What is Excessive daytime Sleepiness?

When sleepiness interferes with daily routines and activities, or reduces one's ability to function, it is considered excessive.

You mat have excessive daytime sleepiness if you:

1. Have difficulty paying attention or concentrating at work, school or at home
2. Have performance problems at work or school
3. Struggle to stay awake when inactive, such as when watching television or reading
4. Have difficulty remembering things
5. Must take naps on most days
6. Are often told by others that you are sleepy
7. Fall asleep while driving

What causes Excessive daytime Sleepiness?

Sleepiness can be due to the body's natural daily sleep-wake cycles, inadequate sleep, sleep disorders, or the effect of certain drugs or medications.

Sleep-wake cycle
There are two periods in the day when the body experiences a natural tendency towards sleepiness:
during the late night hours (generally between midnight and 7 a.m.) and again during the mid afternoon (generally between 1 p.m and 4 p.m). If a person is awake during these times, he has a higher chance of falling asleep unintentionally, especially if he has not been getting enough sleep.

Inadequate sleep
The amount of sleep needed each night varies amongst different people. Research has shown that when healthy adults are allowed to sleep unrestricted, the average time spent is 8 hours.

If a person does not get enough sleep even on a single night, a "sleep debt" begins to build and increase until sufficient sleep is obtained. Excessive daytime sleepiness occurs as the debt accumulates. Individuals who do not get enough sleep during the working week tend to sleep longer on the weekends or days off to reduce their sleep debt.

Sleep disorders
Sleep disorders such as sleep apnoea, Narcolepsy, Restless Legs Syndrome and insomnia can cause excessive daytime sleepiness.

Sleep Apnoea is a potentially serious disorder in which a person's breathing is interrupted during sleep, causing the individual to awake many times during the night and experience excessive daytime sleepiness.

People with narcolepsy have excessive sleepiness during the day, even after getting sufficient sleep at night. They may fall asleep at inappropriate times and places.

Restless Legs Syndrome (RLS) causes a person to experience unpleasant sensations in the legs often described as creeping, crawling, pulling, or painful. These sensations frequently occur in the evening, making it difficult for people with RLS to fall aslep, leading to excessive daytime sleepiness.

Insomnia is the perception of poor-quality sleep due to difficult falling asleep, waking up during the night with difficulty returning to sleep, waking up too eartly in the morning, or unrefreshing sleep.

Any of these sleep disorders can result in excessive daytime sleepiness.

Medical conditions and drugs
certain medical conditions and drugs, including prescription medications can also disrupt sleep and cause sleepiness. Some examples include:

1. Chronic illness such as asthma, heart failure, rheumatoid athritis, or any other chronically painful disorder.
2. some medications to treat high blood pressure or heart conditions, amd asthma medications such as theophylline.
3. Akcohol is a sedating drug that can, even in small amounts, make a sleepy person much more sleepy and at greater risk of car crashes and performance problems.
4. caffeine, which is consumed in coffee, tea, soft drinks or medications makes it harder for many people to fall asleep and stay asleep. Caffeine stays in the body for about 3 to 7 hours, so even when taken earlier in the day, it can cause problems at night.
5. nicotine from cigarettes or a skin patch is a stimulant and makes it hatder to fall asleep and stay asleep.

Shift Work & Problem Sleepiness
More shift workers get less sleep over 24 hours as compared to day workers. Sleep loss is greatest for night shift workers, those who work early morning shift, and female shift workers with children at home.

The humen sleep-wake system is designed to prepeare the body and mind for sleep at night and wakefulness during the day. These natural rhythyms make it difficult to sleep during daylight hours and to stay awake during the night hours, even in people who are well rested.

In addition to the sleep-wake system, environmental factors can influence sleepiness in shift workers. Shift workers whi try to sleep during the day are often interrupted by noise, light, telephones, family members and other distractions.

In shift workers, problem sleepiness may result in:

1. Decreased productivity due to poor night work performance
2. Increased risk of accidents and injuries at work
3. Decreased quality of life
4. Increased risk of automobile accidents

What you can do?
Getting Enough Sleep
Many prople do not set aside enough time for sleep on a regular basis. A first step may be to evaluate their daily activities and sleep-wake patterns to determine how much sleep is obtained. if a person is consistently getting lest than 8 hours of sleep per night, more sleep mey be needed. A good approach is to gradualy move to an earlier bedtime.

For example, if an extra hour of sleep is needed, try going to bed 15 minutes earlier each nught for four nights, then keep to the last bedtime. This method will increased the amount of time in bed without causing a sudden change in schedule. however, if work or family schedules do not permit the earlier bedtime, a 30 to 60 minute daily nap may help.

Tips for Shift Worker
The following may be helpful if you are working on shift:

1. reduce the amount of night work
2. Increase the total amount of sleep by adding naps and lengthening the amount of time alotted for sleep
3. Increased the intensity of light at work
4. Have a predictable schedule of night shifts
5. Eliminate sound and light in the bedroom during daytime sleep

Medications

In general, medications do not help problem sleepiness, and some may make it worst. Caffeine can help to reduce sleepiness and increase alertness, but only temporarily. It can also cause problem sleepiness to become worse by interrupting sleep.

Medications may be prescribed for patients in certain situations. Foe example, the short-tertm use of sleeping pills has been shown to be helpful in patients diagnosed with acute insomnia. Long-term use of sleep medication is recommended only for the treatment of specific sleep disorders.

While alcohol may shorten the time it takes to fall asleep, it can disrupt sleep later in the night, and therefore add to problem sleepiness.


Where can I get help?

If you think you are getting enough sleep but still feel sleepy during the day, consult your physician. Your physician may then refer you for a thorough evaluation of your problem.


Sleep Disorders Unit,
Singapore general hospital (Sing-Health).
Website:www.sgh.com.sg