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Causes of Excessive Sleepiness: Sleep Apnea, Narcolepsy, RLS

Do you struggle to stay awake during work and other activities and you don't know why? Could sleep apnea or another medical condition be the main culprit?

Sometimes the cause of sleepiness isn't easy to figure out. Here is information that can point you in the right direction and help you find the treatment that works best for you.

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For Walt Kowalski of Jackson, Mich., bedtime isn't the relaxing end to the day, but the beginning of another nerve-jangling night with restless legs syndrome. Soon after lying down, unpleasant electricity-like sensations creep into Kowalski's legs. An urge to move grows and becomes irresistible. The feelings force him to kick, move, or get up and walk. The unpleasant symptoms return and often keep him walking in the night, robbing him of sleep. Restless legs syndrome (RLS) is an often misunderstood...

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What Is Excessive Sleepiness?

Sleepiness is likely a problem for you if:

  • You have trouble waking in the morning
  • You often feel sleepy during your waking hours
  • Naps don’t take the edge off your sleepiness

Along with having to drag yourself through the day, you may also have:

  • Loss of appetite
  • Trouble with thinking or memory
  • Feelings of irritability or anxiety

About 20% of adults have sleepiness severe enough to affect their regular activities.

Conditions That Can Cause Sleepiness

Not getting enough sleep -- sometimes by choice -- is the most common cause of excessive sleepiness. Working at night and sleeping during the day is another. Other causes include drug, alcohol, or cigarette use, lack of physical activity, obesity, and the use of certain medications.

But nodding off when you want or need to be awake may also be caused by an underlying condition. Depression or a sleep disorder -- such as restless legs syndrome, sleep apnea, or narcolepsy -- are common causes of problem sleepiness.

Restless Legs Syndrome and Sleepiness

Restless legs syndrome (RLS) is a disorder characterized by unpleasant sensations in the legs and a strong urge to move them. RLS may also cause jerky leg movements every 20 to 30 seconds throughout the night. Sometimes RLS can affect other parts of the body, too.

RLS symptoms may occur or get worse while you’re at rest or sleeping. Because the symptoms are usually worse at night, they can greatly interrupt your sleep and lead to sleepiness when you need to be awake. RLS can be so bad, it is mistaken for insomnia.

Treatment for Restless Legs Syndrome

Moving your legs lessens RLS symptoms. These steps may also be enough to relieve symptoms of RLS:

  • Take iron or vitamin B12 or folate supplements if your doctor says your levels are low and recommends them.
  • Talk to your doctor about whether a medication or herbal remedy that you’re taking may be making symptoms worse. These could include medication that treats high blood pressure, nausea, colds, allergies, heart conditions, or depression.
  • Stay away from alcohol, caffeine, and nicotine.
  • Maintain a healthy diet, exercise regularly, and try relaxation techniques such as hot baths and massage.

If these steps are not enough, several types of medication are useful for treating the symptoms of restless legs syndrome or for inducing deep sleep. They include:

  • Anti-seizure drugs such as carbamazepine, gabapentin, and valproate. Horizant (gabapentin enazcarbil) is a newer drug that is used in restless legs syndrome treatment.  It was not developed as a seizure medicine.
  • Anti-parkinsonian drugs such as levodopa/carbidopa, pergolide, pramipexole, and ropinirole
  • Benzodiazepines such as clonazepam, diazepam, lorazepam, and temazepam
  • Opiates such as codeine, methadone, and oxycodone for severe RLS

Because these drugs have not been compared thoroughly in studies, the best approach is to start with one and see how it works. If it’s ineffective, work with your doctor to find an alternative. In severe cases, a combination of drugs may work best.

 

WebMD Medical Reference

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