What is the best treatment for excessive daytime sleepiness?

Obstructive sleep apnea (OSA) – a sleep disorder characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep – affects nearly one billion people globally and often leads to excessive daytime sleepiness (EDS). 

The standard treatment for OSA – a positive airway pressure (PAP) mask, which uses compressed air to support lung airways during sleep – can help relieve some of the symptoms. However, many people suffering from OSA still experience excessive daytime sleepiness and could thus benefit from anti-fatigue medication. 

“Fifteen to 30 percent of people in North America have a diagnosis of OSA and the prevalence could be much higher as many others are undiagnosed. Many people have symptoms as the condition is highly associated with obesity, which affects a large and increasing number of people in Canada, the United States, and other high-income countries,” said study lead author Tyler Pitre, a resident physician in Internal Medicine at McMaster University in Canada.

“Among those patients, many will have EDS, which affects their quality of life, making them less productive and also puts them at risk of other psychological issues. Improving this situation is of paramount importance to physicians.”

“The most important thing that people with OSA should do is use their PAP machine, but if they are still sleepy there are options in the form of medications that can reduce their tiredness.”

To assess which are the best treatments for EDS, Pitre and his colleagues conducted a systematic review of 14 clinical trials of anti-fatigue medications involving 3,085 participants, and analyzed additional data from several databases, such as MEDLINE, CENTRAL, EMBASE, and ClinicalTrials.gov. 

The analyses revealed that the drug solriamfetol – a selective dopamine and norepinephrine reuptake inhibitor (DNRI) that helps promote wakefulness and alertness – is the most effective treatment for EDS.

However, since this medicine can also raise blood pressure, it can be quite risky for individuals suffering from OSA, as many of them have cardiovascular issues. Thus, some of these people could perhaps benefit more from other anti-fatigue drugs, such as armodafinil–modafinil and pitolisant.

“It would be interesting to see how effective these anti-fatigue medications will be for treating related illnesses such as chronic fatigue syndrome and long Covid, now that we know they work for a similar condition,” concluded senior author Dena Zeraatkar, an assistant professor of Public Health at McMaster.

The study is published in the journal Annals of Internal Medicine.

More about obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated episodes of complete or partial obstructions of the upper airway during sleep. These obstructions cause breathing to briefly and repeatedly stop during sleep.

Here are some key points about obstructive sleep apnea:

Symptoms

The most common symptoms of OSA include loud snoring, gasping for air during sleep, waking with a dry mouth, morning headache, difficulty staying asleep (insomnia), excessive daytime sleepiness, difficulty paying attention, and irritability.

Causes

OSA occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support structures including the soft palate, the uvula (a triangular piece of tissue hanging from the soft palate), the tonsils, and the tongue. 

When these muscles relax, the airway narrows or closes as you breathe in, and breathing momentarily ceases. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This pattern can repeat itself five to 30 times or more each hour, all night.

Risk factors

Several factors increase the risk of developing OSA. These include excess weight, neck circumference (people with thicker necks might have narrower airways), a narrowed airway (you might have inherited a narrow throat or have tonsils or adenoids that become enlarged), being male (men are two to three times more likely to have sleep apnea than women), age (it’s more common in older adults), family history, use of alcohol, sedatives or tranquilizers, smoking, and certain medical conditions such as congestive heart failure, high blood pressure, type 2 diabetes, Parkinson’s disease, and hormonal disorders.

Complications

Left untreated, OSA can lead to serious complications, including cardiovascular problems (such as high blood pressure, heart disease, heart attacks, and stroke), daytime fatigue and sleepiness, complications with medications and surgery, eye problems (such as glaucoma), and even a decreased quality of life due to excessive daytime sleepiness affecting social interactions, work performance, and personal safety.

Treatment

Treatment for OSA may involve lifestyle changes, such as losing weight, quitting smoking, or avoiding alcohol and sleeping pills. A mouthpiece to adjust the position of your lower jaw and tongue can also be used. Most commonly, continuous positive airway pressure (CPAP) therapy is used, where a device delivers air pressure through a mask placed over your nose while you sleep. In more severe cases, surgery may be an option.

Causes of daytime sleepiness 

Daytime sleepiness, also known as excessive daytime sleepiness (EDS), is a high level of fatigue or drowsiness during the day. It’s not a disorder in itself, but it can be a symptom of an underlying health condition.

Here are some of the potential causes of excessive daytime sleepiness:

Sleep deprivation

The most common cause of daytime sleepiness is not getting enough sleep. This could be due to a busy schedule, poor sleep habits, or an environment not conducive to quality sleep.

Sleep apnea

This is a serious sleep disorder where breathing repeatedly stops and starts during sleep, leading to poor quality sleep and daytime fatigue.

Insomnia

Chronic insomnia can lead to not getting enough sleep and feeling tired during the day.

Narcolepsy

This is a neurological disorder that impairs the brain’s ability to regulate the sleep-wake cycle. It can lead to excessive daytime sleepiness, sudden loss of muscle tone, and sometimes hallucinations.

Restless legs syndrome (RLS)

This condition causes uncomfortable sensations in the legs and an irresistible urge to move them, often disturbing sleep.

Circadian rhythm disorders

These are disorders that disrupt the internal body clock, leading to sleepiness when you should be awake and alertness when you should be sleeping.

Chronic diseases and conditions

Conditions such as depression, anxiety, chronic pain, and others can interfere with sleep and lead to daytime fatigue.

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By Andrei Ionescu, Earth.com Staff Writer

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