Excess Daytime Sleepiness

Excess Daytime Sleepiness = EDS

Overview

• EDS can be described as tiredness, fatigue, lack of energy

• EDS = inability to maintain wakefulness and alertness during the major waking episodes of the day with sleep occurring unintentionally and inappropriately for at least 3 months

• Hypersomnia is used interchangable

• Fatigue = Lack of physical or mental energy

  • Inability to initiate activity

  • Reduced capacity to maintain activity

  • Difficulty with concentration, memory, emotional stability

Prevalence

• 10 to 25% of the population

Risk factors

These were most likely associated with EDS

• Insomnia

• Smoking

• Anxiety / depression

• Somatic symptoms

• Snoring

• Obesity

Causes

Insufficient sleep

• Sleep deprivation

• Environmental intrusions

Sleep Disorders

• OSA

• Central sleep apnea

• Sleep related hypoventilation

• Central hypersomnolence

  • Narcolepsy

  • Idiopathic

• Circadian rhythm sleep-wake disorders

  • Delayed sleep-wake phase

  • Advanced, Irregular, Non-24h, Jet lag, Shift work

• RLS and PLMD

Neurological

• Neurodegenerative (PD, MSA, Alzheimer’s, DLB)

• Myotonic dystrophy

• MS and ALS

• ABI

Medical and Genetic

• Thyroid

• Obesity

• CKD

• Adrenal insufficency

Psychiatrist

• Depression

• Anxiety

• Susbtance use

• Psychogenic

Medication

• Benzodiazepines

• Antipsychotics

• Beta-Blockers

• Antihistamines

• Sedative Antidepressants

Evaluation

• Snoring

• Leg discomfort

• Cataplexy

• Depression

Exam

• Usually normal

Tools

• ESS

Testing

• Polysomnography

• Home sleep apnea testing

• MSLT

Management

• Behavioural counselling

• CPAP

• Medication for RLS

• Stimulants for a central disorder of hypersomnolence

• Changes in medication that cause hypersomnolence

• Treat underlying psychiatric conditions, chronic pain or depression

Resources:

• Approach to Excess Daytime Sleepiness - Up To Date