Daytime sleepiness and its causes
Since daytime sleepiness is a natural consequence of poor sleep, obstructive sleep apnea , in which sleep is very disturbed, can be considered a significant cause of daytime sleepiness.
The concept of “daytime sleepiness” is subjective, so patients with sleep apnea can sometimes position their condition not as drowsiness, but as constant weakness or fatigue. Often such patients are mistakenly diagnosed with “chronic fatigue syndrome” or “hidden depression”.
With obstructive sleep apnea, patients experience periodic collapse of the lumen of the upper respiratory tract with a temporary cessation of breathing. An episode of apnea ends with incomplete awakening from sleep ( micro -awakening ). Breathing stops last at least 10 seconds, and sometimes much longer, and can be repeated hundreds of times a night.
hypopnea index (that is, the number of respiratory disorders that have occurred) is directly related to the degree of daytime sleepiness. This is reflected in the classification of sleep apnea by severity .
- With a mild course of the disease , daytime sleepiness, as a rule, is minimally expressed. Respiratory distress index less than 20 per hour.
- The moderate course is characterized by severe daytime sleepiness, which worries the patient when he is engaged in calm activities. Respiratory distress index greater than 20 but less than 40 episodes per hour.
- A severe course is characterized by constant daytime sleepiness, which disrupts the normal functioning of the patient. There are concomitant diseases of the cardiovascular system and other organs, as well as numerous pronounced symptoms of apnea syndrome (ischemic heart disease, impotence, reflux esophagitis, frequent urination at night, sweating during sleep, mental decline, and much more). The index of respiratory disorders in this case will be 40 or more episodes per hour.
It should be noted that some patients are not critical of their condition (the main clinical “events” unfold in sleep, and the person may not see or feel them), so some people downplay the degree of daytime sleepiness and other complaints. In some cases, patients with moderate sleep disturbances report severe daytime sleepiness, while patients with a significant number of sleep apneas report minimal complaints.
Drowsiness always becomes apparent in patients who are in a relaxed state: during rest, watching television, reading. Extreme drowsiness is manifested by moments of falling asleep during a conversation and eating. Irresistible drowsiness can occur in the most inopportune situations – for example, when driving a car . Sometimes episodes of automatic behavior are noted: a person unconsciously performs meaningless actions, and then does not remember anything about it.
Daytime sleepiness from sleep apnea and sudden falling asleep while driving are the cause of road traffic accidents, often with serious injuries or death. Drowsiness during the working day limits the production capabilities of a person, causes injuries or layoffs. Considering the manifestations of obstructive sleep apnea syndrome from these positions, one can be convinced of the need for timely diagnosis and treatment of this disease.
Watch a short video about the mechanisms behind obstructive sleep apnea and its consequences.
There are several questionnaires that help to suspect an increased risk of obstructive sleep apnea. For preliminary self-diagnosis, you can conduct an Epworth screening test , it will approximately help determine the degree of daytime sleepiness. It should be clarified that the test results cannot be regarded as an accurate diagnosis. The latter can be established only on the basis of a consultation with a somnologist and after polysomnography .
In addition to obstructive sleep apnea, severe daytime sleepiness may be accompanied by chronic insomnia, narcolepsy, and periodic limb movement syndrome during sleep. In all these cases, it is worth contacting a somnologist to clarify the diagnosis.
CPAP therapy is used for sleep apnea syndrome . This treatment method is very effective in combating daytime sleepiness and other symptoms of sleep apnea, and also reduces the risk of complications of the disease.
At present, improved Prisma Line CPAP devices from the new line of Weinmann – Loewenstein (Germany) have been developed. Their use allows the most effective and comfortable treatment of the entire spectrum of respiratory disorders in patients with obstructive sleep apnea syndrome.
Clinical example . The patient turned to the Center for Sleep Medicine at the Rehabilitation Clinic in Khamovniki because of increased daytime sleepiness, which posed a risk of an accident due to falling asleep at the wheel.