Assessing Excessive Daytime Sleepiness in Primary Care

Abstract

Disorders of excessive daytime sleepiness (EDS) exact a high toll in terms of individual suffering, and, because of their relationship with motor vehicle and industrial accidents, public health.

The principle causes of EDS are conditions that repeatedly disturb sleep continuity such as obstructive sleep apnea (OSA), neurological states such as narcolepsy, medication side effects, and, importantly, insufficient sleep. Though depression and a handful of medical conditions can sometimes manifest EDS, they more often cause fatigue than actual sleepiness.

Evaluation of EDS in the primary care setting begins with detailed medical history and sleep logs, by which an individual charts their estimated sleep pattern. Most individuals experience heightened daytime sleepiness if they obtain less than 7 h of sleep. If EDS is not fully explainable by medical conditions, medication effects, and insufficient sleep, then formal sleep testing for other elements in the differential diagnosis such as sleep apnea or narcolepsy is necessary

Most of the conditions that cause hypersomnolence are readily identifiable and treatable—sleep apnea with CPAP, narcolepsy with stimulant medications, and insufficient sleep with behavioral modification (“sleep extension”).