A Brief Overview of Excessive Daytime Sleepiness

Excessive daytime sleepiness (EDS) is more than just feeling tired—it can impair cognitive function, increase accident risk, and impact emotional well-being. In this expert discussion, Nishi Bhopal, MD, founder and medical director of telepsychiatry practice Pacific Integrative Psychiatry, breaks down how to distinguish EDS from general fatigue, explores its prevalence in key demographic groups, and shares essential clinical insights to improve diagnosis and management.

Watch now for practical strategies that can enhance patient care and outcomes for patients with sleep disorders in your neurology practice.

For more expert insights, visit the Sleep Disorders Excellence Forum here on Neurology Learning Network.

Read the Transcript:

Nishi Bhopal, MD: I'm Dr Nishi Bhopal, MD, I am a physician, board certified in sleep medicine, psychiatry, and integrative holistic medicine. I'm the founder of Pacific Integrative Psychiatry. We're an online telehealth practice seeing patients across the state of California. I'm also the founder of Intra Balance, which is an online platform teaching physicians, therapists, and other health care practitioners about clinical sleep medicine. I do that through a YouTube channel and online courses.

Neurology Learning Network (NLN): What is excessive daytime sleepiness and how does it differ from general fatigue as well as other sleep-wake disorders?

Dr Bhopal: Excessive daytime sleepiness is characterized by difficulty staying awake and staying alert during normal waking hours, and it leads to an increased propensity to fall asleep in inappropriate situations. Excessive daytime sleepiness can significantly impair daily functioning and quality of life. So, it's really a symptom. It can result from various causes, like not getting enough sleep, from other sleep disorders like obstructive sleep apnea and narcolepsy. It can be a symptom of those types of disorders.

It can also be a symptom of circadian rhythm disorders, and of course, medical and psychiatric conditions.

How it differs from general fatigue is that with excessive daytime sleepiness, patients have an increased propensity to fall asleep during normal waking hours. What that means is if you ask a patient, "if you were to lie down right now, could you fall asleep?"

The patient with excessive daytime sleepiness might say, "Yes, if I lie down in the middle of the day, I'm going to fall asleep, or I need to take a nap." They have this urge to sleep during the day, whereas with general fatigue, it's more a subjective feeling of tiredness or a lack of energy that's not necessarily relieved by sleep. With those patients, I'll ask them questions to distinguish between, "are you sleepy or are you fatigued?" The patient with fatigue will say, "well, I just want to rest. I just want to lie down." However, they may not necessarily fall asleep, so simply asking that question can provide some clues as to whether this is excessive daytime sleepiness or more general fatigue.

NLN: How prevalent is EDS in the US population, and are there any patient populations that are particularly affected?

Dr Bhopal: Excessive daytime sleepiness is actually really common. It's quite prevalent in the United States. There was a study in 2012 showing that almost 20% of the population experience some degree of excessive daytime sleepiness, and about 11% of people report severe excessive daytime sleepiness.

There are certain demographics that are more likely to be affected by excessive daytime sleepiness or EDS. Some of these demographics include:

• Women; women are more likely to report severe EDS compared to men.
• Younger adults aged 18 to 24, and even up to the age of 34, have a higher rate of EDS compared to older adults.
• People with chronic conditions such as diabetes, high blood pressure, COPD, asthma, and pain disorders.

As I was saying before, there are certain sleep disorders that are more likely to be associated with EDS. These include things like obstructive sleep apnea, insomnia (here's a little bit of a caveat there—some patients with insomnia have excessive daytime sleepiness, but most patients with insomnia have hyper arousal, which is the opposite), sleep deprivation, which is distinct from insomnia, and restless leg syndrome. And then, of course, psychiatric conditions like depression and anxiety, obesity, and metabolic conditions are also associated with EDS, specifically diabetes.

So overall, EDS is incredibly common, affecting a substantial portion of the United States population with a higher prevalence in women, younger adults, and people with chronic medical and psychiatric conditions.

NLN: What are the most common symptoms of EDS that clinicians and patients should be more aware of? How do these symptoms impact daily functioning?

Dr Bhopal: The most common symptoms of EDS include an overwhelming urge to sleep during the day. This is characterized by difficulty staying awake and staying alert, and patients might report that they fall asleep unintentionally in inappropriate situations. This includes things like going to the movies, they might fall asleep watching tv, and some patients even report falling asleep driving or having this urge to sleep, or just this overwhelming feeling of sleepiness while driving, which is a safety hazard, of course.

So, we want to be asking about a propensity to have these episodes of extreme feelings of sleepiness or maybe even dozing off in inappropriate situations.

How it affects people in their day-to-day functioning is that it can impair their cognitive abilities. They might have difficulty with concentration, memory, or decision-making. They might notice that they're making careless mistakes at work, such as typos in their emails, or they may be struggling with academic performance if they're in school.

I mentioned this public safety issue. There's an increased risk of accidents, specifically motor vehicle accidents, with people who have excessive daytime sleepiness. People also might notice social and emotional difficulties. When people are tired, they're more likely to be irritable or anxious or depressed, and this can carry through into their relationships. This might even lead to longer term issues with low self-esteem and social isolation. I've seen patients who struggle with EDS, and their family members or loved ones might label them as lazy or tell 'em they're just not trying hard enough. Their family members might get frustrated with them because of it. This can also lead to more subtle relational issues.

 EDS can also exacerbate other conditions. It can make depression worse. People might experience worsening symptoms of anxiety, and it can further diminish their quality of life as well.

Interested readers can explore Dr Bhopal's YouTube Channel here.

Nishi Bhopal, MD, is board-certified in psychiatry, sleep medicine, and integrative holistic medicine. She graduated from the University College Cork School of Medicine, completed her psychiatric residency at Henry Ford Health System, and a fellowship in sleep medicine at Harvard Medical School. She is the founder and medical director of Pacific Integrative Psychiatry, an online practice in California where patients receive a whole-person approach to anxiety, depression, and sleep disorders, including nutrition, psychotherapy, and integrative and functional medicine. In addition to her private practice, Dr Bhopal is the founder of IntraBalance, an educational platform for physicians and therapists that includes a YouTube channel and online courses on clinical sleep medicine for healthcare practitioners. Her passion is making clinical sleep medicine easy to understand and accessible to all.