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Medical history, your current and past these abnormalities include hypothyroidism, hyperthyroidism, hyperlipidemia because of the multifactorial nature.

30.01.2015

Constant sleepiness after stroke, what will help me sleep while pregnant - For You

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Modafinil for excessive sleepiness associated with shift-work sleep disorder [published correction appears in N Engl J Med.
Pagel failed to disclose relationships he developed with two pharmaceutical companies after submitting this article and before it was published. Persons with excessive daytime sleepiness are at risk of motor vehicle and work-related incidents, and have poorer health than comparable adults.
Questionnaires such as the Stanford Sleepiness Scale and the Epworth Sleepiness Scale (Figure 124) are validated, patient-completed assessments of daytime sleepiness that can be used as screening tests.
A physician should report patients who fail to comply with treatment, particularly high-risk persons such as airline pilots, truck, bus, and occupational drivers, and those with a history of recent sleepiness-associated incidents.
The most common causes of excessive daytime sleepiness are sleep deprivation, obstructive sleep apnea, and sedating medications.


Other potential causes of excessive daytime sleepiness include certain medical and psychiatric conditions and sleep disorders, such as narcolepsy. The presence of excessive daytime sleepiness in a patient with insomnia suggests a comorbidity such as a sleep-related breathing disorder or a mood disorder.13MEDICATION AND DRUG EFFECTSSleepiness is the most commonly reported side effect of pharmacologic agents that act on the central nervous system. Obstructive sleep apnea is a particularly significant cause of excessive daytime sleepiness. The evaluation and management of excessive daytime sleepiness is based on the identification and treatment of underlying conditions (particularly obstructive sleep apnea), and the appropriate use of activating medications. Sedating antihistamines, longer-acting benzodiazepines, and sedating antidepressants are associated with decreased performance on driving tests and increased rates of next-day motor vehicle incidents attributed to daytime sleepiness.13,15,16 Of the antihypertensive medications in widespread use, tiredness, fatigue, and daytime sleepiness are side effects commonly associated with beta blockers such as propranolol (Inderal), but sedation is also the most common side effect reported for the alpha2-agonists clonidine (Catapres) and methyldopa (Aldomet, brand no longer available in the United States).
About 20 percent of adults in the United States report a level of daytime sleepiness sufficient to interfere with daily activities, and excessive daytime sleepiness is the leading symptom of patients presenting to sleep clinics.1 The prevalence of excessive daytime sleepiness is highest in adolescents, older persons, and shift workers,2 but assessment of its true prevalence is difficult because of the subjective nature of the symptoms, inconsistencies in terminology, and a lack of consensus on methods of diagnosis and assessment.


Adolescents abusing stimulants such as amphetamines and cocaine may experience persistent daytime sedation after long episodes of drug-induced wakefulness.OSAExcessive daytime sleepiness is the most common symptom of OSA.
Sometimes treatment of excessive daytime sleepiness can be as simple as discontinuing or modifying the use of such agents. In patients with OSA, approximately 23 percent of women and 16 percent of men experience excessive daytime sleepiness.17 Sleep-related breathing disorders may be significantly under-recognized as causes of excessive daytime sleepiness. Psychiatric conditions, especially depression, can also result in excessive daytime sleepiness.



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