Excessive daytime sleepiness

EDS can be a symptom of a number of factors and disorders. Specialists in sleep medicine are trained to diagnose them. Some are:

• insufficient quality or quantity of night time sleep;[4]
• misalignments of the body's circadian pacemaker with the environment (e.g., jet lag, shift work, or other circadian rhythm sleep disorders);
• another underlying sleep disorder, such as narcolepsy, sleep apnea,[5] idiopathic hypersomnia, or restless legs syndrome;
• disorders such as clinical depression or atypical depression;
• tumors, head trauma, anemia, kidney failure, hypothyroidism, or an injury to the central nervous system;[6]
• drug abuse;
• genetic predisposition;[7]
• vitamin deficiency, such as biotin deficiency; and
• particular classes of prescription and over-the-counter medication.

An adult who is compelled to nap repeatedly during the day may have excessive daytime sleepiness; however, it is important to distinguish between occasional daytime sleepiness and excessive daytime sleepiness, which is chronic.

A number of tools for screening for EDS have been developed. One is the Epworth Sleepiness Scale which grades the results of a questionnaire with eight questions referring to situations encountered in daily life. The ESS generates a numerical score from zero (0) to 24 where a score of ten [10] or higher may indicate that the person should consult a specialist in sleep medicine for further evaluation.[8][9][10]

Another tool is the Multiple Sleep Latency Test (MSLT), which has been used since the 1970s. It is used to measure the time it takes from the start of a daytime nap period to the first signs of sleep, called sleep latency. Subjects undergo a series of five 20-minute sleeping opportunities with an absence of alerting factors at 2-hour intervals on one day. The test is based on the idea that the sleepier people are, the faster they will fall asleep.[11][12]

The Maintenance of Wakefulness Test (MWT) is also used to quantitatively assess daytime sleepiness. This test is performed in a sleep diagnostic center. The test is similar to the MSLT as it also relies on a measurement of initial sleep latency. However, during this test, the patient is instructed to try to stay awake under soporific conditions for a defined time.[13][14]

The use of Electroencephalography (EEG) readings is essential for the objective diagnosis of EDS. The initial sleep latency employed in the MSLT and the MWT is mainly derived from EEG recordings.[14] Moreover, power characteristics in the alpha-band of resting-state EEG readings, correlating with somnolence, also showed a correlation with the presence of EDS.[15][16][17]

Treatment of EDS relies on identifying and treating the underlying disorder which may cure the person from the EDS. Drugs like modafinil,[18] Armodafinil,[19] Xyrem (sodium oxybate) oral solution, have been approved as treatment for EDS symptoms in the U.S. There is declining usage of other drugs such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine), amphetamine (Adderall), lisdexamfetamine (Vyvanse), methamphetamine (Desoxyn), and pemoline (Cylert), as these psychostimulants may have several adverse effects[20] and may lead to dependency, especially when illicitly misused.[21]

• Kleine-Levin syndrome