Excessive Daytime Sleepiness And What It Means For You

Do you find yourself sacking out in front of the television nearly every night? Do you wish you could just stay up a little longer, but end up crashing despite your best attempts? Do you worry about your ability to drive carefully or perform your daily tasks without falling asleep in the middle? You might have what is known as Excessive Daytime Sleepiness.

Although there are a number of possible causes, hypersomnia can be a serious condition that puts you at risk for injury or other health concerns. Understanding how to spot the signs of EDS will help you know when to seek help.

Hypersomnia Definition: Most adults do just fine with 7-9 hours of sleep. People who need much more sleep, or who struggle to stay awake during the day even after a long night’s rest, may suffer from hypersomnia. Hypersomnia can be cyclical, meaning they may come and go. The primary factor is that they are repetitive, happening regularly, daily or several times a day.

What Is Excessive Daytime Sleepiness (EDS)?

Practically everyone knows what it means to feel excessively tired during the day after a poor night of sleep. You think you could drop into bed and be asleep within minutes. When this is a common aspect of your daily life, it’s time to pay closer attention. In some cases, EDS is part of a hypersomnia condition like narcolepsy. In other instances, it may be related to conditions that affect the quality of your sleep. Proper diagnosis can help to determine the most likely scenario.

Symptoms of EDS

EDS is somewhat of a broad category that might describe a lot of behaviors. Here are a few signs that your sleepiness is more than just a one-off:

• persistent tiredness throughout the day or during certain periods

• inability to stay awake during the day

• incidence of falling asleep during non-sleep activities

• difficulty waking up in the morning or after napping

• no relief of symptoms after a long rest

The period of sleepiness can come on quickly or instantaneously. Some people experience EDS as an irrepressible urge to sleep that they may try to fight. Others simply fall asleep with no warning.

Excessive Daytime Sleepiness Risks

Falling asleep on the couch while watching a movie with the family is an inconvenience. Falling asleep while driving a car is a disaster. When you cannot control where, how or when you fall asleep, you may be putting yourself, your family and others at serious risk. The National Safety Council estimates that up to 6,500 people per year are killed in car accidents caused by drowsy driving.

This may seem like an extreme example, but there are dozens of other situations in which a lack of alertness can cost you. When you feel tired all the time, or encounter periods throughout the day in which you simply can’t stay awake, you risk the following:

• operating machinery unsafely and hurting others

• injury if you fall asleep while standing or walking

• forgetting to take important medications (or taking too much)

• making mistakes in crucial aspects of your job

• leaving infants and young children to care for themselves

EDS can be managed, even if it can’t necessarily be cured. If you are concerned that you might end up in one of these situations (or you already have), consult with your doctor.

Common Causes of Excessive Daytime Sleepiness

Once you believe you have EDS in some form, you want to start exploring possible causes. For most people, excessive tiredness during the day is caused by sleep deprivation, sedating medications or Obstructive Sleep Apnea (OSA). People who can’t seem to get enough down time for sleep at night may be able to quickly correct it by changing their sleep routines. Persistent EDS without an obvious cause may indicate further testing for:

• neurological disorders

• psychiatric conditions

• hypersomnias

• related sleep disorders

• other conditions like diabetes or thyroid issues

Figuring out which one applies to a particular person usually calls for one or more visits to a sleep specialist for evaluation.

Hypersomnias

Almost everyone with hypersomnia has EDS, but not everyone with EDS has hypersomnia. Hypersomnia is characterized by certain behaviors related to sleep, most notably the inability to stay awake without medical treatment. Hypersomnias include:

• Narcolepsy: Persistent, sudden sleeping, sometimes linked with an immediate loss of muscle control.

• Kleine-Levin Syndrome: Periods of sleepiness that can force a person to sleep all day for days, weeks or even months. Patients may have no symptoms for months or years between episodes.

• Idiopathic Hypersomnia: An excessive need to sleep that does not have an identified cause.

Since these conditions require a lot of observation, they can take up to several years to diagnose.

Ways to Diagnose Hypersomnia

Sleep experts usually call upon a variety of methods to determine the nature and extent of a person’s EDS. They often begin with the Epworth Sleepiness Scale (ESS). This is a self-completed survey that helps people evaluate how easily they can fall asleep in a variety of relaxing but non-sleeping scenarios. Patients are asked to rate from 0-3 how likely they are to fall asleep during eight different activities. The score helps the doctor decide which tests to perform. They may also evaluate people using the STOP-Bang Questionnaire. With this questionnaire, the doctor uses a binary scoring (0 means no, 1 means yes) to rate patients on eight separate risk factors for obstructive sleep apnea (OSA).

Experts rely on objective testing as well, typically through a polysomnogram. Polysomnography is commonly called a sleep study. It involves the overnight testing of a person’s:

• breathing

• blood oxygen levels

• heart rate

• body position

• snoring

• sleep behaviors

• brain waves

• sleep stages

Medical professionals attach a number of sensors designed to measure and record these aspects during a regular night of sleep at a clinic or hospital. The testing area is set up to provide a sleep environment as close to normal as possible. The results of the sleep study can provide concrete information about a person’s sleep quality and other ways to verify or rule out various conditions.

In some cases, doctors may request a Multiple Sleep Latency Test (MSLT) during the day after the sleep study. The MSLT evaluates how quickly someone falls asleep during the day. When used in conjunction with the overnight test, it can help determine whether someone may have narcolepsy, idiopathic hypersomnia or a similar condition.

Obstructive Sleep Apnea and Excessive Daytime Sleepiness

Although Obstructive Sleep Apnea is not a hypersomnia, it is a common cause of excessive daytime sleepiness. OSA means that a person’s airway closes partially or completely while they sleep. The brain keeps waking up the body to breathe, which can disrupt sleep as often as 60 times per hour. This results in daytime tiredness, but can also lead to serious disorders like heart disease or stroke.

Doctors often begin with the STOP-Bang Questionnaire to look for the following risk factors for OSA:

• Snoring

• Tiredness

• Observed apnea

• High blood pressure

• BMI

• Age

• Neck circumference

• Male gender

Having a positive on three or more of these puts a person at a moderate or severe risk for developing OSA, if they do not already have it. A correct diagnosis allows people to receive proper treatment that ensures a steady airflow and better sleep. Some patients with OSA need to use a continuous positive airway pressure (CPAP) machine every night. Others may benefit from wearing an oral mouthpiece at night that keeps the airway open.

Managing Hypersomnia

Many of these conditions are impossible to cure, but they can be managed in different ways. Doctors may prescribe stimulants or anti-depressants to people with hypersomnia, as a way to create a temporary alertness that allows them to perform normal activities. Otherwise, experts recommend sticking to a sleep routine that allows plenty of time for rest, and minimizing active or dangerous tasks at times when sleep is likely. Avoiding alcohol and other sedatives may help to minimize the effects of the condition.

Dragging yourself through every day when you would rather be sleeping is no way to live. There’s a way out, and it may be less intimidating than you think. Our sleep medicine specialists can help you identify the cause of snoring or excessive daytime sleepiness and find a pathway forward. To learn more about our services or schedule a consultation, contact us at (425) 698-1732.