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Evaluating for Excessive Daytime Sleepiness

People with excessive daytime sleepiness (EDS) may use vague terms to describe their sleepiness, such as being tired all the time, fatigue, or a lack of energy.1 They may even deny being sleepy.1 The perspective of friends and family members is important when talking to your patients about their sleepiness.1

Listen carefully, and if EDS is suspected, evaluate for:

  • Characteristics (e.g., frequency, duration)1,2
    • People with EDS usually feel a constant, irrepressible pressure for sleep.3,4
  • More obvious EDS manifestations (e.g., daytime naps, automatic behaviors)3
  • Less obvious EDS manifestations (e.g., tired all the time, fatigue, mood disruption, neurocognitive impairment such as poor memory, difficulty concentrating, challenges with decision making)
  • Propensity for sleepiness or dozing1,3,5:
    • In sedentary/inactive situations?
    • In more active situations (e.g., while talking or eating)?
  • Impact of EDS on1,3:
    • Driving
    • Functioning
    • Quality of life
  • Frequency and duration of both involuntary and planned sleep episodes/naps2
  • Effect of sleep on the EDS3,4:
    • Are nighttime sleep and/or daytime naps refreshing? If yes, how quickly does EDS return? People with EDS usually feel refreshed, although only briefly, after sleep.
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If EDS is present, evaluate your patients for cataplexy and other symptoms.

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Stories from people living with narcolepsy can help when evaluating your patients.

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  1. Ahmed IM, Thorpy MJ. Clinical evaluation of the patient with excessive sleepiness. In: Thorpy MJ, Billiard M, eds. Sleepiness: causes, consequences and treatment. Cambridge University Press; 2011: 36-47.
  2. Thorpy MJ, Dauvilliers Y. Clinical and practical considerations in the pharmacologic management of narcolepsy. Sleep Med. 2015;16(1):9-18.
  3. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed.; 2014.
  4. Dauvilliers Y, Arnulf I, Mignot E. Narcolepsy with cataplexy. Lancet. 2007;369:499-511.
  5. Johns M, Hocking B. Daytime sleepiness and sleep habits of Australian workers. Sleep. 1997 Oct;20(10):844-849.

Performance of routine tasks without awareness.

Sudden and brief loss of muscle strength or tone, often triggered by strong emotions. Narcolepsy with cataplexy is known as type 1 narcolepsy.

Complete collapse to the ground; all skeletal muscles are involved.

Only certain muscle groups are involved.

Biological clock mechanism that regulates the 24-hour cycle in the physiological processes of living beings. It is controlled in part by the SCN in the hypothalamus and is affected by the daily light-dark cycle.

Frequent inappropriate transitions between states of sleep and wakefulness.

The inability to stay awake and alert during the day.

A neurotransmitter that supports wakefulness. The TMN is the only source of histamine in the brain.

Vivid, realistic, and frightening dream-like events that occur when falling asleep.

Vivid, realistic, and frightening dream-like events that occur when falling asleep.

A neuropeptide that supports wakefulness and helps control non-REM sleep and REM sleep.

Primary brain region for regulating the timing of sleep-wake states.

Unintentionally falling asleep due to excessive daytime sleepiness.

Brief, unintentional lapses into sleep or loss of awareness.

A validated objective measure of the tendency to fall asleep in quiet situations.

A state of sleep when muscle tone is decreased. Deep stages help to restore the body.

Overnight study used to diagnose sleep disorders by monitoring sleep stages and cycles to detect disruptions of a normal sleep pattern.

Normally occurs at night and includes vivid dreams. Also known as “paradoxical sleep.”

Daytime and evening habits and routines to help improve nighttime sleep.

Brief loss of control of voluntary muscles with retained awareness at sleep-wake transitions.

Sleep-onset REM period.

People with type 1 narcolepsy have low levels of hypocretin.

Narcolepsy without cataplexy; the cause of type 2 narcolepsy is unknown.