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Problem Sleepyness  

Patients who are frequently sleepy at inappropriate times may have "problem sleepyness." 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) sleepyness.

Performance impairment caused by sleepiness is comparable to that caused by. Patients with problem sleepyness may complain of having difficulty with concentration, fatigue and emotional lability.

Causes of Problem Sleepiness

In all people, sleepyness is regulated by two primary processes: the body's circadian rhythm, which causes an increase in sleepiness twice during a 24-hour period (in general, during the hours between

The need for sleep and the circadian rhythm interact to determine a person's levels of sleepiness and narcolepsy and sleep apnea.

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.13

Insomnia. 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 have

Drugs 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 sedative

Caffeine 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

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 time

Identifying 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