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Diagnosing Excessive Sleepiness

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Logan Foley

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Dr. Anis Rehman

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Do you feel sleepy on a regular basis? If you have trouble staying awake during the day, you may have excessive sleepiness, and you’re not alone. One in five people suffers from excessive sleepiness. In fact, excessive sleepiness is one of the most common sleep complaints people have besides insomnia.

Unfortunately, many people go about their daily lives feeling excessively sleepy without mentioning it to their doctor. Sometimes, people brush off sleepiness laziness, or a lack of motivation, when it can actually be a symptom of something more serious.

Excessive sleepiness takes a toll on your work, school, relationships, and daily life. It can cause car accidents and workplace injuries. If you feel like you’re always sleepy, even after sleeping, it’s time to talk to your doctor about your sleepiness.

When to Talk to Your Doctor About Excessive Sleepiness

Excessive sleepiness should be taken seriously, as it could be a sign of an underlying health condition or sleep disorder — especially if you think you’re getting enough sleep, eating well, and exercising regularly. If you have an upcoming physical or wellness visit, discuss excessive sleepiness with your doctor then. If not, consider scheduling an appointment with your primary care doctor to discuss why you feel tired all the time.

Don’t wait for your doctor to ask you about your sleep. Doctors rarely ask about sleep issues unless they have reason to believe there is a problem. A National Sleep Foundation poll found that seven in ten people said that their doctor had never asked them about their sleep. Your doctor can diagnose your excessive sleepiness and recommend next steps, but it’s up to you to be proactive and bring up your sleep problems to your doctor.

Preparing for Your Sleep Appointment

Your doctor will ask several questions to figure out why you are always so tired. You can come prepared for your appointment by thinking about the answers to these questions ahead of time, and even writing them down. These questions may include:

  • How long have you been feeling excessively sleepy?
  • Do you have difficulty falling or staying asleep at night?
  • Do you feel this sleepy every day, on a regular basis?
  • Do you feel drowsy while working or driving? Have you ever fallen asleep doing these activities?
  • Do you wake up during the night? If so, how many times and how often during the week?
  • How many hours of sleep do you get on a typical weeknight and weekend night?
  • What is your bedtime and wake time?
  • Has your sleep partner noticed you make any loud snores or choking sounds during your sleep?
  • Do you exhibit symptoms of other sleep disorders, such as teeth grinding, restless legs sensations, or abnormal movements during sleep?
  • Is there anything that makes your sleep schedule irregular, such as a new baby, shift work, medical condition, or stress?
  • Do you follow a healthy diet? How often do you consume caffeine, alcohol, nicotine, or other drugs?
  • Does anyone in your family have a sleep disorder?

To answer these questions, it can be helpful to keep a sleep diary in the two weeks leading up to your appointment. Write down when you went to bed, when you woke up, the total amount of time you slept, and whether or not you woke up during the night. You can also use a sleep tracking device, like a fitness wearable or mobile app, to help you record your sleep-related data.

During your appointment, be sure to inform your doctor of your personal and family medical history, and of any medications you’re currently taking.

    Next Steps After an Excessive Sleepiness Diagnosis

    Once your doctor diagnoses you with excessive sleepiness, they will try to determine what’s causing the problem, order tests if necessary, and provide recommendations for treatment.

    Your doctor may determine your sleepiness is due to poor sleep hygiene, such as an irregular sleep schedule or drinking too much caffeine or alcohol. They’ll provide recommendations on how to improve your sleep behaviors.

    Excessive sleepiness is a common symptom of undiagnosed sleep apnea, narcolepsy, hypersomnia, restless legs syndrome, and circadian rhythm disorders like shift work disorder. If your doctor suspects a sleep disorder is a reason you feel tired all the time, they may refer you to a sleep center. There, you may take a number of tests.

    • Epworth Sleepiness Scale: You’ll likely begin by filling out the Epworth Sleepiness Scale. This scale is a simple diagnostic questionnaire that asks you to rate your likelihood of falling asleep on a scale of 0 to 3 in eight situations, such as while watching TV or being stopped in traffic.
    • Polysomnogram: If the doctor suspects you have sleep apnea, they might recommend a sleep study, or polysomnogram. During this exam, you’ll spend the night at the sleep center with technicians monitoring your brainwaves, heart and lung activity, breathing patterns, body movements, and other key vitals while you sleep.
    • Multiple Sleep Latency Test: If you exhibit symptoms of idiopathic hypersomnia or narcolepsy, the doctor may also administer a Multiple Sleep Latency Test (MSLT) after your polysomnogram. In this exam, you’ll be asked to take five 20-minute naps, at two-hour intervals during the day. They’ll record how long it takes you to fall asleep.
    • Maintenance of Wakefulness Test: Although this is not used for diagnostic purposes, a Maintenance of Wakefulness Test (MWT) may be ordered. This exam measures the opposite of the MSLT, or how long you can stay awake. It may be used to evaluate patient safety in activities such as driving.

    Excessive sleepiness can also be a side effect of certain medications, in which case your doctor may suggest prescribing an alternative medication. Several health conditions can also contribute to excessive sleepiness, such as anemia, depression, fibromyalgia, chronic kidney disease, liver disease, chronic obstructive pulmonary disease (COPD), diabetes, hypothyroidism, congestive heart failure, vitamin deficiency (B12), Addison’s disease, adrenal insufficiency, or allergic rhinitis. If your doctor suspects an underlying health condition is contributing to your sleepiness, they may order blood work or refer you to another specialist.

    If you always feel sleepy, speak to your doctor. There could be a number of things contributing to your excessive sleepiness, and your doctor can help you figure it out.

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