In this blog, we will briefly discuss excessive daytime sleepiness or hypersomnia and how it affects the chronic fatigue symptoms. We will discuss some basics about its evaluation and management of the disease and some helpful tips with that. Please see prior blog on chronic fatigue syndrome for other details about symptoms and manifestations of the disease process. This is a huge area of discussion but we will discuss a few important things useful in practical life. Many patients may have chronic fatigue symptoms but may not have full chronic fatigue syndrome or fibromyalgia. Irrespective of that they may feel miserable because of persistent fatigue or lethargy. This blog is written especially to help those patients for a better understanding of the disease process and how one can help himself/herself.
Hypersomnia or excessive daytime sleepiness is a condition where one has difficulty in keeping himself/herself awake during the daytime. This can lead to social, professional, emotional and psychological problem in the long run if untreated. Specifically, this can lead to roadside accidents or other injuries to self or others.
There are many reasons for the excessive daytime sleepiness such as sleep apnea, restless leg syndrome, drug-related side effects, prior trauma, depression, narcolepsy, and/or medication side effects especially psychiatric and seizure medication. There may be other neurological or psychiatric disorders, substance abuse, sleep deprivation or other sleep disorders causing the hypersomnia and associated chronic fatigue symptoms.
Sleep apnea is a medical disease where one stops breathing completely for at least 10 seconds or longer for more than 5 times an hour. It is medically diagnosed by a sleep study only. Sleep apnea is a very important medical condition that needs to be evaluated if one has snoring, daytime sleepiness like falling asleep watching TV or reading a book, or if there is witnessed apnea by family members and/or history of hypertension. If the neck size is 17 inches or larger in men and 16 inches or larger in women then there is a high chance that one may have sleep apnea. If these are the symptoms then one needs a diagnostic polysomnography or diagnostic sleep study for the evaluation of sleep apnea. If the diagnostics sleep study is positive then one needs treatment with a CPAP (Continuous Positive Airway Pressure) machine. Also, one may need a second sleep study called a CPAP study or CPAP polysomnography for the titration of the CPAP pressure. One will have to use the CPAP as a treatment for sleep apnea.
One may have Restless Leg Syndrome (RLS), and if the symptoms are very significant and affecting sleep then medical treatment with Requip or Mirapex may be needed. One may have constipation, irregular bowel movement or irritable bowel syndrome and this needs to be addressed with the modification of diet and Ayurvedic herbs, which may help in many cases. There may be peripheral neuropathy if one is diabetic. It may affect the leg movement during sleep called periodic leg movement. In many patients, one who has sleep apnea and restless leg syndrome, once the CPAP is started may decrease or resolve these symptoms in a few months. If one has anemia then he/she may need iron supplements.
Narcolepsy is a very rare but significant medical condition affecting the sleep-wake cycle with unique symptoms. A person who has narcolepsy may have severe daytime sleepiness with other symptoms like Cataplexy where one can fall down on laughing or with an emotional outbreak. They do get a feeling of paralysis. Cataplexy is a very significant hallmark of the disease. Almost all the patients are young and report severe daytime sleepiness. They need an overnight diagnostic sleep study to be done with next day morning followed by a Multiple Sleep Latency Test (MSLT). During the MSLT they usually have at least 2 or more REM sleep or dream sleep out of the 4 to 5 nap cycles. Treatment is with a commonly used drug, Provigil (modafenil), and close medical supervision is necessary for this condition. Generally, this is a life-long disease that needs to be monitored. Other different drugs may be needed if the patient does not respond to Provigil (modafenil).
There are many other medical conditions affecting the sleep. One needs to speak to their physician for a discussion and evaluation. Improvement of the sleep hygiene and having a regular sleep wake cycle, regular exercise, and weight loss if appropriate helps. If one is interested in alternative therapy, then Ayurveda or traditional Indian medicine works great if one can find a Ayurvedic health practitioner to add the treatment regimen with modification of the Ayurvedic diet based on one’s own body type. Also, the body-type specific herbal regimen may further help to detoxify the body gradually. If one has sleep apnea then one needs to use the CPAP regularly. Ayurvedic Herbs take at least 1-2 years to go deep in the tissue before any major effect is seen. Some people start to notice some improvement within a few months.
An Integrative Medical approach is better than just a pharmacological treatment. An Integrative approach may help in managing a complex disease. There is no one drug that can take care of these problems, as it is a very complex multi-system involved problem. When an Ayurvedic treatment regimen is added it takes time. It generally takes time to show improvement as Ayurveda works slowly but helps to rejuvenate the body slowly. Just like any other disease, the response is different from person to person. If one learns Yoga from a Yoga instructor and does different relevant exercises such as the Pranayama or breathing exercise of Yoga, this may help alleviate the symptoms. It does take months to improve so one needs to be patient be disciplined with their diet, exercise, sleep hygiene, lifestyle, etc.