“Sometimes a nap is 20 minutes. Sometimes it is 3 hours.”– Nicki

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Evaluating for Ongoing Excessive Daytime Sleepiness

People with excessive daytime sleepiness (EDS) may use vague terms to describe their sleepiness, such as being tired all the time, fatigue, or a lack of energy. They may not recognize the extent of their sleepiness and may even deny being sleepy.1 However, even less obvious manifestations of EDS can have a substantial impact.2,3 The perspective of friends and family members is important when talking to your patients about their sleepiness.1

Listen carefully, and evaluate for:

  • Characteristics (e.g., frequency, duration)1,4
  • More obvious EDS manifestations (e.g., daytime naps, automatic behaviors)5
  • Less obvious EDS manifestations (e.g., tired all the time, fatigue, mood disruption, neurocognitive impairment such as poor memory and attention, difficulty concentrating, challenges with decision making)1,2,5
  • Propensity for sleepiness or dozing1,5,6:
    • In sedentary/inactive situations
    • In more active situations (e.g., while talking or eating)
  • Impact of EDS on1,5:
    • Driving
    • Daily functioning
    • Quality of life
  • Frequency and duration of both involuntary and planned sleep episodes/naps4
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If EDS is present, evaluate your patients for cataplexy and other symptoms.

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The Narcolepsy Assessment Tool may help your patients assess how narcolepsy may be interfering with their lives.

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  1. Ahmed IM, Thorpy MJ. Clinical evaluation of the patient with excessive sleepiness. In: Thorpy MJ, Billiard M, eds. Sleepiness: Causes, Consequences and Treatment. Cambridge, UK: Cambridge University Press; 2011: 36-47.
  2. Thorpy M, Morse AM. Reducing the clinical and socioeconomic burden of narcolepsy by earlier diagnosis and effective treatment. Sleep Med Clin. 2017;12(1):61-71.
  3. Overeem S, Reading P, Bassetti C. Narcolepsy. Sleep Med Clin. 2012;7:263-281.
  4. Thorpy MJ, Dauvilliers Y. Clinical and practical considerations in the pharmacologic management of narcolepsy. Sleep Med. 2015;16(1):9-18.
  5. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
  6. Johns M, Hocking B. Daytime sleepiness and sleep habits of Australian workers. Sleep. 1997;20(10):844-849.

Performance of routine tasks without awareness.

Sudden and brief loss of muscle tone, often triggered by strong emotions or certain situations. Narcolepsy with cataplexy is known as narcolepsy type 1.

Complete collapse to the ground; all skeletal muscles are involved.

Only certain muscle groups are involved.

Biological clock mechanism that regulates the 24-hour cycle in the physiological processes of living beings. It is controlled in part by the SCN in the hypothalamus and is affected by the daily light-dark cycle.

Frequent awakenings and inappropriate transitions between states of sleep and wakefulness during nighttime sleep.

The inability to stay awake and alert during the day.

A neurotransmitter in the brain that supports wakefulness.

Vivid, realistic, and frightening dream-like events that occur when falling asleep.

A neuropeptide that supports wakefulness and helps suppress non-REM sleep and REM sleep.

Primary brain region for regulating the timing of sleep-wake states.

Unintentionally falling asleep due to excessive daytime sleepiness. Also known as “sleep attacks.”

Brief, unintentional lapses into sleep, or loss of awareness.

A validated objective measure of the tendency to fall asleep in quiet situations.

People with narcolepsy type 1 have low levels of hypocretin.

Narcolepsy without cataplexy; the cause of narcolepsy type 2 is unknown.

A state of sleep characterized by slower-frequency, more synchronized neuronal activity and decreased muscle tone. Deep stages help to restore the body.

A multiparameter test that monitors physiologic signals during sleep; used as a diagnostic tool in sleep medicine.

A state of sleep characterized by low-amplitude, fast-frequency EEG, vivid dreams, and loss of muscle tone. Normally occurs 60-90 minutes after sleep onset. Also known as “paradoxical sleep.”

Brief loss of control of voluntary muscles with retained awareness at sleep-wake transitions.

Sleep-onset REM period.