Monday, June 17, 2024

Excessive Daytime Sleepiness And Depression

Definition And Assessment Of Hypersomnias

How to manage Depression with daytime sleepiness? – Dr. Sulata Shenoy

In the literature, hypersomnia refers to a specific sleep-disorder-related diagnosis, such as narcolepsy in the International Classification of Sleep Disorders , or an associated symptom in various diagnostic entities, such as MDD in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision . In the latter condition, the predominant complaint is excessive sleepiness for at least one month , evidenced by either prolonged sleep episodes or daytime sleep episodes occurring almost daily.

Is Excessive Sleepiness Common In Women

According to research, women experience better quality of sleep than men yet report more sleep-related issues. As mentioned earlier, one of the symptoms of Premenstrual Syndrome is increased tiredness. The scientists add that pregnancy and menopause may also disrupt womens sleeping patterns.

They found that some disorders linked to EDS are more common among women than men and vice-versa. For example, women are more likely to develop Restless Legs Syndrome, while men are more prone to REM Sleep Behavior Disorder and Kleine Levin syndrome.

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Identifying And Treating Causes Of Excessive Sleepiness

Learning the cause of your excessive sleepiness is essential because of the significant toll excessive sleepiness can take on your life. Excessive sleepiness in adolescents can negatively impact their school performance, personal relationships, overall health, and driving ability. In adults, excessive sleepiness can greatly affect their work, leading to lower productivity, more absent days, and even an increased risk of on-the-job accidents.

If youre experiencing excessive sleepiness, tell your doctor. They should work with you to determine the cause and identify appropriate treatments. To diagnose underlying problems, your doctor might:

  • Ask questions about your sleep quality, sleep habits, and daytime drowsiness concerns
  • Ask questions about your medical history, including any past psychiatric diagnoses
  • Ask you to complete a questionnaire rating the sleepiness you feel at different times of day
  • Order a sleep study
  • Order other medical tests or refer you to another type of doctor

Depending on what comes out of your examination, your doctor will likely recommend one of the following treatments for EDS:

  • Improved sleep hygiene, such as a consistent bedtime and nighttime routine
  • Treatment for underlying sleep disorders, such as a continuous positive airway pressure machine for obstructive sleep apnea or sleep medications for other disorders
  • Evaluation by a physician to treat underlying disease
  • Medications that promote wakefulness

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Definition Of Incident Persistent And Remitted Eds

Commensurate with our previous cross-sectional study, the presence of EDS was established based on a moderate-to-severe self-report of daytime drowsiness or sleepiness occurring most of the day and/or irresistible sleep attacks . Each question was answered on a 4-point Likert scale , and the presence of EDS was defined as a moderate or severe report to either of the 2 questions. Of the 1,395 subjects who were followed-up, 222 reported EDS at baseline and 1,173 did not. Subjects were classified according to their baseline and follow-up status into: no EDS , incident EDS , remitted EDS , and persistent EDS .

Types Of Depressive Disorders

Sleep Problems Treatment

Significant feelings of sadness or a loss of interest in their normal daily activities are common in all depressive disorders. Specific forms of depression vary based on the severity of symptoms and the situation in which they develop.

The most well-known type is major depressive disorder, and it is marked by symptoms that affect a person virtually every day for an extended period of time. It commonly involves sleep disruptions.

Persistent depressive disorder, also called dysthymia or chronic depression, may involve fewer symptoms than major depression, but symptoms last for at least two years and any symptom-free period lasts no longer than two months.

Other types of depression, such as premenstrual dysphoric disorder and seasonal affective disorder tend to come and go over shorter periods but can also involve significant sleeping problems.

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Consequences Of Excessive Daytime Sleepiness

Being sleepy can have wide-ranging effects on health and daily life. Consequences of daytime sleepiness include:

  • Increased risk of car and work accidents
  • Worse quality of life
  • Problems regulating mood and emotions
  • Social and relationship problems

Excessive sleepiness may be particularly dangerous for young adults, shift workers, medical staff, and people who drive a lot.

Long-term sleep deprivation has been linked to a higher chance of developing diabetes, obesity, heart disease, and other chronic conditions. Daytime sleepiness in children may affect development, while in older adults, daytime sleepiness heightens the risk for falls and may be a risk factor for cognitive impairment, memory loss, and earlier mortality.

Excessive Daytime Sleepiness Among Children And Adolescents

Its reported that sleep disorders linked to EDS are present in 25-40 percent of children and adolescents. EDS can negatively impact school performance, relationships with family and friends, extracurricular activities, health, and driving.

The primary conditions that could lead to EDS in teens are sleep deprivation, poor sleep hygiene, insomnia, circadian rhythm changes, chronic somatic pathologies, psychiatric disorders, movement disorders, respiratory disorders, parasomnias, and the use of drugs or medications.

Experts say that a young person may have EDS if they are snoozing more at night or during the day compared to others in their age group. Other warning signs are sleeping more than usual on weekends and vacations, difficulty waking up, or falling asleep at inappropriate moments like playing games or watching television.

To diagnose EDS, a doctor will need to review the patients medical history and conduct a physical exam. Feedback from teachers or caregivers may be included as well.

Although there is a range of treatment options for EDS in young people, including drug therapies, the health experts conclude that the preferred method is to implement behavioral and educational changes.

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Periodic Limb Movement Disorder

When someone experiences Periodic Limb Movement Disorder , they will move their limbs in repetitive movements throughout the night, which could impact their sleep in the process. This condition occurs in about 80 percent of those with Restless Legs Syndrome. People with Narcolepsy and Obstructive Sleep Apnea may also experience PLMD.

When To See Your Doctor

Recognizing Narcolepsy and Excessive Daytime Sleepiness

Not only could Excessive Daytime Sleepiness be symptomatic of an underlying condition, but it also puts you at a higher risk of getting into a motor vehicle accident. Its best to reach out to your doctor as soon as possible if you believe you may have this sleep problem. This way, your physician can properly diagnose your condition.

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Multiple Sleep Latency Test

This test will likely be administered if your physician believes you may have Idiopathic Hypersomnia or Narcolepsy. During the test, youre given 4-5 opportunities to fall asleep every two hours during the day. The specialist will examine your sleep latency and how quickly you enter REM sleep.

An MLST is considered positive if a patient has an average sleep latency below 8 minutes with no more than one nap for Idiopathic Hypersomnia and two naps for Narcolepsy. The patient must also reach REM sleep.

Mood Symptoms Associated With Hypersomnia Disorders

Comorbidity between hypersomnia disorders and mood symptoms, particularly depression, is frequently reported in both clinical and research settings. However, the causal relationship between the two conditions remains unclear. Hypersomnia symptoms may also be misdiagnosed as depression, because MDD symptoms according to the DSM-IV-TR are common features of hypersomnia disorders.

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Are Energy Drinks Safe

Some folks turn to energy drinks to help keep themselves alert, but health experts warn these could have serious health repercussions.

According to the National Center for Complementary and Integrative Health, the number of emergency-room visits due to energy drink consumption doubled between 2007 and 2011. They add that young people are particularly vulnerable to the dangers of energy drinks. Its reported that college students who mix energy drinks with alcohol are more likely to binge drink, and kids who consume too much caffeine could comprise their developing cardiovascular and nervous systems.

It may also be unclear how much caffeine is in energy drinks or supplements since its not mandatory to list the amount on the label. Consuming too much caffeine can cause jitteriness, digestive issues, dehydration, heart and blood vessel problems, anxiety, and disrupt sleep patterns.

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New Research Looked At Whether A History Of Depression Changed Outcomes In Patients With Sleep Apnea Or Narcolepsy Who Use Sunosi To Control Excessive Daytime Sleepiness

Teeth Whitening

Depression history is prevalent in people with narcolepsy and obstructive sleep apnea, but regardless of mental health status, Sunosi improves excessive daytime sleepiness in both these patient populations, according to new research.

The research, published recently in the Journal of Psychiatric Research, also found that concomitant antidepressant use did not affect response to solriamfetol.

This study suggests that safety and efficacy of solriamfetol for treating excessive daytime sleepiness in narcolepsy and obstructive sleep apnea are not affected by depression history, the authors wrote. Moreover, the findings emphasize the high prevalence of depression in people with sleep disorders and suggest that increased awareness of this association may have clinical significance.

This secondary analysis included data from two 12-week, randomized, double-blind, placebo-controlled trials in adult patients with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea. The analysis showed that treatment with Solriamfetol improved excessive daytime sleepiness symptoms both in patients with and without a clinical history of depression, compared to placebo.

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Excessive Daytime Sleepiness In Depression And Obstructive Sleep Apnea: More Than Just An Overlapping Symptom

  • 1Department of Psychology, Zhenjiang Mental Health Center, Zhenjiang, China
  • 2Department of Psychiatry, Zhenjiang Mental Health Center, Zhenjiang, China

Excessive daytime sleepiness is a significant public health concern, with obstructive sleep apnea being a common cause, and a particular relationship exists with the severity of depression. A literature search on OSA, depression, and EDS was performed in PubMed. The chosen evidence was limited to human studies. Available evidence was systematically reviewed to ascertain the association of EDS with depression and OSA according to the general population and some specific population subgroups. In addition, effectiveness of continuous positive airway pressure was analyzed as a standard therapy for improving EDS and depression in patients with OSA. In the general population, patients with OSA, and some other subpopulations, the review contributed to: delineating the prevalence of EDS substantiating the relationship of EDS and depression presenting the relationship between EDS and OSA and revealing that the duration of CPAP is crucial for its therapeutic effects in improving EDS and depressive symptoms in patients with OSA.

Excessive Daytime Sleepiness: Causes Test And Treatments

Excessive Daytime Sleepiness is defined by having an increased pressure to fall asleep during typical wake hours. It is a common complaint of many adults and children. It is the most common symptoms of people with sleep disorders. EDS is a leading cause of fatalities from motor vehicle accident.

Sleep deprivation has also been associated with the Chernobyl nuclear power plant meltdown, Exxon Valdez oil spill, and the space shuttle, Challenger, explosion.

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A Sign Of Atypical Depression

Dr. Drerup says that oversleeping is a symptom in 15% of people with depression and she notes that it tends to more often be related to atypical depression.

Atypical depression is a specific type of depression in which the persons mood can improve in response to a positive event. But even though their mood may brighten, its only temporary and the root depression remains.

Often, they dont realize theyre depressed, Dr. Drerup adds. Besides oversleeping, other symptoms are increased appetite and interpersonal sensitivity, like the feeling of being rejected. And that depression feeds into other reasons sleep can be so greatly affected.

Effect Of Cpap On Eds And Symptoms Of Depression In Osa

Excessive Daytime Sleepiness

Various conservative behavioral therapies are also used for OSA and CPAP is commonly chosen to treat OSA. Numerous studies have been conducted to evaluate the efficacy and/or effectiveness of CPAP in treating a wide range of OSA symptoms. Baseline sleepiness is the only factor predictive of compliance , and a high depression score is associated with non-compliance with CPAP . When nasal CPAP is titrated properly, hypopnea and apnea in patients with OSA syndrome are abolished completely, and arousal and oxygen desaturation disappear during CPAP once OSA is successfully treated . Since repetitive arousal or oxygen desaturation in brain tissue during sleep presumably contributes to the development of depression, a more complete understanding of the relationship between OSA and depression can be appreciated by examining changes in depressive symptoms .

Short-Term Treatment

Long-Term Treatment

These findings emphasize the importance of close follow-up of EDS and depressive symptoms once CPAP treatment is initiated in patients with OSA. It is regrettable that most of the current studies were related to OSA with depressive symptoms, and there is a lack of studies on CPAP for treatment of OSA comorbid depression. Skepticism has been expressed concerning the effectiveness of CPAP because of a lack of randomized controlled trials.

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What Causes Excessive Sleepiness

Any condition that keeps you from getting good quantity and quality sleep at night can cause excessive sleepiness during the day. Daytime sleepiness may be the only symptom you know, but other signs, such as snoring or kicking, may be occurring while youre asleep.

For many people with sleep disorders, its a bed partner who observes other key symptoms. Regardless of the cause, its important to have your sleep condition evaluated if daytime sleepiness is keeping you from making the most of your day.

Among the more common causes of excessive sleepiness are:

Evaluating And Screening For Excessive Daytime Sleepiness

According to American Family Physician, when evaluating a patient for EDS, your doctor may use the Stanford Sleepiness Scale or the Epworth Sleepiness Scale. These questionnaires are completed by the patient, who rates their sleepiness in certain situations. For example, if a patient scores above a 12 on the Epworth Scale or has a history of falling asleep while driving, they will need to be evaluated further.

Additionally, doctors should look into the patients medical history and perform a physical exam and laboratory test. They should also go over any medications the patient is currently taking to see if those could be the cause of extreme sleepiness.

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What To Expect At Your Office Visit

Your provider will examine you to determine the cause of your drowsiness. You will be asked about your sleep patterns and health. Questions may include:

  • How well do you sleep?
  • How much do you sleep?
  • Do you fall asleep during the day when you do not plan to nap ? If so, do you awake feeling refreshed? How often does this happen?
  • Are you depressed, anxious, stressed, or bored?
  • What medicines do you take?
  • What have you done to try to relieve the drowsiness? How well did it work?
  • What other symptoms do you have?

Tests that may be done include:

  • CT or MRI scan of the head

Treatment depends on the cause of your drowsiness.

Obesity Depression Have Role In Excessive Daytime Sleepiness

I Want to Learn About Sleep Apnea
Penn State Milton S. Hershey Medical Center
Obesity and depression not only lack of sleep are underlying causes for regular drowsiness, according to researchers. They say the findings could lead to more personalized sleep medicine for those with excessive daytime sleepiness .

Obesity and depression — not only lack of sleep — are underlying causes for regular drowsiness, according to Penn State College of Medicine researchers. They say the findings could lead to more personalized sleep medicine for those with excessive daytime sleepiness .

As much as 30 percent of the general population experiences EDS — daytime drowsiness or sleepiness occurring most of the day that can include irresistible sleep attacks. Feeling overly tired during the day can reduce job productivity and increase errors and absenteeism and may lead to more serious issues like car crashes.

Previous research has associated EDS with obesity, depression and sleep apnea, but the new study is the first to use physiologic sleep data to infer causation and investigate mechanisms. It is also the first observational study of EDS over several years.

“Obesity and weight gain predicted who was going to have daytime sleepiness,” said Julio Fernandez-Mendoza, assistant professor of psychiatry at the Sleep Research and Treatment Center at Penn State College of Medicine. “Moreover, weight loss predicted who was going to stop experiencing daytime sleepiness, reinforcing the causal relationship.”

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Subjective Assessment Of Hypersomnia

The hypersomnia symptoms associated with mood disorders are not specific and may include non-imperative EDS, long non-refreshing naps, long sleep time, and sleep inertia. EDS should be distinguished from insufficient sleep and fatigue. Fatigue is not necessarily relieved by increased sleep and may be unrelated to sleep quantity or quality. However, it is difficult to differentiate between EDS and fatigue, which may overlap considerably in mood disorders. It is also particularly difficult to differentially diagnose between idiopathic hypersomnia and less severe forms of depression .

Hypersomnia assessed with a single yes/no response was found to be refractory after antidepressant intake, persisting even when other symptoms had remitted . Hypersomnia may also predict the onset of a major depressive episode , and hypersomnia persistence after depressive symptoms have been managed may be a condition in those at risk for developing recurrent depressive episodes .

Why Do I Have Excessive Sleepiness

If you experience excessive sleepiness, youve probably asked yourself, Why am I so sleepy during the day? There is no single, universal answer to that question because different people experience excessive daytime sleepiness for various reasons.

Research shows people experience EDS as a result of a wide variety of underlying causes, such as:

  • Sleep deprivation due to lifestyle, jet lag, or sleep problems
  • Neurological disorders such as Parkinsons and epilepsy
  • Psychiatric disorders such as depression and anxiety
  • Health problems such as heart and liver failure
  • Medications such as pain medications and alcohol

If you dont have health or psychiatric problems that could be causing your EDS, consider exploring the possibility of a sleep disorder. Since poor sleep causes sleepiness, EDS is a symptom of multiple sleep disorders.

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