Excessive daytime sleepiness: Diagnosing the causes
Although poor energy, hypersomnia, amotivation, irritability, and frustration often suggest a depressive disorder or chemical dependency, these symptoms also may point to one or more sleep disorders. The author reviews assessment, diagnostic possibilities, and treatment options for the sleepy patient.
Psychiatrists treating a patient with chronic insomnia may appropriately undertake several trials of behavioral interventions or sedating medications before making a referral to a sleep disorder center. Patients can struggle with unrecognized primary sleep disorders for years, and many are evaluated by psychiatrists who institute an empiric trial of stimulating antidepressant medications. Use of antidepressants in these situations is unlikely to cause harm, but they might complicate diagnostic testing. When coexisting depression and a primary sleep disorder are confirmed, management of the sleepy patient optimally entails specific treatments that separately target each condition.
Related resources
- National Sleep Foundation www.sleepfoundation.org
- American Academy of Sleep Medicine www.asda.org
- American Sleep Apnea Association www.sleepapnea.org
- Restless Legs Syndrome Foundation www.rls.org
- Association for the Study of Light Therapy and Biological Rhythms www.sltbr.org
Disclosure
The author reports no affiliation or financial arrangements with any of the companies whose products are mentioned in this article.
Drug brand names
- Carbidopa/levodopa • Sinemet
- Gabapentin • Neurontin
- Pramipexole • Mirapex
- Trazodone • Desyrel
- Zolpidem • Ambien
