Excessive sleepiness is a very common problem that affects millions of people worldwide. It is defined as an overwhelming desire to sleep that interferes with daily life.

It is a very subjective symptom and therefore hard to diagnose. It is often related to a disease called narcolepsy, which is a neurological condition that causes the brain to produce too little of a sleep-inducing hormone called hypocretin (Greek for “little lord”). This is the same hormone that is disrupted in cats during cataplexy.

Narcolepsy is an automatic disorder, or a disorder where you don’t have voluntary control over your symptoms. However, excessive sleepiness is not always linked to this disorder. It can also be caused by other medical conditions, by side effects of some medications or by depression.

There are many symptoms linked to this disorder including insomnia, cataplexy, sleep paralysis, hypnagogic hallucinations, automatic behavior, sleep drunkenness and others.

The best way to treat this disorder is to use a multi-disciplinary approach. This means that a patient should be treated by a neurologist who can prescribe medications, a psychiatrist who can diagnose and treat any underlying psychiatric conditions and an Internal Medicine doctor who can check for any other medical conditions that can be causing the sleepiness.

However, you can also treat this disorder by yourself with simple lifestyle changes such as keeping a consistent sleep schedule, avoiding naps and other stimulants and eating small meals at regular intervals.

What is Excessive Sleepiness?

Excessive sleepiness is a subjective symptom that is defined as an overwhelming desire to sleep that interferes with daily life. It is usually accompanied by an increased need to urinate early in the morning. 

People with this symptom usually complain of sleeping excessively and for extended periods of time. They also usually complain of waking up tired, even after sleeping for long periods of time.

What causes Excessive Sleepiness?

The causes of excessive sleepiness are many. In most cases, it is a symptom of a disorder called narcolepsy. However, there are other conditions that can cause this symptom including depression, chronic fatigue syndrome, iron deficiency, autoimmune disorders, stroke and others. 

Excessive sleepiness can also be caused by medications, lifestyle habits such as lack of physical activity and others.

What are the best-known treatments for Excessive Sleepiness?

The best-known treatments for excessive sleepiness include a strict schedule and lifestyle changes, medications and surgery.

Lifestyle Changes

Keep a consistent sleep schedule and stick to it. 

If you normally wake up at 8:00 AM, try your best not to go to sleep before 2:00 AM and try getting up before 8:00 AM. This will help you maintain a regular routine and you will be more alert during the day.

Avoid naps and try to get rid of them if possible. 

If you are used to taking naps during the day, try substituting them with walks, short jogs or light exercise.

Avoid stimulants such as caffeine and nicotine. 

You should limit your caffeine intake to 200 mg per day (the equivalent of two cups of coffee). For some people, even this amount may be too much. If you smoke cigarettes, try quitting because it will also help with excessive sleepiness. If you just can’t quit on your own, talk to your doctor to see if he can help you stop smoking.

Medications

There are several medications that are used to treat excessive sleepiness. They usually increase the amount of hypocretin in the brain and therefore make it harder for us to fall asleep.

Pemoline (Cylert) 

This medication was commonly used to treat attention deficit hyperactivity disorder (ADHD), but it was removed from the market because it caused liver damage in some patients.

Modafinil. 

This medication has been approved by the Food and Drug Administration (FDA) to treat narcolepsy and obstructive sleep apnea. It is also commonly used off label to treat excessive sleepiness.

Methylphenidate (Ritalin). 

This medication is commonly used to treat ADHD in children, but it is also used off label to treat adults with narcolepsy or excessive sleepiness caused by obstructive sleep apnea. It can also be used to treat other conditions such as fatigue, depression or chronic pain.

Surgery

Surgery is commonly performed for people with narcolepsy or with obstructive sleep apnea with excessive sleepiness who don’t respond to medications. 

These surgeries are called “somnoplasty” surgeries and they are aimed at reducing the amount of tissue that compresses the nerves that control breathing during sleep. 

Conclusion

Excessive sleepiness is a common symptom that can have several possible causes. It can be either a symptom of a disorder called narcolepsy or of other medical conditions or it can be caused by medications or by lifestyle habits. 

Narcolepsy can be diagnosed by a neurologist, but other conditions have to be diagnosed by a psychiatrist.

The best way to treat excessive sleepiness is to treat the underlying cause. This can be as simple as changing your lifestyle to avoid napping and eating healthier meals to more complex procedures such as surgery.

Can I have narcolepsy with cataplexy but not excessive daytime sleepiness?

Yes. Many people with narcolepsy have cataplexy, but do not have excessive daytime sleepiness.

How common is narcolepsy with cataplexy?

Approximately 1 out of 200 people with narcolepsy has only cataplexy. Most people with narcolepsy have both cataplexy and excessive daytime sleepiness.

How common is narcolepsy without cataplexy?

Approximately 1 out of 2000 people with narcolepsy has excessive daytime sleepiness but no cataplexy.

Can I have narcolepsy without excessive daytime sleepiness?

Yes. Some people with narcolepsy have cataplexy but do not have excessive daytime sleepiness. This is called the “narcolepsy-cataplexy syndrome” (NSS). It is usually caused by a mutation in the hypocretin (orexin) receptor 2 gene (HCRTR2). People with the NSS tend to have symptoms of narcolepsy from childhood, go to sleep very quickly, and have fewer sleep paralysis episodes than people with narcolepsy who also have excessive daytime sleepiness.

Cataplexy in the absence of excessive daytime sleepiness is a rare form of narcolepsy called the “cataplexy-only variant of narcolepsy” (COV). People with COV tend to have less severe cataplexy than those with NSS or people with both cataplexy and excessive daytime sleepiness. People with COV tend to experience cataplexy episodes more often in REM sleep than those with NSS or people with both cataplexy and excessive daytime sleepiness. They also tend to have fewer sleep paralysis episodes than those with NSS or people with both cataplexy and excessive daytime sleepiness.

What causes narcolepsy?

We know that narcolepsy is caused by an autoimmune attack on the brain, mediated by antibodies that destroy the hypocretin (orexin) neurons in the hypothalamus.

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