Daytime sleepiness evaluation

Evaluate CPAP therapy annually or at any time individuals experience symptoms (e.g., daytime sleepiness) despite CPAP therapy. For example, change in pressure settings to alleviate OSA may be needed if weight gain occurs. 

Sleep disorders are common, and are generally underdiagnosed. The two major complaints related to sleep are insomnia ( I can t sleep ) and excessive daytime sleepiness (EDS, I can t stay awake ). EDS is a relatively nonspecific symptom. It can be the end result of any factor that causes sleep disruption, and it can be caused by primary or intrinsic sleep disorders. Insomnia of any cause can result in sleep deprivation and subsequent EDS. The most common cause of EDS in the general population is self-imposed sleep deprivation, or insufficient sleep syndrome. By contrast, the most common causes of EDS seen in a sleep center are primary (intrinsic) disorders of EDS. The American Academy of Sleep Medicine (AASM, formerly the American Sleep Disorders Association) classification of sleep disorders includes over 80 diagnoses that are associated with EDS, but the majority of patients evaluated at sleep centers have sleep apnea, narcolepsy, idiopathic hypersomnia, or periodic limb movements of sleep. 

Johnson EO, Breslau N, Roth T, Roehr T, Rosenthal L. Psychometric evaluation of daytime sleepiness and nocturnal sleep onset scales in a representative community. Biol Psychol 1999 45 764-770. 

The technique most commonly used for objective evaluation of daytime sleepiness is the Multiple Sleep Latency Test (MSLT). It is composed of a series of naps during which subjects are asked not to resist sleep. The speed of falling asleep on tests across time is the chief outcome of the MSLT, which has achieved widespread acceptance because of its simple, intuitive approach to sleepiness. Hence, the greater levels of sleepiness are indicated by more rapid sleep onsets. Furthermore, the MSLT provides several opportunities to test for sleep-onset rapid-eye-movement (REM) episodes, the primary diagnostic sign of narcolepsy. 

Another study, by Devoto et al. (30), evaluated the effects of different amounts of sleep and SWS restriction on the ensuing daytime sleepiness. Six men, after one adaptation night and an initial 8-hr baseline night, were allowed to sleep... 

The MSLT is the most common method of objectively measuring daytime sleepiness in sleep laboratories. This test has been standardized into a form that reliably measures sleepiness in various populations. The MSLT has been used to evaluate levels of sleepiness (1) in conditions of sleep deprivation, reduction, fragmentation, and extension (2) in suspected narcoleptic patients (3) in patients with various disorders of excessive daytime sleepiness (4) in patients with insomnia and (5) in the posttreatment condition of patients with sleep disorders associated with daytime sleepiness. Further work is needed to compare subjective measures of sleepiness and newer performance measures with the MSLT. 

Roth T, Hartse KM, Zorick F, Conway W. Multiple naps and evaluation of daytime sleepiness in patients with upper airway sleep apnea. Sleep 1980, 3 425 440. 

Monitoring parameters for pharmacotherapy of narcolepsy include reduction in daytime sleepiness, cataplexy, hypnagogic and hypnopompic hallucinations, and sleep paralysis. Patients should be evaluated regularly during medication titration, then every 6 to 12 months to assess adverse drug events (e.g., mood changes, sleep disturbances, and cardiovascular abnormalities). If symptoms increase during therapy, PSG should be done. 

Jasinski DR, Kovacevic-Ristanovic R. Evaluation of the abuse habihty of modafinil and other drugs for excessive daytime sleepiness associated with narcolepsy. Clin Neuropharmacol 2000 23(3) 149-56. 

Mitler MM, Gujavarty KS, Sampson MG, Browman CP. Multiple daytime nap approaches to evaluating the sleepy patient. Sleep 1982 5 sll9-sl27. 

Mobile technology can also be used as an aid to self-sleep evaluation, as an initial step in understanding one s own sleep needs, pattern, quality, and structure in connection with subjective complaints regarding difficulties related to sleep and daytime performance, fatigue, or sleepiness. 

Any sleep evaluation begins with acquiring basic verbal/written information from a person regarding personal health, sleep habits and beliefs, mood, sleep environment, individual satisfaction with sleep and daytime function, fatigue and sleepiness, circadian preferences, and more. Population-validated questionnaires regarding all these variables are usually administered during individual visits with sleep or healthcare... 

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