two-hour break in between naps. It takes place over roughly seven hours during a single day, during which the doctors monitor the patients’ brainwaves, EEG patterns, eye movements and more. Here’s how it works:
Before you go to the test facility, you are asked not to consume chocolate, coffee or similar stimulants. In most cases, a formal sleep study takes place the night before the MSLT. You may be asked to submit a urine sample so they can make sure you don’t have any substances in your body that could muddle the test results. After a short questionnaire, electrodes are attached to your head, near the eyes and to the chin to measure and record eye movement, brain waves and muscle tone. By doing this, they can detect when or if you enter REM sleep. After 20 minutes, you’re woken up and wait two hours before doing the test again. The idea is – the easier it is for you to fall asleep (measured by how long it takes), the more signs point towards a sleeping disorder such as narcolepsy. Once you’re done, a neurologist or sleep specialist reviews the results and informs your primary care physician.
Causes of Excessive Daytime Sleepiness
A staggering amount of conditions and factors can bring on EDS. We will present a general list, but not every possible cause will be on it. Because the number of causes is so huge, it’s important to get a diagnosis as soon as possible, to prevent things from getting worse or problems from going undetected. Here’s the list:
– Insufficient sleep quantity or quality during the night. This is particularly troublesome for shift workers or people with nocturnal habits
– Any source of circadian rhythm disruption. Your biological clock can be put off-schedule by problems such as jet lag or shift work, but it may also indicate a full-blown circadian rhythm disorder
– Clinical depression or similar disorders can cause EDS. Poor sleep quality (and all the resulting consequences) are very common in depressive patients
– A variety of sleep disorders, including narcolepsy, restless legs syndrome and sleep apnea
– Side-effects of OTC (over-the-counter) and prescription medication can include or contribute to EDS. If this is the case for you, quickly consult your doctor to receive alternative recommendations, so you can get rid of EDS before other problems crop up. Remember, having a bad sleep schedule can impact your immune system and lead to more complications
– Drug abuse
There are more, but this is enough to paint the picture. The sheer number of possible causes makes your medical history a crucial component of the diagnosis. Make sure the people conducting your tests know every relevant piece of information about your health. Even if your statements are subjective and they revolve around your personal experience, they could be more than enough to eliminate certain causes and speed up the diagnosis.
Consequences of Excessive Daytime Sleepiness
If you’ve ever tried to stay awake for a full day or two, you are familiar with most EDS symptoms. People who are running on an empty sleep tank are far more irritable and difficult to deal with, as their cognitive sharpness and emotional stability are worsened. EDS is also one of the primary factors that lead to drowsy driving, and drowsy driving is as bad as drunk driving when it comes to the risks involved. EDS also amplifies problems like depression and makes the patient less productive, happy and safe as a result. It can feel like all your motivation and energy got flushed away.
It can be hard to distinguish simple physical fatigue from sleepiness, but those are two very different issues. Just because you got a lot of exercise in a given day doesn’t mean you instantly become drowsy and sleepy.
Treating Excessive Daytime Sleepiness
There’s no one reliable cure for excessive daytime sleepiness. The truth of the matter is that in order to get rid of EDS, you have to cure or solve the underlying causes. EDS is a symptom, not a disorder in itself. As a result, EDS treatment can vary greatly depending on where the problem comes from. Sometimes it’s enough to establish and maintain healthy sleeping habits, but often you need proper professional therapy. For example:
Narcolepsy is a very common sleeping disorder since it affects roughly 1 in 2000 people. It makes the brain unable to regulate the cycle of when we sleep and when we’re awake. Normally we spend about 75% of our sleeping time in the NREM stage. That stage is where the body works on repairing and building new tissues and bone structure or strengthening our immune system. REM is essentially the mental counterpart to NREM, as it helps consolidate memories and develop or strengthen cognitive functions. A person suffering from narcolepsy has way more REM sleep than normal, as it starts almost immediately upon falling asleep. On top of that, they can experience REM outbursts during the day, potentially getting into danger.
Other symptoms of narcolepsy include sleep paralysis, hallucinations, and cataplexy (when a patient can fall unconscious after experiencing laughter, terror or crying). Most narcoleptics will have more than one of these four symptoms, but not all of them. Depending on which symptoms they exhibit, treatment may include one or more of the following:
– Antidepressants are often very effective. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are prescribed to people suffering from hallucinations and cataplexy. They’re also known for suppressing REM sleep, which is necessary for a narcoleptic patient to get back to a normal sleep schedule.
– Sodium Oxybate is a strong sedative. Contrary to popular belief, narcoleptics have problems sleeping at night, and treatment like this can help balance their sleep/wake cycle.
– Stimulants are often used to keep patients awake during the day. Alternatively, drugs similar to amphetamine also show good results.
Restless legs syndrome is treated slightly differently. The first step is always to stop all caffeine, nicotine and alcohol intake, as these substances can amplify the problem. While caffeine can help alleviate the feeling of drowsiness during the day, you solve nothing by contributing to the underlying cause of EDS. Check your diet (ideally together with your doctor) for any ingredients that could be contributing to this disorder. Depending on whether it’s primary RLS (for which there is no true cure; you can only alleviate symptoms) or secondary RLS (similar situation to EDS – you want to solve the underlying issue), treatment options may vary, but you can and should introduce physical therapy into your daily routine. For example, getting good amounts of exercise each week, along with proper stretching, can really help you deal with the symptoms. The same applies to massage therapy, ice packs, whirlpool baths, etc.
If you experience RLS symptoms more than twice a week, or your doctor calls for it, you should get medication to help fight these symptoms. If you only sometimes suffer from them, you can take medication only during those days. Here’s a brief list of common medication prescriptions used to treat RLS:
– Anticonvulsants are used to relieve chronic pain, or in some cases, nerve pain. They also relieve RLS symptoms
– Alpha2 agonists stimulate the brain stem’s alpha2 receptors. This is done to dull the part of the nervous system in charge of involuntary muscle movement.
– Dopaminergic agents increase dopamine levels in the brain and improve leg sensations during RLS. However, do not take these drugs daily, as it can often lead to your symptoms getting worse.
– Opiates are a last resort option if nothing else works. They’re normally used to treat pain, but also help relieve RLS symptoms in most patients. Beware, however; opiates are highly addictive.
Note: Even without medication and direct therapy, you can improve your sleep quality and quantity by taking a look at your lifestyle and habits. If you have bad habits that deprive you of sleep, focus on eliminating them as soon as possible. You can make a big difference for yourself that way, and make any other treatment much more effective.
Co-founder of Counting Sheep and Sleepaholic