Excessive Daytime Sleepiness

What is Excessive Daytime Sleepiness?

Excessive daytime sleepiness (EDS) is characterized by an overwhelming, persistent urge to sleep during the day, despite having adequate opportunity for nighttime sleep. It goes beyond normal tiredness—it’s a chronic inability to stay alert and awake during typical waking hours.

EDS affects approximately 20% of the general population and is one of the most common complaints in sleep medicine.

EDS vs. Normal Tiredness

Everyone feels tired occasionally. Excessive daytime sleepiness is different:

Normal Tiredness:

• Occurs after insufficient sleep or very long day
• Improves with adequate rest
• Occasional and situational
• Doesn’t significantly impair function

Excessive Daytime Sleepiness:

• Persists despite adequate sleep opportunity
• Present most days for months
• Severely impairs daily functioning
• Occurs even when well-rested by hours

Symptoms of Excessive Daytime Sleepiness

The Sleepiness Itself

• Difficulty staying awake during:
  • Reading or watching TV
  • Meetings or lectures
  • Driving (extremely dangerous)
  • Conversations
• Unintended naps during the day
• Difficulty waking up in morning despite alarms
• Feeling unrefreshed after sleep

Secondary Effects

• Cognitive impacts: Difficulty concentrating, memory problems, slowed thinking
• Mood changes: Irritability, depression, anxiety
• Performance issues: Mistakes at work, reduced productivity
• Social problems: Missed activities, relationship strain
• Safety risks: Falling asleep while driving or operating machinery

Common Causes of Excessive Daytime Sleepiness

Obstructive Sleep Apnea (Most Common)

Sleep apnea causes repeated awakenings throughout the night—often so brief you don’t remember them. This sleep fragmentation prevents deep, restorative sleep.

Key indicators OSA may be causing your EDS:

• You snore loudly
• Partner witnesses breathing pauses
• You wake with dry mouth or headaches
• Your neck circumference is large
• You’re overweight

Learn more about obstructive sleep apnea →

Insufficient Sleep

• Simply not allowing enough time for sleep
• Very common in modern society
• Usually resolves with adequate sleep opportunity

Poor Sleep Hygiene

• Irregular sleep schedule
• Screen use before bed
• Caffeine too late in day
• Uncomfortable sleep environment

Other Sleep Disorders

• Narcolepsy: Neurological disorder causing sudden sleep attacks
• Idiopathic hypersomnia: Excessive sleepiness without clear cause
• Restless leg syndrome: Uncomfortable sensations preventing sleep onset
• Periodic limb movement disorder: Repetitive limb movements during sleep

Medical Conditions

• Hypothyroidism
• Depression
• Chronic pain conditions
• Neurological disorders
• Heart failure

Medications

• Sedating medications
• Some antihistamines
• Muscle relaxants
• Some blood pressure medications

Health and Safety Risks of EDS

Accident Risk

• Drowsy driving causes an estimated 100,000 crashes annually in the U.S.
• Risk of workplace accidents and injuries
• Impairment similar to alcohol intoxication

Health Consequences

• Increased risk of:
  • Heart disease
  • Stroke
  • High blood pressure
  • Diabetes
  • Weight gain

Quality of Life Impact

• Reduced work performance and earning potential
• Relationship problems
• Missed social activities
• Depression and anxiety
• Lower overall life satisfaction

Evaluating Excessive Daytime Sleepiness

The Epworth Sleepiness Scale

This validated questionnaire asks how likely you are to doze in 8 situations:

• 0-9: Normal
• 10-12: Mild EDS
• 13-15: Moderate EDS
• 16-24: Severe EDS

Scores of 10 or higher suggest evaluation is needed.

Medical Evaluation

A comprehensive evaluation includes:

History Assessment:

• Sleep schedule and habits
• Daytime sleepiness patterns
• Snoring and witnessed apneas
• Medical conditions
• Medication review

Physical Examination:

• Airway anatomy
• Blood pressure
• Weight and BMI
• Signs of underlying conditions

Sleep Study: Sleep testing is often essential to identify the cause of EDS.

Important: Sleep studies must be ordered and interpreted by a physician. We coordinate with physicians who can arrange home sleep testing or in-lab polysomnography.

Learn about HSAT coordination →

Treatment Depends on the Cause

If Sleep Apnea is the Cause

Oral Appliance Therapy: For mild to moderate OSA, custom oral appliances:

• Keep your airway open during sleep
• Allow continuous, uninterrupted sleep
• Result in dramatic improvement in daytime alertness

CPAP Therapy: Continuous positive airway pressure:

• Effective for all severities of OSA
• Prevents airway collapse
• Restores normal sleep architecture

Many patients report feeling like “a new person” once sleep apnea is effectively treated.

Lifestyle Modifications

Regardless of cause, these help:

• Maintain consistent sleep schedule
• Ensure adequate sleep opportunity (7-9 hours)
• Practice good sleep hygiene
• Avoid alcohol and sedatives
• Treat underlying medical conditions
• Regular exercise (but not close to bedtime)

Addressing Other Causes

• Medication adjustments with physician
• Treatment of underlying medical conditions
• Specialist referral for other sleep disorders

When Sleep Apnea Treatment Helps EDS

Patients successfully treated for sleep apnea often experience:

Within Days to Weeks:

• Waking feeling more refreshed
• Easier time staying awake during day
• Improved alertness and energy
• Clearer thinking and better concentration

Ongoing Benefits:

• Improved work performance
• Better mood and relationships
• Enhanced quality of life
• Reduced health risks
• Safe driving

When to Seek Help

You should seek evaluation if:

• Your Epworth Sleepiness Scale score is 10 or higher
• You’ve fallen asleep while driving or had near-misses
• Sleepiness significantly impacts work or relationships
• You snore and have daytime sleepiness
• Lifestyle changes haven’t helped
• You’re concerned about your sleep quality

Our Approach

We help evaluate excessive daytime sleepiness by:

1. Comprehensive Consultation: Discuss your symptoms, sleep patterns, and history
2. Airway Assessment: Evaluate for anatomical factors
3. Sleep Study Coordination: Help arrange physician-ordered testing
4. Treatment Planning: If sleep apnea is diagnosed, discuss oral appliance therapy
5. Follow-Up Care: Monitor improvement in daytime symptoms

Getting Started

Don’t accept excessive daytime sleepiness as normal. Effective treatments exist, and proper diagnosis is the first step.

Schedule a consultation to discuss your daytime sleepiness and explore whether sleep apnea or another treatable condition may be the cause.

Note: Home sleep apnea testing (HSAT) is ordered and interpreted by a physician. We coordinate testing and provide oral appliance therapy as a CPAP alternative in collaboration with the patient’s sleep physician.