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Excessive Daytime Sleepiness (EDS): Causes, Symptoms, Treatments

Nearly everyone has had a day where they feel so tired during the day, that they have a difficult time staying awake. For a majority of individuals, the tiredness is caused by insufficient sleep and/or a possible hangover from partying too hard the previous night. However, some people battle a condition known as “excessive daytime sleepiness” (EDS) which results in chronic feelings of fatigue and sleepiness throughout the day – even after a full night’s sleep.

What is Excessive Daytime Sleepiness (EDS)?

In cases of excessive daytime sleepiness, individuals become extremely sleepy throughout the day even after a full night’s sleep. This is much different than the sleepiness you may occasionally experience when you don’t get enough sleep. Excessive daytime sleepiness generally occurs even after a person has gotten an adequate amount of sleep. In other words, a person may sleep 8 hours and throughout the day they may feel extremely sleepy.

The sleepiness that is caused by excessive daytime sleepiness is so severe that it often becomes a major impairment on an individual’s daily functioning. In some cases the excessive sleepiness can be dangerous to both the sufferer and others in his or her environment, especially if they are involved in operating heavy machinery or driving a motor vehicle. Among certain people, excessive daytime sleepiness (EDS) is considered its own condition, but more often it is a symptom resulting from another sleep disorder like narcolepsy or sleep apnea.

Those with EDS typically end up taking frequent naps throughout the day. The napping generally becomes excessive, but regardless of how much sleep the person gets, it never seems to be enough. These individuals also often have significant problems functioning in social settings such as at work or with friends due to the fact that they constantly feel sleepy. This is a condition that detrimentally affects functioning in all aspects of a person’s life.

Excessive Daytime Sleepiness: Symptoms

For some healthcare practitioners, it can be difficult to diagnose excessive daytime sleepiness (EDS) due to the fact that it is not the same as experiencing occasional daytime sleepiness. Nearly everyone experiences occasional sleepiness throughout the day, but this doesn’t that they should be diagnosed with EDS.

  • Chronic fatigue: Those who feel sleepy all the time may experience chronic fatigue. No matter how much sleep they get, they feel tired both physically and mentally. The level of fatigue during waking hours can depend on the severity of the case.
  • Chronic sleepiness during the day: A telltale symptoms of EDS is if a person experiences sleepiness everyday during waking hours. In this case, the individual may not be able to hold down a job, function in society, or even take care of themselves.
  • Cognitive impairment: A person with this condition may have a tough time thinking clearly, remembering things, and maintaining awareness. In some cases, all they can think about is sleep and/or feeling extremely sleepy.
  • Concentration problems: Those with EDS may be unable to concentrate on anything other than getting their next sleep fix. When the sleepiness kicks in, it is impossible to maintain a high enough arousal to accomplish tasks and concentrate. This is characterized by an increase in slower, theta brain waves and a reduction in faster, beta brain waves.
  • Dozing during the day: Those with EDS may frequently doze throughout the day. The dozing may be at an unexpected time such as at work, driving, while talking on the phone, or mid-conversation. No matter how hard a person tries, they may have a tough time fighting the urge to doze.
  • Frequent napping: Those with this condition often nap consistently throughout the day. Sometimes they may sleep for nearly the entire day due to the fact that they cannot fight the urge to sleep. Regardless of how much they nap, it never seems to elevate their arousal.
  • Long-term condition: For a majority of individuals with EDS, it doesn’t just appear randomly out of the blue. If it does, it is likely a side effect of some other undiagnosed medical condition. If you’ve been experiencing this or another wakefulness or sleep disorder over the long term, chances are that this is an accurate diagnosis.
  • Inability to complete tasks: Those who feel tired all the time may have extreme difficulty holding down a job, let alone completing any tasks on the job. If you are in school and have excessive daytime sleepiness, you may be unable to stay awake during your classes, let alone finish your assignments and take tests. Even finishing basic household tasks like laundry, cooking, and cleaning may be difficult.
  • Inappropriate sleep times: Those with EDS often fall asleep at inappropriate times such as in the middle of a meeting, while eating, while driving, or while socializing. To others the need for sleep during inappropriate situations may seem rude and/or confusing.
  • Oversleeping: Those with this condition may oversleep frequently. Despite getting plenty of sleep during their normal night-time sleep cycle, they may sleep more than necessary throughout the day. Regardless of how much sleep they get, they seem to be stuck in a trap of always needing more.
  • Tiredness: Even when a person isn’t sleeping, they may feel more tired than average. It is believed that those with EDS have abnormalities in their level of arousal. The central nervous system is unable to become stimulated enough to keep a person alert and awake throughout the day and they feel tired.
  • Urges to sleep: People with EDS often have uncontrollable urges to sleep at seemingly random times. In some cases, if they do not satisfy these urges by taking a nap, they will intensify. Over time, it becomes difficult to fight the urges and a person usually ends up getting too much sleep.

Diagnosis for Excessive Daytime Sleepiness

A variety of diagnostic tools for determining whether someone has EDS have been created. Besides self-reporting of symptoms to a professional, most people undergo the Multiple Sleep Latency Test (MSLT) which tests how quickly you fall asleep as well as any abnormalities in brain waves during sleep. An individual may also be given a questionnaire called the Epworth Sleepiness Scale (ESS) to determine the degree of functional impairment caused by EDS.

Multiple Sleep Latency Test (MSLT): This is a sleep test that has been used by professionals since the 1970s. It measures how quickly a person falls asleep from when they prepare to take a nap. It is believed that individuals with excessive daytime sleepiness will be quicker to fall asleep than those without it. The test helps practitioners understand whether someone is physically tired vs. excessively sleepy.

This test also looks at various brain waves to determine whether an abnormal amount of time is spent in a particular phase of sleep (e.g. REM). In addition to looking at brain waves, the patient’s muscle activity and eye movements are tracked. The test requires 7 hours to complete for accurate feedback.

Epworth Sleepiness Scale (ESS): This is a rating scale that is frequently used to help diagnose excessive daytime sleepiness and other sleep disorders. It was created in 1991 and involves administering a patient a series of questions. It asks the patient to rate the likelihood that they will fall asleep on a scale from 0 to 3 for eight specific scenarios. The scoring is conducted by adding together the numbers.

  • 0 to 9 score: Scoring between a 0 and 9 is considered within the normal range. Therefore someone that doesn’t score above 9 isn’t believed to have a sleep disorder.
  • 10 to 24 score: Those that score between this range suggest that the person needs some sort of medical evaluation for their sleep.
    • 11 to 15 score: This suggests that a person likely has mild sleep apnea or some other mild sleep condition.
    • 16+ score: Those that score above 16 are believed to have narcolepsy and/or severe forms of sleep apnea.

Specific questions in this scale are believed to be more accurate than others in predicting whether someone suffers from a sleep disorder like EDS. It is recommended that results of this test shouldn’t be discussed with any patient until all questions have been asked.

In nearly all cases, a sleep specialist and/or neurologist will take a look at the results from your testing. You will then get a better understanding of whether you fit the specific diagnostic criteria for “excessive daytime sleepiness” or whether your sleepiness isn’t excessive enough to fit this diagnosis.
Note: It should be noted that many people experience some daytime sleepiness, but this does not indicate that it is “excessive.”

Causes of Excessive Daytime Sleepiness

There are a variety of conditions that can cause excessive daytime sleepiness. In most cases, a person is not born feeling excessively sleepy throughout the day. Additionally it should be mentioned that in rare cases, excessive daytimes sleepiness is diagnosed without a definitive cause. In these cases, it is assumed that certain genetic and epigenetic factors play a role.

  • Anemia: Those with a deficiency of iron often become excessively lethargic and sleepy. A blood test is the easiest way to determine whether you may have low iron. As soon as adequate levels of iron are restored, the excessive daytime sleepiness generally disappears.
  • Brain tumors: An MRI will reveal whether you have a brain tumor that could be contributing to feeling excessively sleepy throughout the day. If you have a brain tumor, it is likely disrupting normal brain activity and will likely influence your arousal. When the tumor is successfully treated, normal alertness is restored.
  • Chronic fatigue syndrome: It can be difficult to distinguish chronic fatigue syndrome from excessive daytime sleepiness. In some cases, the two conditions have significant overlap. Those who are chronically fatigued can suffer from excessive sleepiness throughout the day and vice versa.
  • Circadian rhythm disruption: Individuals with disrupted circadian rhythms can experience excessive sleepiness throughout the day. Your circadian rhythm refers to natural biological processes that occur at specific times within a 24 hour period. When this becomes disrupted, you may experience excessive daytime sleepiness and inability to sleep at night.
  • Depression: Those that are diagnosed with major depression are prone to feeling extremely sleepy throughout the day. Whether this sleepiness is a result of the medications that they are taking or whether it’s a byproduct of the depression itself, it is often difficult to cope with. In the event depression is causing the sleepiness, a doctor may prescribe a stimulatory antidepressant such as Wellbutrin or an augmentation strategy like Modafinil.
  • Drug withdrawal: Those going through withdrawal from any type of drug whether it be a prescription or an illicit one, it is common to feel excessive sleepiness throughout the day. During drug withdrawal an individual often is unable to get a quality night’s sleep, resulting in excessive sleepiness throughout the day.
  • Genetics: In some cases, people end up with a genetic predisposition to excessive daytime sleepiness. In other words, if this is a condition that is known to run in the family, there is a possibility that the cause stems from specific genetic factors.
  • Head trauma: Those that endure a head injury can become excessively sleepy throughout the day as a result. Head injuries alter brain activity and depending on the severity, may lead to long-term changes in sleep.
  • Hypothyroidism: When the thyroid gland produces inadequate amounts of thyroid hormone, a person generally becomes fatigued, depressed, and feels a significant amount of “brain fog.” They may have difficulty maintaining alertness and may suffer from excessive daytime sleepiness. Once this condition is properly treated, the sleep cycle will generally fix itself.
  • Idiopathic hypersomnia: This is a neurological disorder that is basically synonymous with excessive daytime sleepiness. It is considered a rare diagnosis, but generally occurs from an early age and is considered a lifelong, chronic condition.
  • Illicit drugs: Individuals that abuse or are addicted to illicit drugs may experience a drug-induced form of excessive daytime sleepiness. For example, a person who abuses a stimulant like cocaine may deplete dopamine stores over time, leading to excessive sleepiness. In most cases of drug addiction, once a person is functioned sober for an extended period of time, the excessive sleepiness subsides.
  • Inadequate sleep quantity: Someone who is overworking and simply not getting enough sleep at night may experience excessive sleepiness during the day. This is generally the result of improper self-care. As soon as sleep quantity is increased, the excessive sleepiness generally subsides.
  • Insomnia: Individuals with extreme cases of insomnia may experience symptoms of excessive daytime sleepiness. This is due to a disrupted sleep cycle and/or the individual not getting adequate sleep at night. In most cases, steps can be taken to address the insomnia and for many individuals, the EDS subsides as the insomnia improves.
  • Kidney failure: Those who are experiencing kidney failure may experience a reversal of day and night. They may be unable to sleep at night, but may also have difficulty staying awake throughout the day due to excessive daytime sleepiness.
  • Low melatonin: Some individuals may have a deficiency in the hormone melatonin. In this case, falling asleep may be difficult and sleep quality may be poor. This could result in a case of excessive daytime sleepiness. Fortunately, melatonin can be increased with supplementation.
  • Narcolepsy: This is a neurological disorder that frequently causes excessive daytime sleepiness. Narcolepsy is a condition that is developed when the autoimmune system attacks neurons that are responsible for producing “hypocretin” This leads to abnormal sleep-wake cycle regulation by the brain, and can lead to a variety of symptoms.
  • Jet lag: This is a well-documented disorder of the circadian rhythm in which a person flies to another time zone and has difficulty adjusting. This can lead to disruptions in a person’s sleep for a few days until they adjust. In many cases jet lag can lead to excessive daytime sleepiness.
  • Poor sleep quality: Regardless of how long you are in bed at night, if your sleep quality is poor, it may affect you the following day. It is recommended to always maximize comfort, eliminate external noise, and create a comfortable environment to increase sleep quality. Those who may not have very much room, are sleeping on an uncomfortable surface, etc. may experience EDS as a result of poor sleep quality.
  • Prescription drugs: Many people do not realize that the side effects of many prescription drugs can include drowsiness and sleepiness. Specific drugs like the hypnotics and opioids tend to depress activity in the central nervous system, leading to increased potential for sleepiness throughout the day. If you are taking any prescription drugs – regardless of the type, it could be directly contributing to your excessive daytime sleepiness.
  • Restless leg syndrome: This is a neurological disorder in which a person cannot stop moving their legs due to sensations that they experience. It is shown to affect a person’s sleep quality, often significantly reducing it, leaving the person more tired than usual. In extreme cases, it may lead to excessive sleepiness throughout waking hours.
  • Shift work sleep disorder: This is a circadian rhythm disorder that is developed among some individuals who work shifts. When a person is forced to work at night and sleep during the day in order to accommodate work, it creates a variety of changes in a person’s ability to sleep and function. Excessive daytime sleepiness is a common symptom associated with SWSD.
  • Sleep apnea: This is a sleep disorder that occurs when an individual experiences gaps in their breathing. Each gap or “pause” in between breaths is referred to as an “apnea” and can last for seconds to minutes depending on the person. Someone with sleep apnea may experience excessive daytime sleepiness and fatigue as a result of the improper breathing.
  • Stress: Those prone to high levels of stress may experience sleepiness throughout the day. While it may not be enough to get an EDS diagnosis, some individuals with very high stress may actually get diagnosed with this condition. High stress can lead to a nervous breakdown, which deprives the brain and body of energy especially if adrenaline levels remain high over an extended period.
  • Vitamin deficiencies: It is recommended to make sure that you do not have any possible vitamin or nutrient deficiencies. For example, those with a deficiency of biotin can develop extreme lethargy, which may lead to an EDS diagnosis. It is highly recommended to evaluate your macronutrient intake and test levels to rule out nutritional causes.

Note: This is an inconclusive list of potential causes for excessive daytime sleepiness. A variety of other conditions may be contributing to your condition so always be sure to consult a medical professional for evaluation.

Excessive Daytime Sleepiness Treatment

If you have been diagnosed with excessive daytime sleepiness, it is important to seek out proper treatment. Excessive daytime sleepiness can actually be dangerous if you are working a job that mandates a high level of employee alertness. Activities such as driving and operating heavy machinery often put yourself and others at risk when you are excessively sleepy.

Realize that if your condition is caused by a specific condition (e.g. drug withdrawal), your body will naturally recover as time continues to pass. Other conditions like vitamin deficiencies and hypothyroidism can be directly addressed. Addressing certain conditions directly often eliminates the need to treat excessive daytime sleepiness as a separate condition. In most cases, people without sleep disorders like narcolepsy can overcome EDS naturally.

However, there are certain individuals that may be experiencing EDS as a result of narcolepsy and other uncontrollable factors. In these cases, pharmaceutical intervention is often necessary to help manage the symptoms.

  • Eugeroics: The most common drugs to treat excessive daytime sleepiness are a class of drugs known as the eugeroics. These tend to elicit stimulatory effects, but aren’t as addictive as the psychostimulant class. Most would argue that they are superior in promoting wakefulness and reducing cases of excessive daytime sleepiness. Many believe that they also have nootropic effects, but some people are reluctant to use them due to unknown long term effects.
  • Psychostimulants: This includes most ADHD medications or drugs that increase arousal in the central nervous system. These are known to increase wakefulness and cortical arousal, leading to increases in energy and performance. Many people have successfully used these drugs to effectively combat the effects of excessive daytime sleepiness.

Do you have excessive daytime sleepiness (EDS)?

Excessive daytime sleepiness can be a highly frustrating condition to deal with. I personally have had short term battles with it during my years of being overmedicated with psychotropic drugs. Certain combinations of antidepressants and antipsychotics made it extremely difficult to wake up in the morning, let alone stay awake during the day. In my situation, I had to wait a significant period of time after withdrawing from all psychotropic drugs before some energy returned.

It took over 6 months for me to get some energy back so that I could stay awake in my high school classes. Eventually my energy levels returned full force and I no longer experience excessive sleepiness throughout the day. If you speculate that you have excessive daytime sleepiness, be sure to understand the specific cause for you personally. Not everyone with EDS has the same cause – for one individual it may be narcolepsy, while for another it may be the result of shift work.

Also be sure to get formal testing done to verify that you do in fact have EDS. Many people assume that a little bit of tiredness throughout the day qualifies as excessive tiredness; they are easily distinguished by professionals. If you have any experience coping with excessive daytime sleepiness or are currently dealing with it, feel free to share some thoughts in the comments section below.

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