Excessive daytime sleepiness (EDS) is the most common complaint evaluated by sleep-disorder specialists. While sleep apnea is the most common cause of EDS there are a number of other conditions that may cause it. To understand and treat EDS, it’s necessary to know the patient’s medical history and to explore relevant symptoms before diagnosing sleep apnea as the cause. For example, congestive heart failure is commonly associated with sleep apnea and patients with renal failure may experience restless leg movement. Some medications can also cause daytime sleepiness.
Among the possible causes of EDS are upper airway resistance, narcolepsy, depression, restless leg syndrome, withdrawal from stimulants, insufficient sleep, drug dependence and abuse, medication side effects, brain tumors and forms of hypersomnia (over sleeping at night).
A good sleep history is needed to diagnose EDS and that can include a sleep study, information about the patient’s sleep habits from his/her bed partner and a medical history. Determining whether a sleep disorder or if just inadequate sleep causing EDS is a necessary step to solving the problem. The patient is asked about which activities are compromised by decreased alertness. Recording the normal bedtime, wake time and average hours of sleep help determine whether the patient has a sleep problem or is just trying to get by on inadequate sleep.
Questioning a patient’s bed partner is helpful in evaluating a patient with EDS. A history of apnea or leg jerks can aid the diagnosis. The age at onset of symptoms also provides a clue to the disorder. Apnea typically occurs in middle aged or older patients while narcolepsy usually starts in late adolescence or the 20s.
The care and understanding needed to find the cause of EDS or other sleep disorder will be available at the Alto Sleep Clinic.