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Aetiology

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The causes of excessive daytime sleepiness may be divided into:

  • insufficient quantity of sleep
    • probably the most common cause of EDS
      • a common extrinsic cause of insufficient sleep is lack of time because of work or social pressures
        • however, most people make up for insufficient sleep during weekends or holidays
        • insomnia, owing to an intrinsic hyperarousal state that affects sleep onset and maintenance, is the commonest cause of insufficient sleep
  • poor quality of sleep
    • poor sleep (quality) can be classified as caused by extrinsic or intrinsic factors
      • sleep disturbance caused by extrinsic environmental noise, light, or medical disorders causing pain and discomfort is usually obvious
      • intrinsic sleep disorders—obstructive sleep apnoea and periodic limb movement syndrome—are common causes of disturbed sleep
        • these patients typically report sleeping for enough duration (eight hours or more) but their sleep is disturbed by recurrent arousals from obstructed breathing and leg kicking, respectively
  • unwanted drug effects
  • primary neurological disorders
    • narcolepsy, idiopathic hypersomnia, and circadian rhythm disorders are the main intrinsic neurological disorders affecting the sleep wakefulness centre in the hypothalamus

Reference:

  • Drug and Therapeutics Bulletin (2004); 42(7):52-6.
  • Brown J, Makker KM. An approach to excessive daytime sleepiness in adults. BMJ 2020;368:m1047

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