Excessive Sleepiness

What Is Excessive Sleepiness?
Excessive sleepiness (ES) is a common symptom of various medical conditions. It is characterised by difficulty in maintaining wakefulness and an increased ability to fall asleep in inappropriate circumstances and situations.

What causes ES?
Significant alterations in either the normal body processes or circadian processes (the body’s internal 24hr clock) can lead to ES. While normal sleepiness is relieved by sleep, ES may persist despite efforts to obtain appropriate sleep.

What conditions cause ES?
Significant overlap exists among disorders of sleep or wakefulness; hence, ES is rarely due to a single cause. ES may be caused by sleep-wake dysregulation (e.g. narcolepsy, idiopathic hypersomnia), sleep disruption (e.g. obstructive sleep apnoea/hypopnoea syndrome [OSAHS], Parkinson’s disease, depression, myotonic dystrophy, multiple sclerosis), or circadian misalignment (e.g. shift work sleep disorder [SWSD]). ES has also been documented in a variety of other medical, neurological and psychiatric conditions including schizophrenia, epilepsy, and brain injury.

Why is ES not recognised?
Despite being treatable, ES is under-recognised, under-treated and often misdiagnosed. This may be because patients fail to acknowledge the symptoms, or because physicians fail to recognise that ES can persist despite treatment of the underlying condition.

What are the effects of ES?
The effects of ES can be debilitating and can have a profound influence on the quality of life and safety of affected patients. The reduced ability of individuals with ES to function normally also has economic and public health implications. ES can affect work and school performance, and has a significant influence on psychological and social functioning. Individuals with ES are also at increased risk for accidents.

Why should ES be recognised?
Considering the serious consequences of ES, it is essential for it to be identified and distinguished from fatigue and tiredness, which are prevalent in many disorders.

How is ES recognised?
A variety of assessment tools are used to measure the symptoms of ES. These include tests carried out in a specialist centre as well rating scales that can be completed by the patient or physician.

How is ES managed?
Ways of managing ES depend on the condition, with early recognition and appropriate treatment of ES being essential to improving quality of life for the patient. Patient education is an important part of any treatment plan. Treatment of ES and related symptoms should be aimed at treating the underlying disease, if a treatment is available, and include the use of sleep hygiene (e.g. extensions of time in bed, frequent naps). Drug treatment for ES may be necessary when treatment of the underlying condition fails to fully resolve the symptoms of ES.

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