What Is Daytime Sleepiness Or Fatigue?
The disorder known as daytime sleepiness or fatigue is also called “excessive daytime sleepiness, or ESD.” It consists of the inability to sustain wakefulness with an irrepressible desire to sleep, even with the awareness that this would be risky or not recommended.
The symptoms affect all the daily life of these people; They cannot drive, nor can they stay awake at work meetings. They even find it difficult to hold conversations with close people or strangers.
What is daytime sleepiness or fatigue?
Daytime sleepiness or fatigue disorder is an alteration of the circadian rhythm, that is, the internal and external periods of the body whose function is to regulate the moments of a day, a month, a year and even a life. The altered cycle here is the sleep-wake cycle.
Patients with daytime sleepiness fall asleep anywhere, no matter what type of activity they are doing. The schedule doesn’t matter either, even if they woke up from the whole night sleeping less than an hour ago.
This desire, which is physiological and natural to rest the tissues and balance the internal environment, happens unexpectedly and involuntarily. It is the excess of a basic need.
The study of sleep medicine has separated sleepiness into two variants: subjective and objective. Based on them, it is established that the desire to sleep, normal or pathological, responds to measurable cellular changes and a personality configuration that is very particular.
Subjective drowsiness
In subjective drowsiness the need perceived by the person prevails. Sometimes a single yawn is enough to enter that state of tiredness that does not seem to be resolved in any way other than sleeping.
Also the loss of concentration, the drooping of the eyelids below their level and the inability to solve habitual tasks are indicative.
Objective drowsiness
Objective sleepiness is the propensity to fall asleep as such, and it can be measured through instruments designed for that. An EEG can detect it, as can an oculogram. They are measurements of the electrical activity of the tissues that reveal when the body requests rest.
Causes of the disorder
The origins of daytime sleepiness or fatigue are varied. In general terms, we can distinguish two causal groups: primary and secondary.
Primary
Among the primary causes we have the following:
- Narcolepsy: it is a state of excessive drowsiness that appears as acute attacks of drowsiness.
- Idiopathic hypersomnia: this is the name given to the appearance of the disease without finding another way to catalog it. Its intimate mechanisms are not known and it has, as a characteristic sign, excessive difficulty in waking the person after falling asleep.
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The secondary causes of daytime sleepiness or fatigue are pathologies that include, among their symptoms, excessive sleep, either due to a hormonal imbalance, a change in oxygenation or an imbalance in circadian rhythms. Some are as follows:
- Obstructive sleep apnea: These patients sleep poorly at night because not enough oxygen enters them. Because of this, they feel tired during the day.
- Jet lag : this famous time change for a flight that crosses several countries is within the alterations of the circadian rhythm. It is temporary, since after a few days or even hours, normal sleep is recovered.
- Night worker syndrome: tasks that involve performing at night affect the normal functioning of the body during the day. The watchmen, for example, or the nurses with rotating shifts, may experience drowsiness on some of their shifts.
- Stroke: After a stroke, people can be left with neurological sequelae, including excessive fatigue.
- Meningitis and encephalitis: inflammation of the brain tissue or its compression could alter the functioning of the biological clock that is commanded from the region known as the “thalamus”
- Psychiatric illnesses: depression and anxiety, as large representatives of this group, present with sleep disturbances that include insomnia. These patients can spend entire nights without sleep, which in the short term leads to sleep during the day, in daily tasks.
How is daytime sleepiness or fatigue diagnosed?
Diagnosing the disorder is not always easy. Sometimes when the symptoms are clear, there is not much doubt that the professional may have. However, the difficulty lies in finding the ultimate cause of excessive sleepiness, because depression is not the same as narcolepsy.
To refine the diagnosis, measuring instruments are used that are, above all, subjective. That is, the doctor and the patient complete questionnaires and scales that determine, broadly speaking, the severity of the affectation.
Among the tests performed by the professional is the observation of behavior, registering yawning, blinking frequency and possible forward head rocking. In turn, it can be assessed whether the patient is functional or not, by measuring their response to stimuli and reflexes.
The affected person himself has the option of filling out certain scales and questionnaires to aid in the diagnosis. There are many of them, such as Stanford and Epworth.
As a last option, there are the neurophysiology tests . Electrical activity is measured during some time of the day to know if certain tissues tend to physiologically drowsy, even after hours. Electroencephalograms, polysomnograms, and evoked potentials are used.
Can this problem be treated?
Treatment of daytime sleepiness or fatigue is difficult. If its root cause is established, then the approach will aim to correct that. Take obstructive sleep apnea as an example, which will lead to the use of a night mask to improve oxygen intake during the night.
If the cause is primary, one of the few drugs that exists for the purpose is Modafinil. It is not an amphetamine, but its effect is similar, since it activates the body in general. However, strict control is imposed on its use due to the risk of dependency.
Finally, it is essential that the doctor certify the ability of the patient to do or not do certain tasks. Some people cannot even drive their private vehicle because of the risk that this entails. Certain changes must be applied in daily routines to reduce the consequences of this disorder.
