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EXCESSIVE DAYTIME SLEEPINESS

Excessive daytime sleepiness can be quite distressing and causes significant functional impairment. It could be associated with any of the following factors or medical conditions:

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  • Insufficient sleep

  • Sleep apnea

  • Side effects of certain medications

  • Marijuana and other substance use

  • Circadian rhythm disorders (Shift work, jet lag, delayed sleep phase)

  • Periodic limb movements of sleep

  • Narcolepsy

  • Idiopathic hypersomnolence

  • Long sleeper

  • Kleine-Levine syndrome

  • Menstrual related hypersomnia

  • Hypersomnia secondary to medical conditions like Parkinson's, Multiple sclerosis, brain tumors, head trauma etc  

 

The severity of sleepiness is measured subjectively using Epworth Sleepiness Scale and objectively using in-lab sleep tests.  The treatment of excessive daytime sleepiness typically involves treatment of the underlying cause with or without the need for additional medications.

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NARCOLEPSY
Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness/daily, irrepressible need to sleep for at least 3 months. Other symptoms may include cataplexy ( loss of muscle tone lasting for a few seconds usually triggered by emotions especially laughter, anger), sleep paralysis, hallucinations during wake-sleep transition or when waking up from sleep. Patients with narcolepsy may also experience poor quality of sleep, depression, acting out dreams, weight gain.

The overall prevalence of narcolepsy is 79.4/100,000; 50% greater among females across all age groups. The symptoms typically start in late teens and early twenties.

Narcolepsy is diagnosed based on in- lab sleep tests which consists of an overnight polysomnography followed by a daytime nap test ( Multiple Sleep Latency Testing). 

Treatment of narcolepsy consists of behavioral modifications and medications. Behavioral changes include scheduled short naps, good sleep hygiene, avoiding sedentary activities, routine exercise. Medication options are stimulant and non-stimulant medications to treat daytime sleepiness and promote wakefulness. 


Sodium oxybate is the standard recommendation to treat cataplexy in addition to daytime sleepiness and poor nocturnal sleep.
Some antidepressants can be effective in treating cataplexy.

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