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Problem Sleepiness
Patients who are frequently sleepy at inappropriate times may have "problem sleepiness." Problem sleepiness usually is the result of inadequate sleep secondary to primary sleep disorders (such as obstructive sleep apnea, insomnia, restless legs syndrome or narcolepsy), other medical conditions (such as chronic bronchitis or congestive heart failure) or lifestyle factors (such as shift work) sleepiness.
Performance impairment caused by sleepiness is comparable to that caused by. Patients with problem sleepiness may complain of having difficulty with concentration, fatigue and emotional lability.
Causes of Problem Sleepiness
In all people, sleepiness is regulated by two primary processes: the body's circadian rhythm, which causes an increase in sleepiness twice during a 24-hour period.
The need for sleep and the circadian rhythm interact to determine a person's levels of sleepiness and narcolepsy, sleep apnea, narcolipsy
Primary Sleep Disorders
Obstructive Sleep Apnea. Obstructive sleep apnea, a potentially life-threatening disorder, is produced by a narrowing or collapsing of the upper airway during sleep that restricts or prevents breathing.13Insomnia. Patients with insomnia complain that sleep is difficult to initiate or maintain, or that the sleep they get is neither refreshing nor restorative.5,17 Insomnia is the most prevalent sleep-related complaint;
Restless Legs Syndrome and Periodic Limb Movements in Sleep. The symptoms of restless legs syndrome are commonly reported and include sensations of creeping, crawling, pulling and tingling, which cause an irresistible urge to move the legs. These symptoms usually occur before sleep onset,
Narcolepsy. Narcolepsy is a chronic sleep disorder that produces severe problem sleepiness. The primary symptoms of narcolepsy are excessive and overwhelming daytime sleepiness--even after
Narcolepsy is often misdiagnosed. Symptoms usually first become evident during adolescence and
Other Medical Conditions
Persons with medical conditions such as chronic bronchitis and asthma have more problems initiating and maintaining sleep than do healthy people.2527 Persons who have congestive heart failure may haveDrugs that Disrupt Sleep
Prescription and over-the-counter drugs, as well as caffeine, alcohol and nicotine, can have substantial effects on sleep and sleepiness. For example, long-acting benzodiazepines have residual sedativeCaffeine can fragment sleep. The half-life of caffeine is between three and seven hours, so even coffee consumed during the day may be an important cause of sleeplessness at night, thereby causing
Lifestyle
The need for sleep varies among individuals and, because of this, it is difficult to recommend a specific quantity of sleep for all persons. When adults are allowed to sleep without restriction, the average timeIdentifying Patients with Problem Sleepiness
Patients may underestimate their own degree of sleepiness. Questions regarding specific sleep/wake habits and activities, as well as input from family members, can reveal significant signs of problem
Management of Problem Sleepiness
Problem sleepiness can occur in any age group. Direct questions of the kind highlighted in Table 1 should be asked to identify inappropriate sleepiness. Family members also may be able to help clarify the situation. Patients need to be aware of the obligatory nature of sleep and its importance for
Primary Sleep Disorders
Sleep disorders are chronic, necessitating long-term management and monitoring. Primary care physicians play an important role in case-finding, as well as management of patients with sleep
In patients with sleep apnea, treatment options range from behavioral therapies to oral/dental appliances and surgical interventions. Many patients are treated with nasal continuous positive airway pressure (CPAP), in