Excessive daytime sleepiness due to medical disorders and medications
- Brian James Murray, MD, FRCPC D, ABSM
Brian James Murray, MD, FRCPC D, ABSM
- Associate Professor of Neurology, Department of Medicine
- Sunnybrook Health Sciences Centre, University of Toronto
Some patients have excessive daytime sleepiness (EDS) that is not caused by common disorders such as insufficient sleep, obstructive sleep apnea, or narcolepsy. This may manifest as excessive napping, inappropriate daytime sleep, or even accidents caused by falling asleep while driving or during other activities. In many cases, EDS is due to a treatable medical disorder, and proper diagnosis and treatment offers the possibility of improved daytime sleepiness along with improved medical outcomes.
This topic reviews medical and neurologic disorders associated with problematic sleepiness, beyond primary sleep disorders. An approach to the initial evaluation and management of a patient with EDS is presented separately. The evaluation and management of persistent sleepiness in patients with a known diagnosis of obstructive sleep apnea is also reviewed separately. (See "Approach to the patient with excessive daytime sleepiness" and "Evaluation and management of residual sleepiness in obstructive sleep apnea".)
Excessive daytime sleepiness (EDS) refers to the tendency to fall asleep in inappropriate settings. EDS is separate from fatigue, which can be manifested as difficulty or inability initiating activity, reduced capacity maintaining activity, and/or difficulty with concentration, memory, and emotional stability. Terms may be used interchangeably by patients, however, and it is not always possible to distinguish them by history alone. (See "Approach to the patient with excessive daytime sleepiness", section on 'Definitions' and "Approach to the adult patient with fatigue".)
Insufficient sleep is the most common and easily overlooked cause of excessive daytime sleepiness (EDS) . In addition to a thorough history, a sleep log (table 1 and table 2) and actigraphy may help document the amount of sleep obtained and can identify factors contributing to poor sleep quality. High-risk groups include:
●Shift workers, who tend to progressively accumulate sleep loss over time (see "Sleep-wake disturbances in shift workers")
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- INSUFFICIENT SLEEP
- NEUROLOGIC DISORDERS
- Focal central nervous system lesions
- Neurodegenerative disorders
- Encephalitis and postinfectious syndromes
- Neuromuscular disorders
- Neurogenetic disorders
- MEDICAL CONDITIONS
- Cardiovascular disease
- Respiratory conditions
- Systemic inflammation
- Hematologic disorders
- Metabolic encephalopathy
- Peptic ulcer disease and reflux
- Vitamin deficiencies
- Sleep aids and opioids
- Medications used for neurologic and psychiatric disorders
- Medications used for other conditions
- Substance abuse
- EVALUATION AND MANAGEMENT