- • Sleepiness results from habits leading to inadequate
time asleep, alterations in daily sleep patterns, primary sleep
disorders, medications, or medical diseases; not all sleepiness
is from sleep apnea.
- • Taking a good history is critical to treatment
of disease and appropriate sleep laboratory referral.
Hypersomnolence is defined as sleepiness or drowsiness during
the day, sometimes even after a full night’s sleep. Sleepiness
can lead to irritability, depression, or lack of vigilance, with
resultant falling asleep when driving. Sleepiness can also impair
cognitive function and lead to poor job performance. The impact
of sleepiness on health and daytime functioning is underestimated
and often ignored by physicians as well as the public. Accidents
on the road are increasingly associated with sleepiness and are
expensive. In the United States, the indirect costs of sleep-related accidents
are estimated to be one hundred billion dollars per year.
Sleepiness is common, and can be caused by poor general sleep
habits as well as sleep disorders (Table 29–1).
Sleepiness from inadequate hours of sleep is widespread in our society,
with fewer hours of sleep time today compared to 100 years ago for
the average adult. Changes in circadian rhythm in sleep, such as
advanced or delayed sleep phase, may lead to enhanced sleepiness.
For example, getting to bed at 4:00 am and
arising at 7:00 am for school may be
the most comfortable schedule for an adolescent, but results in
daytime sleepiness (delayed sleep phase). There are large numbers
of people doing shift work, and others with poor quality sleep or
inadequate sleep due to insomnia. Daytime sleepiness is frequently
a hallmark of obstructive sleep apnea, as discussed in Chapter 28: Sleep Apnea & the Upper Airway
Sleepiness may also result from underlying medical conditions as
well as primary sleep disorders such as sleep apnea, narcolepsy, or
restless leg syndrome. Often, patients with sleepiness from insomnia,
defined as the inability to get to sleep or stay asleep, or those
with poor sleep habits are referred for sleep apnea evaluation without
having had a sleep history taken by the referring physician. To
evaluate sleep apnea appropriately and distinguish it from other
conditions, it is important to take a good sleep history, know how
common systemic diseases impact sleep, and learn how to refer appropriate
patients to a sleep laboratory for diagnostic sleep apnea testing.
Table 29–1. Diagnoses
and Conditions Causing Sleepiness. |Favorite Table|Download (.pdf)
Table 29–1. Diagnoses
and Conditions Causing Sleepiness.
|Insomnia||Very common||Trouble initiating or maintaining sleep|
|Lack of sufficient sleep||Very common||Sleeps in on weekends|
|Poor sleep hygiene||Very common||Sleepiness or insomnia|
|Circadian rhythm problem||Common||Pattern of advanced or delayed time of sleep|
|Obstructive sleep apnea||Common||Cessation of breathing at night|
|Central sleep apnea||Moderate||Congestive heart failure or ...|
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