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Daytime Sleepiness

Aka: Daytime Sleepiness, Sleepiness, Daytime Tiredness, Tiredness, Hypersomnia, Hypersomnolence, Disorder of Excessive Daytime Sleepiness
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  1. See Also
    1. Sleep Stage
    2. Hypersomnolence Causes
    3. Narcolepsy
    4. Insomnia
  2. Causes
    1. Hypersomnolence Causes
  3. History
    1. History of Sleepiness
    2. Comorbid significant medical conditions (e.g. Neurologic Disorders)
    3. Medications (including non-prescription items, supplements and herbals)
    4. Alcohol and other drugs of abuse
    5. Mood and emotional stressors
    6. Lifestyle, night-time work hours, and sources of sleep deprivation
    7. Sleep habits (including Insomnia, snoring, and possible Sleep Apnea)
    8. Restless Leg Syndrome
  4. Screening: Significant daytime somnolence indicating additional evaluation
    1. Falling asleep while driving OR
    2. Epworth Sleepiness Scale >12
  5. Differential Diagnosis
    1. Insomnia (Disorder of Initiating and Maintaining Sleep or DIMS)
      1. Insomnia typically causes paradoxical daytime hyperarousal instead of Sleepiness
      2. Insomnia with excessive Daytime Sleepiness suggests comorbidity (e.g. Sleep Apnea)
  6. Labs
    1. Thyroid Function Tests
    2. Renal Function tests
    3. Serum Calcium
    4. Arterial Blood Gas (ABG)
      1. Rule-out Hypercapnia
  7. Diagnostics: Sleep Study
    1. Step 1: Overnight polysomnography evaluates for Sleep Apnea
      1. Positive: Treat Sleep Apnea
      2. Negative: Perform step 2 testing
    2. Step 2: Polysomnography evaluates sleep onset latency (time to fall asleep)
      1. Multiple Sleep Latency Test (MSLT)
        1. Hypersomnolence with early onset REM Sleep diagnoses Narcolepsy without cateplexy
      2. Maintenance of Wakefullness Test (MWT)
        1. Assess waking performance in alertness-critical professions (e.g. drivers, pilots)
  8. Management: General
    1. Treat underlying cause (e.g. Sleep Deprivation, Sleep Apnea, Restless legs syndrome)
    2. Practice Sleep Hygiene and ensure adequate sleep time
  9. Management: Stimulant Medications
    1. See Narcolepsy for specific management
    2. Contraindications
      1. Untreated Sleep Apnea
      2. Other secondary causes not fully excluded
      3. Mild or unproven Hypersomnolence
    3. Indications
      1. Excessive Sleepiness despite appropriate Sleep Apnea management with CPAP
      2. Daytime Sleepiness with shift work disorder
      3. Other moderate to severe excessive Daytime Sleepiness
    4. First-line agents
      1. Modafinil (Provigil)
        1. Best safety profile and lowest abuse potential of all stimulant agents
        2. Czeisler (2005) N Engl J Med 353(5): 476-86
    5. Other agents (higher risk of abuse and side effects)
      1. Dextroamphetamine (Dexedrine)
      2. Methylphenidate (Ritalin)
      3. Pemoline (Cylert)
        1. Risk of hepatotoxicity
  10. References
    1. Kreiger (2000) Sleep 23:S95-8
    2. Pagel (2009) Am Fam Physician 79(5): 391-6

Drowsiness (C0013144)

Definition (NCI) The sensation of struggling to remain awake.
Concepts Finding (T033)
MSH D012894
SnomedCT 206711009, 79519003, 158122000, 271782001
English Drowsiness, Drowsinesses, SLEEPINESS, DROWSINESS, DROWSY, Somnolence, [D]Drowsiness, [D]Drowsiness (context-dependent category), Drowsiness, function, drowsy, drowsiness, drowsy (physical finding), drowsiness (symptom), [D]Drowsiness (situation), drowsiness was observed, somnolence, Sleepy, Drowsy, Sleepiness, Drowsiness, function (observable entity), Drowsy (finding), Drowsiness (function), sleepiness
Portuguese SONOLENCIA, Sonolência, LETARGIA
Dutch slaperigheid, suf voelen, Slaperigheid
French Endormissement, Envie de dormir, ASSOUPISSEMENT, ENVIE EXCESSIVE DE DORMIR, Somnolence, Assoupissement
German Verschlafenheit, Schlaefrigkeit, Schläfrigkeit, DOESIGKEIT, SCHLAEFRIGKEIT, Somnolenz
Italian Sonnolenza
Spanish Tendencia al sueño, Adormecimiento, [D]modorra (categoría dependiente del contexto), [D]Drowsiness, Somnolencia, ADORMECIMIENTO, MODORRA, [D]modorra (situación), [D]modorra
Japanese 眠気, 傾眠状態, ﾈﾑｹ, ｹｲﾐﾝｼﾞｮｳﾀｲ
Czech Ospalost
Hungarian Álmosság
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Fatigue (C0015672)

Definition (NCI) A disorder characterized by a state of generalized weakness with a pronounced inability to summon sufficient energy to accomplish daily activities.
Definition (MEDLINEPLUS)

You‘re tired, weak, exhausted, weary, worn out. You have a lack of energy and as a result you feel distressed. You’re not functioning as well as you should. It’s called fatigue, and everyone feels it at times.

Acute fatigue is normal tiredness with occasional symptoms that begin quickly and last for a short time. Rest may help ease acute fatigue and let you return to your normal activities. Chronic fatigue syndrome (CFS) is a disorder that causes extreme fatigue. This fatigue is not the kind of tired feeling that goes away after you rest. Instead, it lasts a long time and limits your ability to do ordinary daily activities. Fatigue may also accompany other conditions, including pregnancy, anemia, or cancer, or may result from medicines or emotional problems.

Fatigue is a common symptom. Your health care provider can help find the cause and recommend ways to relieve it.
Definition (NCI) A survey question about whether a person has experienced a lack of energy.
Definition (NCI) A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.
Definition (NCI) That state, following a period of mental or bodily activity, characterized by a lessened capacity for work and reduced efficiency or accomplishment, usually accompanied by a feeling of weariness, sleepiness, or irritability. (On-line Medical Dictionary)
Definition (NCI) I have a lack of energy.
Definition (HHC) Exhaustion that interferes with physical and mental activities.
Definition (NAN) An overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level
Definition (MSH) The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.
Definition (CSP) state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.
Concepts Sign or Symptom (T184)
MSH D005221
ICD10 R53.83
SnomedCT 206767001, 206771003, 302758002, 158169005, 139126000, 84229001, 248274002, 367392001
French FATIGUE, Fatigue extrême, Perte d'énergie, Energie diminuée, Ereinté, Lassitude, Sensation de manque total d'énergie, EPUISEMENT, FAIBLESSE, LASSITUDE, Fatigue
English FATIGUE, FATIGUE EXTREME, Fatigued, TIREDNESS, WEARINESS, [D]Fatigue, [D]Tiredness, [D]Fatigue (context-dependent category), [D]Tiredness (context-dependent category), Extreme fatigue, Decreased energy, decreased energy, tiredness, fatigue (diagnosis), fatigue, Tiredness (finding), [D]Fatigue (situation), Feeling of total lack of energy, Fatigue extreme, Tired out, [D]Tiredness (situation), Fatigue NOS, Fatigue [Disease/Finding], rndx fatigue (diagnosis), rndx fatigue, fatigu, lacking energy, fatigues, fatigus, loss of energy, tired time, fatigue extreme, extreme fatigue, weariness, fatigued, tatt, time tired, energy loss, fatiguing, tired all the time, Lack Energy, Energy decreased, Tiredness, Lack of energy, Loss of energy, Weariness, Fatigue (finding), Lack of energy (finding), Lacking in energy, Lacking in energy (finding), Fatigue, Lack of Energy, lack of energy, Lack (of);energy
Portuguese FADIGA, Fadiga extrema, Sensação de falta total de energia, Perda de energia, Exausto, Energia diminuída, CANSACO, ESGOTAMENTO, EXAUSTAO, Fadiga
Spanish FATIGA, Abatimiento, Sensación de falta absoluta de energía, Pérdida de energía, Fatiga extrema, Cansado, Cansancio, Falta de energía, [D]cansancio (categoría dependiente del contexto), faltante de energía (hallazgo), [D]fatiga (categoría dependiente del contexto), faltante de energía, Fatigue, Tiredness, [D]Fatigue, ABATIMIENTO, CANSANCIO, FATIGA EXTREMA, [D]cansancio, [D]cansancio (situación), [D]fatiga (situación), [D]fatiga, cansancio, falta de energía (hallazgo), falta de energía, fatiga (hallazgo), fatiga, pérdida de energía, Fatiga
German ERMUEDUNG, Mangel an Energie, Muedigkeit extrem, Ueberdruss, Energie abgenommen, abgeschlafft, Gefuehl voelligen Energiemangels, Muedigkeit, ABGESCHLAGENHEIT, MUEDIGKEIT STARK, MUEDIGKEIT, Ermuedung, Ermüdung, Müdigkeit
Italian Affaticamento, Affaticamento estremo, Esaurito, Sensazione di totale mancanza di energia, Perdita di energia, Energia ridotta, Stanchezza
Dutch vermoeid, moeheid, uitzonderlijk moe, verlies van energie, gevoel van energieloosheid, energie afgenomen, vermoeidheid, Moeheid
Japanese 活力低下, 活力喪失感, 活力喪失, 疲労困ぱい, 極度の疲労, 疲労, ﾋﾛｳｺﾝﾊﾟｲ, ｶﾂﾘｮｸﾃｲｶ, ｶﾂﾘｮｸｿｳｼﾂｶﾝ, ﾋﾛｳ, ｷｮｸﾄﾞﾉﾋﾛｳ, ｶﾂﾘｮｸｿｳｼﾂ
Swedish Trötthet
Czech únava, Utahanost, Extrémní únava, Utahaný, Ztráta energie, Úbytek energie, Únava, Vyčerpanost, Pocit celkového nedostatku energie
Finnish Väsymys
Russian UTOMLENIE, USTALOST', УСТАЛОСТЬ, УТОМЛЕНИЕ
Croatian UMOR
Polish Znużenie, Zmęczenie
Hungarian Kimerültség, Defatigatio, Kifáradt, Teljes energiahiány érzete, Energia elvesztése, Fáradtság, Kimerültség, extrém, Csökkent energia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Hypersomnolence (C0751229)

Concepts Sign or Symptom (T184)
MSH D006970
English HYPERSOMNOLENCE, HYPERSOMNOLENT, hypersomnolence, hypersomnolent, Hypersomnolence
Czech hypersomnolence
Portuguese Hipersonolência
Spanish Hipersomnolencia
French Hypersomnolence
German Hypersomnolenz
Dutch Hypersomnolentie
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Hypersomnia (C0917799)

Definition (NCI) A disorder characterized by characterized by excessive sleepiness during the daytime.
Definition (NCI) A sleep disorder characterized by excessive sleepiness during the daytime.
Definition (PSY) Excessive sleepiness.
Concepts Sign or Symptom (T184)
MSH D006970
ICD9 780.54
ICD10 G47.10, G47.1
SnomedCT 309732001, 206751007, 158154009, 230486000, 77692006, 191998008, 158149000, 270961006
English Hypersomnia disorder, Hypersomnias, HYPERSOMNIA, INCREASED SLEEPING, Hypersomnia, NOS, Hypersomnia NOS, [D]Hypersomnia NOS, Sleeping Excessive, [D]Hypersomnia (context-dependent category), [D]Hypersomnia NOS (context-dependent category), [D]Hypersomnia, sleeping too much (symptom), sleeping too much, sleeping too much (hypersomnia), hypersomnia, [D]Hypersomnia (situation), Sleep excessive, [D]Hypersomnia NOS (situation), Hypersomnia NOS (disorder), Hypersomnia, unspecified, increased sleep, much sleeping too, excessive sleep, excessive sleepiness, sleep too much, too much sleep, much sleep too, excessive sleeping, Primary Hypersomnia, Excessive sleep, Excessive sleepiness, Sleeps too much, Hypersomnia (disorder), Hypersomnia [D], Hypersomnia
Italian Ipersonnia, Sonno eccessivo
Dutch slaap overmatig, hypersomnie, Hypersomnia
French Sommeil excessif, Hypersomnie
German exzessiver Schlaf, Hypersomnie
Portuguese Sono excessivo, Hipersonia, Hipersónia
Spanish Sueño excesivo, [D]hipersomnia, SAI (categoría dependiente del contexto), [D]hipersomnia (categoría dependiente del contexto), Hypersomnia NOS, Hypersomnia [D], [D]Hypersomnia, Hipersomnia, [D]hipersomnia, SAI (situación), [D]hipersomnia, SAI, [D]hipersomnia, [D]hipersomnia (situación), hipersomnia (trastorno), hipersomnia, SAI (trastorno), hipersomnia, SAI, hipersomnia
Japanese 睡眠過剰, 過眠症, ｽｲﾐﾝｶｼﾞｮｳ, ｶﾐﾝｼｮｳ
Czech hypersomnie, Nadměrný spánek, Hypersomnie
Hungarian Hypersomnia, Túlzott mértékő alvás
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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