Sleepiness Handbook

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Sleepiness Handbook


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A positive answer to any of these questionsmay indicate excessive sleepiness.

Areyouoftensleepywhenyoushouldbeawake?

Areyourelyingoncoffeeandcaffeinatedsoftdrinksto getthroughtheday?

Areyouordoyouknowofateenagerwhohastrouble fallingasleepatnightandstrugglestogetupinthe morning?

Areyouordoyouknowofanolderadultwhogets

Excessive Sleepiness Is aSerious Problem

Peoplewithexcessivesleepinesshavetroublewith memoryandconcentration.

Studentswithexcessivesleepinessgetlower gradesandhavelowergraduationratesthan otherstudents.

Excessivesleepinessaffectsjobperformance. Onesurveyreportedthat46%ofAmericanssay thattheyhavemissedworkormademistakes atworkatleastonceintheprevious3months becauseofexcessivesleepiness.

Excessivesleepinessisamajorcauseoftrafc accidents.Peoplewithexcessivesleepinessdont reactasquicklyandtheyhavemoreaccidents. TheNationalHighwayTrafcSafetyAdministration

Is Excessive Sleepiness Affecting You and Your Family?

sleepyearlyintheeveningandawakensbefore sunrise?

Doyousnoreorhavetroublebreathingduringsleep?

Doyouhaveuncomfortablefeelingsinyourlegsthat keepyoufromsleeping?

Doessomeoneinyourfamilyworkatnightandhave difcultygettingtosleepduringtheday?

Doyousleeplonghours,butyoujustdontwakeup feelingrefreshed?

estimatesthatatleast100,000accidentsperyear arethedirectresultofdriverfatigue.Driverswho fallasleepatthewheelareparticularlydangerous

becausetheycrashhead-onatfullspeedwithout tryingtobrakeorturn.

Excessivesleepinessaffectsfamilyrelationships. Peoplewithexcessivesleepinesscanbeirritable andhardtolivewith.Theymaybetootiredtoenjoy theirtimewithfamilyandfriends.Theymayhave sleepdisorderswithsnoringandmovements duringsleepthatdisturbtheirbedpartnerssleep aswell.

Manymedicalandpsychiatricdisordersare associatedwithpoorsleep,includinghighblood pressure,heartdisease,obesity,diabetes,

depression,andanxietydisorders.

Excessivesleepinessiscommon.Inonesurvey, 26%reportedgettingagoodnightssleeponly afewdayspermonth,and24%saidthattheir sleepproblemshavesomeimpactontheirdaily lives.Halfoftherespondentssaidthattheywere tiredorfatiguedatleastonedayperweek,and 17%saidthishappenseverydayoralmostevery day.

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Clinical Pracce Tool

EPWORTH SLEEPINESS SCALE

Name:

Date:

Age:

How likely are you to doze off or fall asleep in the following situations, in contrast to justfeeling tired? This refers to your usual behavior in recent times. Even if you have not donesome of these things recently, consider how they would have affected you. Use the followingscale to choose the most appropriate numberfor each situation:

0 = would neverdoze1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing Chance ofSituation Dozing

Sitting and reading __________

Watching television __________

Sitting inactive in a public place (eg, at a theater or meeting) __________

As a passenger in a car for an hour without a break __________

Lying down to rest in the afternoon when circumstances permit __________

Sitting and talking to someone __________

Sitting quietly after a lunch without alcohol consumption __________

In a car while stopped for a few minutes in traffic __________

TOTAL: __________

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540-545.Johns MW, Hocking B. Daytime sleepiness and sleep habits of Australian workers. Sleep. 1997;20:844-849.

Interpreting Results

0-10 Average score; normal population

11 and up Insufficient sleep; consider improving sleephygiene; consultation with a sleep specialistrecommended

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What You Can Expect From YourHealthcare Provider if You HaveExcessive Sleepiness?

Whenyouvisityourhealthcareprovidertodiscussyourexcessivesleepiness,youwillbeprovidinghimor herwithdetailedinformationaboutyoursleep.Yourprimarycareprovidercanoftenidentifythecauseofexcessivesleepinessandofferhelp.

Toidentifyandtreatthecauseofyourexcessivesleepiness,yourhealthcareproviderwillprobablyaskquestionslikethese:

Whendidthisproblembegin,andhowoftendoesit happen?

Whendoyouusuallygotobedandwhendoyouget up?

Howlongdoesittakeyoutofallasleep?

Ifyouwakeupduringthenight,howlongdoesittake

tofallbackasleep?

Doyousnore?Doyoueverwakeupgaspingfor breath?

Doyoufeelrefreshedwhenyougetupinthemorning, orisithardtogetoutofbed?

Doyoufallasleepduringtheday?

Doyouusetobaccooralcohol?Whenandhowmuch?

Howmuchcoffee,tea,andothercaffeinated beveragesdoyoudrink?

Doyoueverusesleepingpills?

Areyouunderstress?Hasanythingstressful happenedrecently,likeadivorceorjobloss?

Doyoundyourselfworryingwhenyouaretryingto fallasleep?

Dootherfamilymembershavetroublesleeping?

Doyoutraveloften?Haveyoutraveledrecently?

YourhealthcareprovidermayalsoaskyoutolloutaquestionnaireliketheEpworthSleepinessScaleonpage3orkeepasleepdiarylikeonpage6.Ifyoucan,youmightllouteitheroftheseformstohelpyoupreparefortheofcevisit.BringthediaryandEpworthSleepi-nessScalewithyouandshowthemtoyourhealthcareprovider.

Yourhealthcareproviderislikelytoreviewyourmedica-

tions,includingthoseprescribedbyotherproviders,aswellasover-the-countermedicationsandsupple-ments.Youmightconsiderbringingallyourmedicationswithyou.

Yourhealthcareprovidermaydoaphysicalexaminationtoruleoutmedicalcausesofexcessivesleepiness.

Dependingontheinformationyouprovide,yourhealth-careprovidermaywanttodofurthertesting.Abloodtestmightbeneededifthereisapossiblethyroidproblem.Ifyoumighthaveasleep-relatedbreathingdisorder,suchassleepapnea,youmaybeaskedtospendanightina

sleeplaboratorywheretestsaredoneasyousleep.

Yourhealthcareprovidermayneed2or3visitstoprovideaspecicdiagnosisandtreatment.Ofcourse,treatmentwilldependonthediagnosis.

Yourhealthcareprovidermaydiscussapossible changeinyourmedicationstoeliminateanythat causesleepproblems.

Ifyouhavesleepapnea,youmayneedanapparatus tohelpyoubreatheduringthenight.

Circadianrhythmdisorders,thosecausedbyan

internalclockthatdoesnotmatchyoursleeping schedule,maybetreatedbyexposuretobrightlights atparticulartimesoftheday.

Behavioraltreatment,suchaschangingyourhabits andsleepingenvironment,canbeveryeffectivefor somesleepdisorders.

Relaxationtechniquesmaybehelpfulifanxietykeeps youfromfallingasleep.

Ifyoursleepproblemsarecausedbydepressionor anxietydisorders,thoseunderlyingcausesshouldbe treatedappropriately.

Yourhealthcareprovidermaydecidetoprescribe medicationtohelpyousleep.

Ifnecessary,ifyourproblempersistsafteryour treatmentsareinplace,othermedicationsthatcan helpyoustayalertduringthedaymaybeprescribed.

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Causes of Poor Sleep andExcessive Sleepiness

Caffeine,foundincoffee,tea,chocolate,andmanysoftdrinks,isastimulantthatmaykeepyouawakeordisturbyoursleep.

Nicotine,fromsmokingorchewingtobacco,isanotherstimulantthatcaninterferewithpropersleep.

Certain medications* can interfere with sleep.Some common examples:

Albuterolorsalbutamol(AccuNeb,Proventil,Ventolin, Volmax,VoSpireER)

Dextroamphetamine(Dexedrine,DextroStat)

Methylphenidateormethylphenidylacetatehydrochloride (Concerta,MetadateCD,Methylin,MethylinER, Ritalin)

Phenylephrine(Neo-Synephrine,Ah-ChewD,Despec-SF, DimetappColdDrops,GilchewIR,Nasop,Phenyl-T, SudafedPE,SudogestPE,TriaminicThinStripsCold,

Wal-PhedPE)

Guaifenesin/phenylephrine/phenylpropanolamine (Ami-Tex,Banex,Dura-Gest,Duratex,Enomine,Entex, Fentex,Guaifenex,Phenylfenesin,Quintex)

Pseudoephedrine(Afrinol,Cenafed,Chlor-TrimetonNasal Decongestant,Congestaclear,ContacCold,Decofed Liquid,Dimetapp12-HourNon-DrowsyExtentabs, DimetappDecongestant,DrixoralNon-DrowsyFormula, Edac,ElixSureDecongestant,Entex,Genaphed, Myfedrine,Nasofed,Pseudocot-T,Pseudofed, Pseudotabs,Pseudoval,Q-Fed,Ridifed,Seudotabs, Silfedrine,Sudafed,Sudodrin,SudoGest,Sudrine,Superfed, Suphedrin,TriaminicAM,TriaminicSoftchewsAllergy

Congestion,TylenolSimplyStuffy,Uni-Sed,Unifed, Wal-Phed)

Quinidine(Cardioquin,Quinidinegluconate,Quinidine sulfate)

Selectiveserotoninreuptakeinhibitors:citalopram(Celexa), escitalopram(Lexapro),uoxetine(Prozac,ProzacWeekly, Sarafem),paroxetine(Paxil,PaxilCR,Pexeva),sertraline (Zoloft),uoxetinecombinedwiththeatypicalantipsychotic olanzapine(Symbyax)

Theophylline(AerolateIII,AerolateJR,AerolateSr., Aquaphyllin,Asmalix,Bronkodyl,Elixophyllin,Quibron T,QuibronT/SR,Respbid,Slo-Phyllin,SloBid,Slo-Bid Gyrocaps,T-Phyl,Theo-24,Theo-DurSprinkle,Theo- Time,Theo-X,Theobid,TheoCap,Theochron, Theoclear,Theoclear-80,Theo-Dur,Theolair,Theosol-80, Theovent,Truxophyllin,Uni-Dur,Uniphyl)

Certain medications* that might make you drowsyinclude:

Chlorpheniramine

Clonazepam(Klonopin)

Diphenhydramine(Benadryl)

Estazolam(ProSom)

Eszopiclone(Lunesta)

Flurazepam(Dalmane,Dalmadorm)

Temazepam(Restoril)

Zolpidem(Ambien)

Sleep disorders often cause excessive sleepiness:

Sleepapnea Circadianrhythmsleepdisorders Periodiclimbmovementdisorder

Restlesslegssyndrome Narcolepsy

Other medical conditions can interfere with sleep:

Pain Drugoralcoholintoxicationorwithdrawal Thyroiddisorders Shortnessofbreathfromanycause

Medical conditions can cause excessive sleepiness:

Braintumors Chronicobstructivepulmonarydisease Chronicrenaldisease

Congestiveheartfailure Encephalitis Endocrinedisorders Geneticdisordersaffectingthecentralnervoussystem Headtrauma Infections Inammatoryconditions Metabolicconditions Neurodegenerativediseases,suchasAlzheimer disease

Stroke Toxicconditions

Psychological causes of poor sleep: Depression Anxietydisorders Stress Worrying Mania

Environmental causes of poor sleep:

Bedroomtoohotortoocold Noiseorlight Eating,exercise,orcaffeineoralcoholusebefore bedtime

Jetlag

Shiftwork Daytimenapping

*Donotstoporchangeyourmedicationswithoutconsult-ingyourhealthcareprovider.

AdaptedfromtheAmericanAcademyofFamilyPhysicians.Availableat:http://www.aafp.org/afp/990401ap/1911.htmlAdaptedwithpermissionfrom:VanBruntDL,RiedelBW,LichsteinKL.Insomnia.In:HasseltVB,HersenM,eds.SourcebookofPsychologi-calTreatmentManualsforAdultDisorders.NewYork,NY:Plenum;1996:539-556.

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What You Can Do To GetBetter Sleep

Therearemanythingsyoucandoonyourowntoimproveyoursleep.Tryasmanyoftheseasyoucan.

Establish a bedtime routine.Gotobedatthesame timeeverynightandgetupatthesametimeevery

morning,evenonweekends.Thishelpsyourbrain setyourinternalclocksoyouwillbemorelikelytobe sleepyatbedtimeandawakeinthemorning.

Allow enough time for sleeping.Theneedforsleep variesfrompersontoperson,butmostadultsneed7 to9hoursofsleepeverynight.Manypeoplestayup laterthantheyshouldandstruggletogetupinthe morning.

Enjoy quiet, relaxing activities just before bedtime. Takeabath,read,pray,meditate,orlistentoquiet music.Dontdoanythingthatmightmakeyouanxious

orexcitedrightbeforebedtimelikepayingbillsor playingvideogames.Brightlightssignalyourbrain thatitistimetowakeup,soifyoucan,dimthelights beforebedtimeoruselowerwattagebulbsinyour bedroom.

Use your bed only for sleep and sex.Youwantto associateyourbedroomwithrelaxationandsleep. Donoteat,watchtelevision,orplayvideogamesin bed.Keepyourcomputerandworkmaterialsoutof thebedroom.

Make your bedroom comfortable for sleeping.

Itshouldbecool,dark,andquiet.Putblackoutshades andlinedcurtainsonyourwindowstoblocklightfrom thestreet,orweareyeshades.Ifitisnoisy,wearear plugs.Youcanalsoblocknoisebycreatingwhite noisewithanyappliancethatmakesalowhumming sound,likeafan.Itisalsoimportanttohavea comfortablemattressandpillows.Agoodmattress lastsabout10years,soitmaybetimetothinkabout replacingyours.

Dont eat a big meal close to bedtime.Afullstomach canmakeyouuncomfortableanddisturbyoursleep. Spicyfoodsmaycauseheartburn.Ifyoudrinktoo muchliquidintheevening,youmayneedtowakeup tousethebathroomduringthenight.Somepeople

liketohaveasnackbeforebed,butitisbesttokeepit small.

Avoid caffeine in the evening.Manyofusenjoythe stimulatingeffectsofcaffeine,especiallyinour morningcoffeeortea.However,thecaffeineincoffee, tea,soda,andchocolatestaysinyourbodyandcan keepyouawakeormakeyouwakeupduringthe night.Evenifyoucanfallasleepwithcaffeineinyour body,youmayndthatyousleepmoresoundlyand feelbetterinthemorningifyouskiptheevening caffeine.

Avoid tobacco in the evening.Thenicotineintobacco isastimulant.Likecaffeine,itcanmakeithardertofall asleepandcandecreasethequalityofsleep.

Avoid alcohol before bedtime.Manypeoplendthat alcoholhelpsthemfallasleep,butalcoholmaydisturb yoursleeptherestofthenight.Youwillprobablysleep moresoundlyifyoudonotdrink.

Set your worries aside.Somepeoplewhoworrywhen theytrytofallasleepndthatkeepingajournalis helpful.Othersmakealistofconcernstothinkabout tomorrowandsetitasideatbedtime.

Keep naps short.Ifyoumustnapduringtheday,tryto limititto30minutes.Longernapsmaymakeitharder tofallasleepatbedtime.

Get regular exercise.Peoplewhoexercisefallasleep moreeasilyandsleepmoresoundly.Exercisecan makeyoumorealert,however,soitisprobablybetter toexerciseatleast3hoursbeforebedtime.Exercising earlyinthedayispreferred.

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Suggested Reading

AAAFoundationforTrafcSafety.AAAFoundationforTrafcSafety-FAQs:DrowsyDriving.Availableat:http://www.aaafts.org/resources/index.cfm?button=drowsyfaqAccessedApril12,2011.

BreusMJHowtoSleepBetter.WebMD.Availableat:http://www.webmd.com/sleep-disorders/guide/sleep-

hygieneAccessedApril12,2011.

CatalettoME,HertzG.SleeplessnessandCircadianRhythmDisorder.Availableat:http://emedicine.medscape.com/article/1188944-overviewAccessedApril12,2011.

DrakeC,RoehrsT,BreslauN,etal.The10-yearriskofveriedmotorvehiclecrashesinrelationtophysiologicsleepiness.Sleep.2010;33:745-752.

EddyM,WalbroehlGS.Insomnia.AmFamPhysician.1999;59:1911-1916.Availableat:http://www.aafp.org/

afp/990401ap/1911.htmlAccessedApril12,2011.

NationalSleepFoundation.SummaryofFindings.2005SleepinAmericaPoll.Availableat:http://www.sleep-foundation.org/sites/default/les/2005_summary_of_ndings.pdf

NationalSleepFoundation.HealthySleepTips.Availableat:http://www.sleepfoundation.org/article/sleep-topics/healthy-sleep-tipsAccessedApril12,2011.

PagelJF.Excessivedaytimesleepiness.AmFamPhysi-

cian.2009;79:391-396.

PagelJF.Medicationsandtheireffectsonsleep.PrimCare.2005;32:491-509.

ParishJM.Sleep-relatedproblemsincommonmedicalconditions.Chest.2009;135:563-572.

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Documents

Sleepiness Handbook