{"id":22797,"date":"2025-02-06T12:55:33","date_gmt":"2025-02-06T12:55:33","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=22797"},"modified":"2025-11-27T18:06:27","modified_gmt":"2025-11-27T18:06:27","slug":"excessive-daytime-sleepiness-2","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/sleep-medicine\/excessive-daytime-sleepiness-2\/","title":{"rendered":"Excessive Daytime Sleepiness"},"content":{"rendered":"\n<p><strong>Information<\/strong><\/p>\n\n\n\n<p><strong>Note:<\/strong><\/p>\n\n\n\n<p><strong>Behaviourally induced sleep restriction, or \u2018voluntary\u2019 sleep restriction, is the commonest cause of sleepiness in our community!<\/strong><\/p>\n\n\n\n<p>This generally comes down to poor sleep habits, poor sleep hygiene, poor lifestyle and not making sleep a priority. There may be bedroom safety issues and poor sleeping environments, including bed poverty.<\/p>\n\n\n\n<p>Average sleep requirements are 7-8 hours a night for most adults. Some may get by with less (generally not under 4 hours a night) and some may need up to 10 hours a night to function adequately.<\/p>\n\n\n\n<p>Other causes of excessive daytime sleepiness are listed in the figure below.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"568\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Excessive-Daytime-Sleepiness-1024x568.png\" alt=\"Excessive Daytime Sleepiness\" class=\"wp-image-22798\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Excessive-Daytime-Sleepiness-1024x568.png 1024w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Excessive-Daytime-Sleepiness-300x166.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Excessive-Daytime-Sleepiness-768x426.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Excessive-Daytime-Sleepiness.png 1091w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption><span class=\"media-credit\">MM Ohayon<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p>NOTE: Anxiety disorders are very frequently missed as a cause of EDS.<\/p>\n\n\n\n<p>Diagnostic Tools<\/p>\n\n\n\n<p>Generally, a simple history of excessive daytime sleepiness is sufficient. Clearly, physical examination and basic tests are crucial.<\/p>\n\n\n\n<p>The Epworth Sleepiness Scale is helpful. For more information on rarer causes of excessive day time sleepiness see<em> link<\/em><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who can refer:<\/strong><\/h4>\n\n\n\n<p>Any healthcare professional<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Whom to refer:<\/strong><\/h4>\n\n\n\n<p>Any patient in whom a sleep disorder is thought to be contributing to or wholly causing excessive daytime sleepiness.<\/p>\n\n\n\n<p><strong>Essential criteria for referral<\/strong><\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>Sleep diary of at least 4 weeks to ensure that sleep times are regular. Sleeping in at the weekend is a sign of chronic partial sleep deprivation and should be addressed first. <a href=\"https:\/\/sleepeducation.org\/docs\/default-document-library\/sleep-diary.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Sleep Diary AASM<\/strong><\/a><\/li>\n\n\n\n<li>Delayed sleep phase should be addressed fully prior to referral \u2013 this can be diagnosed on a sleep diary for at least 4 weeks see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/sleep-medicine\/circadian-rhythm-disorders\/\" target=\"_blank\" rel=\"noreferrer noopener\">Circadian Rhythm Disorders \u2013 RefHelp<\/a><\/li>\n\n\n\n<li>Sleep hygiene has been addressed.<\/li>\n\n\n\n<li>Medications reviewed.<\/li>\n\n\n\n<li>Lifestyle has been addressed: exercise, caffeine, alcohol, drugs and smoking.<\/li>\n\n\n\n<li>Any medical and psychiatric issues fully addressed.<\/li>\n<\/ol>\n\n\n\n<p>ALL patients must have the following undertaken <strong>and addressed, if necessary,<\/strong> prior to referral:<\/p>\n\n\n\n<p>Full blood count<\/p>\n\n\n\n<p>U\u2019s &amp; E\u2019s<\/p>\n\n\n\n<p>Liver function tests<\/p>\n\n\n\n<p>Thyroid function tests<\/p>\n\n\n\n<p>Full iron studies (Low Ferritin can cause fatigue and must be greater than 100mcg\/l when Restless Legs Syndrome is suspected to allieviate symptoms)<\/p>\n\n\n\n<p>Folate<\/p>\n\n\n\n<p>B12<\/p>\n\n\n\n<p>Vit D levels (if patient meets criteria as per ICE eg evidence of osteomalacia, malabsorption etc)<\/p>\n\n\n\n<p>HbA1C<\/p>\n\n\n\n<p>Chest radiograph, BBV screen and pregnancy testing as well as testing for cortisol deficiency, low testosterone and low female hormones may be useful in selected cases.<\/p>\n\n\n\n<p><strong>Who not to refer:<\/strong><\/p>\n\n\n\n<p>Insomnia \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/sleep-medicine\/insomnia\/\" target=\"_blank\" rel=\"noreferrer noopener\">Insomnia \u2013 RefHelp<\/a><\/p>\n\n\n\n<p>Restless legs syndrome \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/restless-legs-syndrome-rls\/\" target=\"_blank\" rel=\"noreferrer noopener\">Restless Legs Syndrome (RLS) \u2013 RefHelp<\/a><\/p>\n\n\n\n<p>Delayed sleep phase syndrome \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/sleep-medicine\/circadian-rhythm-disorders\/\" target=\"_blank\" rel=\"noreferrer noopener\">Circadian rhythm disorders \u2013 RefHelp<\/a><\/p>\n\n\n\n<p>Behaviourally induced sleep insufficiency<\/p>\n\n\n\n<p>Psychiatric disorders unless a primary sleep disorder is suspected.<\/p>\n\n\n\n<p>Anyone with abuse or dependence issues that have not been addressed first.<\/p>\n\n\n\n<p>We welcome referrals for advice only, if it is felt the patient would benefit from review in clinic this will be offered in addition<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<p>Sci-gateway:&nbsp; RIE &gt; Respiratory Sleep &gt; LI Sleep Referral<\/p>\n\n\n\n<p>Or headed letter to:<\/p>\n\n\n\n<p>Department of Sleep Medicine<\/p>\n\n\n\n<p>Royal Infirmary of Edinburgh<\/p>\n\n\n\n<p>51 Little France Crescent<\/p>\n\n\n\n<p>EH16 4SA<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>Appropriate treatment of the condition diagnosed: primary sleep disorder<\/li>\n\n\n\n<li>Treatment of the medical disorder causing sleepiness or fatigue<\/li>\n\n\n\n<li>Addressing disorders of sleep initiation and maintenance<\/li>\n\n\n\n<li>Adequate sleep! (7-8 hours, maybe more)<\/li>\n\n\n\n<li>Restructure daily activities to include enough time for sleep<\/li>\n<\/ul>\n\n\n\n<p>Basic Sleep Hygiene and Questions around Sleep<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Regular sleep and waking times<\/li>\n\n\n\n<li>Avoid exercise right before bedtime<\/li>\n\n\n\n<li>Increase daytime exposure to bright light<\/li>\n\n\n\n<li>Caffeine, nicotine, alcohol, food, fluid intake and timing<\/li>\n\n\n\n<li>Environment; devices and late-night bright light<\/li>\n\n\n\n<li>Replacing medications that cause fatigue<\/li>\n\n\n\n<li>Regular exercise and moderate aerobic activity<\/li>\n\n\n\n<li>Recognition and discussion of stress<\/li>\n\n\n\n<li>Trial of antidepressants\/anxiolytics for 6 weeks if anxiety or depression is suspected. Please ask the patient directly. They often deny these symptoms and have not been given time to open up about them.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/sleepeducation.org\/docs\/default-document-library\/sleep-diary.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Sleep Diary AASM<\/strong><\/a><strong><u> <\/u><\/strong><\/p>\n\n\n\n<p><a href=\"https:\/\/cks.nice.org.uk\/topics\/tiredness-fatigue-in-adults\/diagnosis\/assessment\/\" target=\"_blank\" rel=\"noreferrer noopener\">Assessment | Diagnosis | Tiredness\/fatigue in adults | CKS | NICE<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/thesleepcharity.org.uk\/information-support\/adults\/sleep-hygiene\/\" target=\"_blank\" rel=\"noreferrer noopener\">Sleep Hygiene &#8211; The Sleep Charity<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Excessive-Daytime-Sleepiness.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Excessive-Daytime-Sleepiness.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/DVLA-tiredness-can-kill-pdf.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/DVLA-tiredness-can-kill-pdf.pdf<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information Note: Behaviourally induced sleep restriction, or &lsquo;voluntary&rsquo; sleep restriction, is the commonest cause of sleepiness in our community! This generally comes down to poor sleep habits, poor sleep hygiene, poor lifestyle and not making sleep a priority. There may be bedroom safety issues and poor sleeping environments, including bed poverty. Average sleep requirements are<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":22654,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1223],"class_list":["post-22797","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-excessive-daytime-sleepiness-2"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/respiratory\/https-apps-nhslothian-scot-refhelp-sleep-medicine\/https-apps-nhslothian-scot-refhelp-excessive-daytime-sleepiness-2\/\" rel=\"tag\">Excessive Daytime Sleepiness<\/a>","rttpg_excerpt":"Information Note: Behaviourally induced sleep restriction, or &lsquo;voluntary&rsquo; sleep restriction, is the commonest cause of sleepiness in our community! This generally comes down to poor sleep habits, poor sleep hygiene, poor lifestyle and not making sleep a priority. There may be bedroom safety issues and poor sleeping environments, including bed poverty. Average sleep requirements are","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22797","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=22797"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22797\/revisions"}],"predecessor-version":[{"id":25794,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22797\/revisions\/25794"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22654"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=22797"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=22797"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}