Excessive Daytime Sleepiness, is it something to worry about?

June 24 12:26 2022 Print This Article

Sleep is one of the most important, daily, physiological functions undertaken by the body. When a person is in deep sleep, the body undertakes repair of damaged cells, replenishing dead cells and performing a general maintenance. Sleep helps improve memory, restore immune system, and fine-tune hundreds of vital processes. If a person is regularly missing out on high-quality sleep, there will be both short-term and long-term consequences.

Sleep deprivation is a common ailment today, and results in Excessive Daytime Sleepiness (EDS) among other consequences. However, less sleep is not the only reason for EDS. It is then important to understand the various causes for this condition so that timely action can be taken. This means, being sleepy in the day-time, once in a while, due to sleep deprivation, is still Ok. But if the same is happening continuously (chronic), then it’s time to seek emergency medical help.

Symptoms of EDS

Symptoms of EDS can vary depending on age, gender, lifestyle, occupation and any underlying ailments. But common symptoms include:

• Trouble staying alert, especially when still (like sitting on a desk or driving)
• Slower reaction times than before
• Trouble focusing or concentrating, performance issues at work
• Feeling irritated all the time
• Moodiness and feeling tired all the time
• Memory issues
• Rash or risky behaviors
• Difficulty in understanding new concepts
• Difficulty making decisions, delayed decision-making and poor decision-making
• Temporary weakness or numbness in the limbs, shaky hands
• Visible symptoms such as hair-fall and dark circles under the eyes

Risk Factors for EDS

• Living alone: People living alone are more prone to depression, insomnia and hence EDS.
• Smoking: Compared to non-smokers, smokers are more prone to hyperarousal of the nervous system in the night-time, leading to poor sleep and hence EDS.
• Sleeping less than 8 hours per night: Sleeping less is a lifestyle choice for some, while for some, occupational challenges is the reason. Both categories are prone to EDS.
• Frequent napping: While napping once in a while in the afternoon may be a good thing and can reduce stress, regular day time napping can become a habit and disrupt normal sleep at night, and this can cause EDS.
• Very little exercise: Exercise has the same effects on the body as a good night’s sleep. It tones all the functions of the body. People who don’t get enough exercise have energy shortfalls, which, among other things, results in EDS.
• Psychological ailments: People who have suffered or currently suffering from depression and bipolar disorder are prone to insomnia and hence EDS.
• Physical ailments: People suffering from diabetes, chronic pain, Parkinson’s disease, Amyotrophic Lateral Sclerosis (ALS) etc. are more prone to EDS.
• Gender: For no clear reason, women are a little more prone to EDS than men.
• Poor sleeping habits in children: Children who get less sleep during the school days and too much sleep on weekends may show symptoms of EDS.
• Alzheimer’s disease: Various studies have shown that an accumulation of beta-amyloid proteins in the brains of people with Alzheimer’s makes them prone to EDS.

Consequences of EDS

Awareness around EDS is quite low, hence this article. Most people dismiss EDS as just a recurring consequence of sleep deprivation. Doing so can be dangerous and have long-term effects.

• Increased risk of accidents at work, or while driving
• Decreased productivity at work or performance in studies
• Problem managing emotions and mood
• Relationship issues with friends, family and co-workers
• Low interest in sex or intimacy
• Low interest in hobbies or extracurricular activities previouslyenjoyed
• Low interest in exercising
• Risk of developing heart disease, obesity, diabetesand other chronic conditions.
• Retarded development in children
• Risk of falls, memory loss, cognitive impairment, Alzheimer’s disease and reduced life-span in seniors

Causes of EDS

Medications:

There are various neurotransmitters which regulate sleep and metabolism. These include dopamine, serotonin, epinephrine, norepinephrine, histamine, acetylcholine, adenosine, glutamate and γ-aminobutyric acid. Some medications interfere with the working of these neurotransmitters, causing EDS in the process. These include:

• Alpha-adrenergic blocking agents
• Anti-emetics
• Anticonvulsants (e.g., hydantoins, succinimides)
• Antihistamines
• Antidepressants (monoamine oxidase inhibitors, tricyclics, SSRIs)
• Anti-diarrhea agents
• Antipsychotics
• Anti-muscarinics and antispasmodics
• Barbiturates
• Medication for Parkinson’s disease
• Anti-tussives
• Skeletal muscle relaxants
• Benzodiazepines, other γ-aminobutyric acid affecting agents, and other anxiolytics
• Opiate agonists and partial opiate agonists
• Beta-adrenergic blocking agents
• Muscle relaxants for the genito-urinary system

Primary Hypersomnias:

Hypersomnia is the technical word for excessive sleep. It could be in the day or night. The causes can be divided into primary and secondary. Secondary Hypersomnias are all these causes of EDS listed below. Primary ones that can cause chronic EDS are:

• Idiopathic Hypersomnia: Where no clear reason can be established, a complex web of factors can cause EDS. This condition is called Idiopathic Hypersomnia (IH).
• Narcolepsy: Sleep goes through various phases one of which is Rapid Eye Movement or REM-sleep or dreamingphase of sleep. In narcolepsy, the REM frequency and timing is disturbed, as a result, bouts of REM sleep can occur in the day-time, causing EDS.
• Menstrual Hypersomnia: Some women experience EDS during the days of their period, and almost every time.
• Kleine-Levin syndrome: A condition that primarily affects adolescents and is marked by EDS, excessive eating and low sex-drive.

Sleep-wake disorders

• Obstructive Sleep Apnea: In this condition, the tissue in the back of the throat relaxes during sleep and partially covers the airway. This leads to loud snoring and gasping for breath during night sleep, sore throat and headache on waking, irritability, attention issues and EDS during day.
• Central Sleep Apnea:In this, the brain doesn’t send the right signals to muscles that control breathing during sleep. EDS is one of the consequences.
• Restless Leg Syndrome (RLS): In this, the person experiences pain and discomfort in the legs causing him/her to frequently shake the legs, both when awake and during sleep.
• Periodic Limb Movement Disorder: Similar to RLS, but here the person experiences involuntary twitching or jerking of the limbs during sleep.

Temporary conditions

• Stress: Physical stress due to excessive workout, work pressures, emotional stress due to a job-loss, physical ailment, abusive partner, toxic workplace, etc.
• Circadian rhythm disorder: Disruptions in the sleep-wake cycle due to jet-lag, night-shift job, partying in the night, late waking and late-rising, etc.
• Obesity: For no clear reason, obese people are more prone to EDS than slimmer people
• Noise: Environmental noises during sleeping hours can cause insomnia and hence EDS

Age-related

• Insomnia: Some elders are able to sleep less during the night, thereby experiencing EDS.
• Urinary incontinence: Elders who rise once or twice in the night to urinate can have disturbed sleep and develop EDS.

Substance abuse:

Regular or excessive alcohol consumption, frequent heavy smoking, and the use of recreational drugs can all affect the neurotransmitters that regulate sleep and the circadian rhythm, thereby causing EDS.

Psychological ailments:

People suffering from Clinical Depression and Bipolar Disorder can experience manic episodes of nervous hyperarousal and insomnia during both day and night causing sleep deprivations. Sooner or later, this results in EDS.

Diagnosing EDS

• Sleep study: Also called Polysomnography, this is a comprehensive test to diagnose sleep disorders. During the study, the person’s brain waves, blood oxygen levels, heart rate, breathing, and eye and leg movements are closely monitored.
• Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT). These 2 tests are modified polysomnography used to measure onset latency or the amount of time it takes to fall asleep, during a series of waking and napping sessions.

Treating EDS

The treatment for EDS will depend on what the underlying cause is. Treatment options include medication, devices and implants and stress-management techniques, among others. A qualified neurologist who specializes in sleep disorders will conduct the above tests, and devise a plan of treatment that will involve different specialists and treatment methods.

Conclusion

To answer the question posed in the title of this article, yes, EDS is a serious condition and the patient, as well as his/her family members must be concerned. If you or any of your dear ones are showing symptoms of EDS, do not panic. Consult a reputed hospital. Specialists there will design the best course of treatment for quick recovery and rehabilitation.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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