109 Sentences With "excessive daytime sleepiness"

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Xyrem is an approved treatment for excessive daytime sleepiness and cataplexy in patients with narcolepsy.
Skimping on sleep can lead to excessive daytime sleepiness, fatigue, clumsiness and weight gain or weight loss.
Xyrem is an approved treatment for both excessive daytime sleepiness and cataplexy in patients with narcolepsy, a chronic neurological disorder.
Xyrem is the only approved treatment for both excessive daytime sleepiness and cataplexy in patients with narcolepsy, a chronic neurological disorder.
Apnea that isn't properly treated has been linked with excessive daytime sleepiness, decreased quality of life, heart attacks and heart failure.
Excessive daytime sleepiness (EDS) is a defining feature of most sleep disorders, and it basically means you're tired all the time.
Regardless, people are sleeping less, and this is fueling the need for anything that can help them manage their excessive daytime sleepiness.
One 2013 study found that female ecstasy users were more likely to report having poor quality sleep and experiencing excessive daytime sleepiness.
On the less extreme end of the spectrum, those left untreated can look forward to seriously disturbed night-time sleep and excessive daytime sleepiness.
"In our study, we wanted to know if excessive daytime sleepiness causes an increase of amyloid over time in people without dementia," Vemuri continued.
This means, for example, planning meals strategically to maximize her wakefulness for important tasks, like driving, since eating can contribute to her excessive daytime sleepiness.
The condition involves pauses in breathing or shallow breaths, which can disrupt sleep and cause excessive daytime sleepiness, according to the National Institutes of Health.
Symptoms include excessive daytime sleepiness, loud snoring, awakening with a dry mouth or sore throat, observed episodes of breathing cessation and morning headaches, according to the Mayo Clinic.
Apnea that isn't properly treated has been linked with excessive daytime sleepiness, decreased quality of life, heart attacks and heart failure, researchers note in the Annals of Internal Medicine.
But on its own, moderate-to-severe insomnia more than tripled the athletes' risk of concussion, and excessive daytime sleepiness - even just a few days a month - more than doubled it.
Few parents will be surprised by the results: The team found a "strong and consistent association" between bedtime media device use and inadequate sleep quantity, poor sleep quality and excessive daytime sleepiness.
His lawyer later said that Mr. Gallagher had an undiagnosed sleep disorder and discovered after the crash that he had severe sleep apnea, which disrupts sleep and may cause excessive daytime sleepiness.
In what researchers say is the first study of its kind, a study published Monday in the journal JAMA Neurology shows that excessive daytime sleepiness in cognitively normal elderly leads to a buildup of a plaque in the brain called amyloid.
Among 190 NCAA Division-1 athletes who completed surveys for the study, the chance of getting a sports-related concussion during the next year was 14.6 times higher for those with both insomnia and excessive daytime sleepiness than for those who were well rested.
Something that tickled up the orexins would be useful for any condition where excessive daytime sleepiness is an issue, not to mention the myriad other situations where low levels of these messengers may play a role, including obesity, depression, post-traumatic stress disorder and dementia.
Something that tickled up the orexins would be useful for any condition where excessive daytime sleepiness is an issue, not to mention the myriad other situations where low levels of these messengers may play a role, including obesity, depression, post-traumatic stress disorder, and dementia.
The American Academy of Sleep Medicine and Sleep Research Society recommends adults get seven to nine hours of sleep a night, so sleeping more than that regularly may indicate hypersomnia, or "excessive daytime sleepiness that is usually not relieved by a nap," Nowakowski says.
Jazz Pharmaceuticals PLC: * JAZZ PHARMACEUTICALS ANNOUNCES FDA ACCEPTANCE OF NEW DRUG APPLICATION FOR JZP-258 FOR CATAPLEXY AND EXCESSIVE DAYTIME SLEEPINESS ASSOCIATED WITH NARCOLEPSY * JAZZ PHARMACEUTICALS - PDUFA GOAL DATE FOR AN FDA DECISION FOR JZP-258 IS JULY 21, 2020 Source text for Eikon: Further company coverage:
But if you think you sleep fine during the night and need multiple naps a day (or just feel sleepy), Dr. Harris says you should consider talking to your doctor about "excessive daytime sleepiness," which is a symptom of a sleep disorder that affects around 20% of the population, according to the National Sleep Foundation.
"The reason is that our circadian rhythm tells our brain when to produce melatonin, our sleep hormone, so if you try to wake while your brain is still producing melatonin, you could feel excessive daytime sleepiness, low energy, decline in mood and cognitive impact," said Lisa Medalie, a behavioral sleep medicine specialist at the University of Chicago Sleep Disorders Center.
A short form of the SWAI exists that contains items for the excessive daytime sleepiness and nocturnal sleep subscales only.
The animals affected exhibited excessive daytime sleepiness with a reduced state of vigilance and severe cataplexy resulted after palatable food and interactions with the owners or with other animals.
It has been shown that excessive daytime sleepiness (EDS) can be improved by prescribed napping in narcolepsy.Takashi, M. (2003). The role of prescribed napping in sleep medicine. Sleep Medicine Reviews, Vol.
Hypersomnia can be primary (of central/brain origin), or it can be secondary to any of numerous medical conditions. More than one type of hypersomnia can coexist in a single patient. Even in the presence of a known cause of hypersomnia, the contribution of this cause to the complaint of excessive daytime sleepiness needs to be assessed. When specific treatments of the known condition do not fully suppress excessive daytime sleepiness, additional causes of hypersomnia should be sought.
Just as other sleep disorders (like narcolepsy) can coexist with sleep apnea, the same is true for UARS. There are many cases of UARS in which excessive daytime sleepiness persists after CPAP treatment, indicating an additional cause, or causes, of the hypersomnia and requiring further evaluation. Sleep movement disorders, such as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD or PLMS) can also cause secondary hypersomnia. Although RLS does commonly cause excessive daytime sleepiness, PLMS does not.
In some cases, hypersomnia can be caused by a brain injury.Guilleminault, C., Faull, K. F., Miles, L., & Van den Hoed, J. (1983). Posttraumatic excessive daytime sleepiness: A review of 20 patients. Neurology, 33(12), 1584–1584.
An adult who is compelled to nap repeatedly during the day may have excessive daytime sleepiness; however, it is important to distinguish between occasional daytime sleepiness and excessive daytime sleepiness, which is chronic. A number of tools for screening for EDS have been developed. One is the Epworth Sleepiness Scale which grades the results of a questionnaire. The ESS generates a numerical score from zero (0) to 24 where a score of ten [10] or higher may indicate that the person should consult a specialist in sleep medicine for further evaluation.
From this point on, he suffered from excessive daytime sleepiness and was eventually diagnosed with narcolepsy, which prevented him from ever being able to drive a car. When the war ended, he returned to England.Wilson (2000), p. 60.
Some of these conditions can be due to underlying health problems such as depression, anxiety, and panic disorders. Common symptoms include excessive daytime sleepiness, having trouble falling asleep, waking up in the middle of the night and having trouble falling or staying asleep.
In 2016, the FDA granted Mylan rights for the first generic version of Cephalon's Nuvigil to be marketed in the U.S. Because armodafinil has a longer half-life than modafinil does, it may be more effective at improving wakefulness in patients with excessive daytime sleepiness.
The chemical gamma-hydroxybutyric acid (GHB) has been studied to increase SWS. In the United States, the Food and Drug Administration (FDA) permits the use of GHB under the trade name Xyrem to reduce cataplexy attacks and excessive daytime sleepiness in patients with narcolepsy.
The SWAI consists of 59 items that provide six subscale scores: excessive daytime sleepiness, nocturnal sleep, ability to relax, energy level, social desirability, and psychic distress. Each item is rated on a 1 to 9 semicontinuous Likert type scale from "always" to "never", based on the previous seven days. The SWAI was normed on 554 subjects in the early 1990s and is currently being validated or has been validated in multiple languages, including Spanish, French and Dutch. For the excessive daytime sleepiness subscale (SWAI-EDS), a score of 40 or below indicates excessive sleepiness, a score of between 40 and 50 indicates possible sleepiness and a score of greater than 50 is normal.
Armodafinil is currently FDA-approved to treat excessive daytime sleepiness associated with obstructive sleep apnea, narcolepsy, and shift work disorder. It is commonly used off-label to treat attention deficit hyperactivity disorder, chronic fatigue syndrome, and major depressive disorder. It has been shown to improve vigilance in air traffic controllers.
The diagnosis of narcolepsy and cataplexy is usually made by symptom presentation. Presenting with the tetrad of symptoms (Excessive daytime sleepiness, sleep onset paralysis, hypnagogic hallucinations, cataplexy symptoms) is strong evidence of the diagnosis of narcolepsy. A Multiple Sleep Latency Test (MSLT) is often conducted in order to quantify daytime sleepiness.
The main treatment of excessive daytime sleepiness is done through central nervous system stimulants. Methylphenidate and Dextroamphetamine are most used stimulants to controlled EDS. Increased dopamine release is felt to be the main property explaining wake-promotion from these medications. Insomnia is another common side effect and may require additional treatment.
This test measures whether a person can stay awake during a time when she or he is normally awake. Like the MSLT, the MWT is performed in a sleep diagnostic center over 4 - 5 nap periods. A mean sleep onset latency of less than 10 minutes is suggestive of excessive daytime sleepiness.
Finally, anti-narcoleptics help treat narcolepsy and excessive daytime sleepiness. Of particular interest are the benzodiazepine drugs which reduce insomnia by increasing the efficiency of GABA. GABA decreases the excitability of neurons by increasing the firing threshold. Benzodiazepine causes the GABA receptor to better bind to GABA, allowing the medication to induce sleep.
CRSD has been frequently associated with excessive daytime sleepiness and nighttime insomnia in patients diagnosed with Alzheimer's disease (AD), representing a common characteristic among AD patients as well as a risk factor of progressive functional impairments.Malkani, R., & Attarian, H. (2015). Sleep in Neurodegenerative Disorders. Current Sleep Medicine Reports, 1(2), 81-90.
Hypopnea is a disorder that may result in excessive daytime sleepiness and compromised quality of life, including traffic accidents, diminished productivity in the workplace, and emotional problems. Cardiovascular consequences of hypopnea may include myocardial infarction, hypertension, coronary heart disease as well other problems such as stroke, psychiatric problems, impotence, cognitive dysfunction and memory loss.
A 2016 meta-analysis found that "Bedtime access and use of media devices was significantly associated with inadequate sleep quantity; poor sleep quality; and excessive daytime sleepiness". The American Academy of Pediatrics recommends screen time for children be limited for multiple reasons, among them that "Too much screen time can also harm the amount and quality of sleep".
Pitolisant, sold under the brand name Wakix, is a medication for the treatment of excessive daytime sleepiness (EDS) in adults with narcolepsy. It is a histamine 3 (H3) receptor antagonist/inverse agonist. It represents the first commercially available medication in its class. Pitolisant enhances the activity of histaminergic neurons in the brain that function to improve a person's wakefulness.
Narcolepsy is a long-term neurological disorder that involves a decreased ability to regulate sleep-wake cycles. Symptoms often include periods of excessive daytime sleepiness and brief involuntary sleep episodes. About 70% of those affected also experience episodes of sudden loss of muscle strength, known as cataplexy. These experiences can be brought on by strong emotions.
The Multiple Sleep Latency Test was created in 1977 by sleep pioneers William C. Dement and Mary Carskadon.Carskadon, M.A.; Dement, W.C. Sleep tendency: an objective measure of sleep loss. Sleep Research 6: 200, 1977.Richardson, G.S.; Carskadon, M.A.; Flagg, W.; Van den Hoed, J.; Dement, W.C.; Mitler, M.M. Excessive daytime sleepiness in man: multiple sleep latency measurement in narcoleptic and control subjects.
Cataplexy is treated with medications. The treatments for narcolepsy and cataplexy can be divided in treatments that act on the excessive daytime sleepiness (ESD) and those which improve the cataplexy. For most of the patients, this will represent a lifelong medication. Nevertheless most of the treatments in humans will act only symptomatically and do not target the loss of the orexin producing neurons.
The Epworth Sleepiness Scale has been validated primarily in obstructive sleep apnea, though it has also shown success in detecting narcolepsy and idiopathic hypersomnia. It is used to measure excessive daytime sleepiness and is repeated after the administration of treatment (e.g., CPAP) to document improvement of symptoms. In narcolepsy, the Epworth Sleepiness Scale has both a high specificity (100%) and sensitivity (93.5%).
Daytime naps are not a replacement for night time sleep. Ongoing communication between the health care provider, person, and their family members is important for optimal management of narcolepsy. Another FDA-approved treatment option for narcolepsy is sodium oxybate, also known as sodium gamma-hydroxybutyrate (GHB). It can be used for cataplexy associated with narcolepsy and excessive daytime sleepiness associated with narcolepsy.
Since the underlying disease mechanism is not yet fully understood, treatment efforts have usually focused on symptom management. There are no FDA-approved medicines for idiopathic hypersomnia. The wake-promoting medications used in narcolepsy are also commonly used off-label to help manage the excessive daytime sleepiness of idiopathic hypersomnia. However, the medications currently used for idiopathic hypersomnia are far from satisfactory.
Narcolepsy is a neurological disabling sleep disorder, characterized by excessive daytime sleepiness, sleep fragmentation, symptoms of abnormal rapid-eye-movement (REM) sleep, cataplexy, hypnagogic hallucinations, and sleep paralysis. Cataplexy is a sudden loss of muscle tone triggered by emotions, which is the most valuable clinical feature used to diagnose narcolepsy. Human narcolepsy is primarily a sporadically occurring disorder but familial clustering has been observed.
Narcolepsy by contrast seems to involve excessive and unwanted REM atonia—i.e., cataplexy and excessive daytime sleepiness while awake, hypnagogic hallucinations before entering slow-wave sleep, or sleep paralysis while waking.Steriade & McCarley (1990), Brainstem Control of Wakefulness and Sleep, §13.1 (pp. 396–400). Other psychiatric disorders including depression have been linked to disproportionate REM sleep.Steriade & McCarley (1990), Brainstem Control of Wakefulness and Sleep, §13.2 (pp. 400–415).
An additional trial (Trial 3/NCT01800045), in which participants with a different type of narcolepsy were exposed to the same dose of pitolisant, was used to add data for evaluation of side effects. The trials were conducted in Europe and South America. The two primary trials enrolled adults with narcolepsy and excessive daytime sleepiness. Participants received pitolisant, placebo, or an approved drug for narcolepsy for eight weeks.
It may also be effective in reducing excessive daytime sleepiness while improving vigilance in primary hypersomnias, such as idiopathic hypersomnia. The drug has also been used in hepatic encephalopathy. It may have beneficial short‐term effects in people with cirrhosis, but there is no evidence for long-term benefits. The onset of action is rapid, and effects are usually seen within one to two minutes.
Restless leg syndrome is a disorder in which patients feel uncomfortable or unpleasant sensations in the legs. These sensations usually occur in the evening, while the patient is sitting or lying down and relaxing. Patients feel like they have to move their legs to relieve the sensations, and walking generally makes the symptoms disappear. In many patients, this can lead to insomnia and excessive daytime sleepiness.
In one study of EMS providers, 24-hour shifts were not associated with a higher frequency of negative safety outcomes when compared to shorter shifts. This is especially relevant for young adults as they require 8–9 hours of sleep at night to overcome excessive daytime sleepiness and are among the highest risk group for driving while feeling tired and sleep deprivation related crashes.
There are many neurological disorders that may mimic the primary hypersomnias, narcolepsy and idiopathic hypersomnia: brain tumors; stroke- provoking lesions; and dysfunction in the thalamus, hypothalamus, or brainstem. Also, neurodegenerative conditions such as Alzheimer's disease, Parkinson's disease, or multiple system atrophy are frequently associated with primary hypersomnia. However, in these cases, one must still rule out other secondary causes. Early hydrocephalus can also cause severe excessive daytime sleepiness.
This pain resolved when the subjects were able to resume their normal sleep patterns. Chronic kidney disease is commonly associated with sleep symptoms and excessive daytime sleepiness. For those on dialysis, approximately 80% have sleep disturbances. Sleep apnea can occur 10 times as often in uremic patients than in the general population and can affect up to 30-80% of patients on dialysis, though nighttime dialysis can improve this.
People with PLMD often have excessive daytime sleepiness (EDS), falling asleep during the day, trouble falling asleep at night, and difficulty staying asleep throughout the night. Patients also display involuntary limb movements that occur at periodic intervals anywhere from 20–40 seconds apart. They often only last the first half of the night during non-REM sleep stages. Movements do not occur during REM because of muscle atonia.
There is about a ten-year delay in diagnosing narcolepsy in adults. Cognitive, educational, occupational, and psychosocial problems associated with the excessive daytime sleepiness of narcolepsy have been documented. For these to occur in the crucial teen years when education, development of self-image, and development of occupational choice are taking place is especially devastating. While cognitive impairment does occur, it may only be a reflection of the excessive daytime somnolence.
Gabitril, meanwhile, received FDA approval as a treatment for partial seizures, but the manufacturer allegedly marketed the drug for anxiety, insomnia, and pain. Provigil was initially approved to treat excessive daytime sleepiness resulting from narcolepsy, and later approved the drug for further label indications. Cephalon allegedly promoted Provigil for a five-year period as a non-stimulant drug for the treatment of sleepiness, tiredness, decreased activity, lack of energy, and fatigue.
Idiopathic hypersomnia is a neurological disorder which is characterized primarily by excessive sleep and excessive daytime sleepiness (EDS).Narcolepsy and hypersomnia: review and classification of 642 personally observed cases. Roth B. Schweiz Arch Neurol Neurochir Psychiatr. 1976;119(1):31-4 It has historically been rarely diagnosed and is often very difficult to diagnose at an early stage; it is usually a lifelong chronic disease, which is often debilitating.
The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime (e.g. excessive daytime sleepiness, decreased cognitive function). Most individuals with OSA are unaware of disturbances in breathing while sleeping, even after awakening. A bed partner or family member may observe an individual snoring or appear to stop breathing, gasp, or choke while sleeping.
In most labs, the test is completed and the patient is discharged home by 7 a.m. unless a Multiple Sleep Latency Test (MSLT) is to be done during the day to test for excessive daytime sleepiness. Most recently, health care providers may prescribe home studies to enhance patient comfort and reduce expense. The patient is given instructions after a screening tool is used, uses the equipment at home and returns it the next day.
Pitolisant is used in adults for the treatment of excessive daytime sleepiness in people with narcolepsy, with or without cataplexy. Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged. Narcolepsy is a sleep problem that is characterized by an irresistible urge to sleep and disturbed nighttime sleep, while cataplexy refers to attacks of severe muscle weakness that cause a person to collapse.
Somnogen is a Canadian multinational pharmaceutical corporation with its global headquarters located in Toronto, Canada. Somnogen produces and develop a wide range of prescription and over-the-counter medications in the field of sleep medicine. Somnogen has a portfolio of products for major areas within the field of sleep/wake therapeutic segment including insomnia and excessive daytime sleepiness. Somogen was founded by Seithikurippu Ratnas Pandi-Perumal, who was an Indian-born Canadian citizen.
Mice that are genetically engineered to lack orexin genes demonstrate many similarities to human narcolepsy. During nocturnal hours, when mice are normally present, those lacking orexin demonstrated murine cataplexy and displayed brain and muscle electrical activity similar to the activity present during REM and NREM sleep. This cataplexy is able to be triggered through social interaction, wheel running, and ultrasonic vocalizations. Upon awakening, the mice also display behavior consistent with excessive daytime sleepiness.
Central sleep apnea or obstructive sleep apnea may cause excessive daytime sleepiness, and these individuals should undergo a sleep study. Non-invasive ventilation may be offered if there is an abnormality. Otherwise, there is evidence for the use of modafinil as a central nervous system stimulant, although a Cochrane review has described the evidence thus far as inconclusive. Some small studies have suggested that imipramine, clomipramine and taurine may be useful in the treatment of myotonia.
"The severity of daytime sleepiness needs to be quantified by subjective scales (at least the Epworth Sleepiness Scale) and objective tests such as the multiple sleep latency test (MSLT)." The Stanford sleepiness scale (SSS) is another frequently-used subjective measurement of sleepiness. After it is determined that excessive daytime sleepiness is present, a complete medical examination and full evaluation of potential disorders in the differential diagnosis (which can be tedious, expensive and time-consuming) should be undertaken.
There is no evidence that PLMS plays "a role in the etiology of daytime sleepiness. In fact, two studies showed no correlation between PLMS and objective measures of excessive daytime sleepiness. In addition, EDS in these patients is best treated with psychostimulants and not with dopaminergic agents known to suppress PLMS." Neuromuscular diseases and spinal cord diseases often lead to sleep disturbances due to respiratory dysfunction causing sleep apnea, and they may also cause insomnia related to pain.
Mood disorders, like depression, anxiety disorder and bipolar disorder, can also be associated with hypersomnia. The complaint of excessive daytime sleepiness in these conditions is often associated with poor sleep at night. "In that sense, insomnia and EDS are frequently associated, especially in cases of depression." Hypersomnia in mood disorders seems to be primarily related to "lack of interest and decreased energy inherent in the depressed condition rather than an increase in sleep or REM sleep propensity".
Somnolence is often viewed as a symptom rather than a disorder by itself. However, the concept of somnolence recurring at certain times for certain reasons constitutes various disorders, such as excessive daytime sleepiness, shift work sleep disorder, and others; and there are medical codes for somnolence as viewed as a disorder. Sleepiness can be dangerous when performing tasks that require constant concentration, such as driving a vehicle. When a person is sufficiently fatigued, microsleeps may be experienced.
Pharmacological treatments are used to chemically treat sleep disturbances such as insomnia or excessive daytime sleepiness. The kinds of drugs used to treat sleep disorders include: anticonvulsants, anti-narcoleptics, anti-Parkinsonian drugs, benzodiazepines, non-benzodiazepine hypnotics, and opiates as well as the hormone melatonin and melatonin receptor stimulators. Anticonvulsants, opiates, and anti- Parkinsonian drugs are often used to treat restless legs syndrome. Furthermore, melatonin, benzodiazepines hypnotics, and non-benzodiazepine hypnotics may be used to treat insomnia.
Potential side effects of medication can also be addressed. Regular follow-up is useful to be able to monitor the response to treatment, to assess the presence of other sleep disorders like obstructive sleep apnea, and to discuss psychosocial issues. The main treatment of excessive daytime sleepiness in narcolepsy is central nervous system stimulants such as methylphenidate, amphetamine, dextroamphetamine, modafinil, and armodafinil. In late 2007 an alert for severe adverse skin reactions to modafinil was issued by the FDA.
In fact, "the most severe cases of daytime somnolence are found in patients affected by narcolepsy or idiopathic hypersomnia." Surprisingly, excessive daytime sleepiness is even more handicapping than the cataplectic attacks of narcolepsy. Due to the consequences of their profound EDS, both idiopathic hypersomnia and narcolepsy can often result in unemployment. Several studies have shown a high rate of unemployment in narcoleptics (from 30–59%), which was felt to be related to the severe symptoms of their illness.
Levodopa is an amino acid and is the precursor to the neurotransmitters dopamine, norepinephrine (noradrenaline), and epinephrine (adrenaline). As per a study of six narcoleptic patients it was found that L-dopa improved vigilance and performance as evaluated by the AVS and the FCRTT, while the capacity to fall asleep rapidly remained unchanged as evaluated by the MSLT. It raises the hypothesis that dopamine may play a role in the physiopathology of excessive daytime sleepiness of this condition.
The hallmark symptom of OSA syndrome in adults is excessive daytime sleepiness. Typically, an adult or adolescent with severe long-standing OSA will fall asleep for very brief periods in the course of usual daytime activities if given any opportunity to sit or rest. This behavior may be quite dramatic, sometimes occurring during conversations with others at social gatherings. The hypoxia (absence of oxygen supply) related to OSA may cause changes in the neurons of the hippocampus and the right frontal cortex.
The only common medical uses for GHB today are in the treatment of narcolepsy and, more rarely, alcoholism, although its use for alcoholism is not supported by evidence from randomized controlled trials. It is sometimes used off-label for the treatment of fibromyalgia. GHB is the active ingredient of the prescription medication sodium oxybate (Xyrem). Sodium oxybate is approved by U.S. Food and Drug Administration for the treatment of cataplexy associated with narcolepsy and excessive daytime sleepiness (EDS) associated with narcolepsy.
In individuals with psychiatric illnesses, sleep disorders may include a variety of clinical symptoms such as excessive daytime sleepiness, difficulty falling asleep, difficulty staying asleep, nightmares, sleep talking, sleep walking, and poor quality sleep, among various others. Sleep disturbances - insomnia, hypersomnia and delayed sleep-phase disorder - are quite prevalent in severe mental illnesses such as psychotic disorders. In those with schizophrenia sleep disorders contribute to cognitive deficits in learning and memory. Sleep disturbances often occur before the onset of psychosis.
GHB was used to treat narcolepsy and cataplexy for more than 15 years and it is the only drug authorised by the EMA to treat the whole disease in adults, and by FDA to treat patients who suffer from cataplexy with the indication to be used for combating excessive daytime sleepiness. This drug helps to normalise the sleep architecture pushing the REM sleep toward its normal setting and inhibits the intrusion during the day of its elements like the paralysis in cataplexy.
The hyperactivity and difficulties in emotional regulation found in children patients are not reported in adults. OSA in adults is nevertheless associated with personality changes and automatic behavior. The biggest impact of OSA is the excessive daytime sleepiness (EDS), reported in approximately 30% of OSA patients. EDS can be caused by the disturbance of sleep quality, the insufficient sleep duration or the sleep fragmentation and it is responsible for further complications as it may lead to depressive symptoms, impairments of social life and decreased effectiveness at work.
Television use was associated with the poorest sleep duration. Adolescent technology-use has also been linked with excessive daytime sleepiness and caffeine consumption, suggesting that technology-use may interfere with sleep and may lead to increased caffeine consumption. Longitudinal data demonstrates that time spent using technology is predictive of short sleep duration, however short sleep duration was also predictive of time spent using technology. More longitudinal research with larger sample sizes is needed to clarify the mechanisms underlying the association between technology-use and sleep during adolescence.
Pitolisant was developed by Jean-Charles Schwartz, Walter Schunack, and colleagues after the former discovered the H₃ receptor. It was the first H₃ receptor inverse agonist to be tested in humans or introduced for clinical use. It was designed and developed by Bioprojet, who has marketed the product in Europe since its approval by the European Medicines Agency in 2016. The FDA approved pitolisant for excessive daytime sleepiness in participants with narcolepsy based primarily on evidence from two trials (Trial 1/NCT 01067222, Trial 2/NCT 01638403).
Insomnia, one of the six types of dyssomnia, affects 21%-37% of the adult population. Many of its symptoms are easily recognizable, including excessive daytime sleepiness; frustration or worry about sleep; problems with attention, concentration, or memory; extreme mood changes or irritability; lack of energy or motivation; poor performance at school or work; and tension headaches or stomach aches. Insomnia can be grouped into primary and secondary, or comorbid, insomnia. Primary insomnia is a sleep disorder not attributable to a medical, psychiatric, or environmental cause.
Eugeroics (originally, "eugrégorique" or "eugregoric"), also known as wakefulness-promoting agents and wakefulness-promoting drugs, are a class of drugs that promote wakefulness and alertness. They are medically indicated for the treatment of certain sleep disorders including excessive daytime sleepiness (EDS) in narcolepsy or obstructive sleep apnea (OSA). They generally have a very low addictive potential. Eugeroics are also often prescribed off-label for the treatment of EDS in idiopathic hypersomnia, a rare and often debilitating sleep disorder which currently has no official treatments approved by the Food and Drug Administration (FDA).
While there are some similarities between adults and children, OSA does not have the same consequences in both populations. Examples of similarities are the snoring – which is the most common complaint in both pediatric OSA and OSA in adults – variability of blood pressure and cardiovascular morbidities. A major difference is the excessive daytime sleepiness (EDS) which is commonly reported in adult OSA, while it is not very common in pediatric OSA. Nevertheless, OSA in adults also implies a large scope of adverse and serious consequences, the latter leading to higher mortality amongst OSA patients.
Contrary to adults, excessive daytime sleepiness (EDS) is not the most commonly reported symptoms in children with OSA. However, using objective questionnaires, it is possible to notice that the frequency of EDS in children is higher than what is reported by the parents or caretakers (40–50%). And the risk for EDS is even increased when OSA is associated with obesity. Due to all the consequences and symptoms it generates, OSA in children lead to a significant decrease in the quality of life, the decrease being even higher when obesity is present.
Untreated OSA also leads to a decreased quality of life, difficulties in social functioning, occupational problems and accidents and a greatly increased rate of vehicle accidents. Those serious outcomes of OSA are mostly related to the excessive daytime sleepiness resulting from the sleep fragmentation and highlight the need to provide the patients with appropriate treatment. Effective treatment majorly improves those adverse consequences, including quality of life. OSA patients also frequently reports pain disorders such as headache or fibromyalgia, OSA patients showing an increased pain intensity alongside a decreased pain tolerance.
Some independent risk factors associated with confusional arousals have been identified. According to studies, they are shift work, hypnagogic hallucinations (also known as hypnagogia), excessive daytime sleepiness, insomnia and hypersomnia disorder, circadian rhythm sleep disorder, restless legs syndrome, obstructive sleep apnea syndrome (OSAS), bipolar disorder, daily smoking, and age of 15–24 years. These risk factors of confusional arousals are somehow related to mental disorders and medical conditions and affecting mostly younger subjects regardless of gender. Precipitating factors include sleep deprivation, use of hypnotics or tranquilisers before bedtime, and sudden awakening from sleep (e.g.
It can also, in some cases, appear in the upper extremities of the body. These movements can lead the patient to wake up, and if so, sleep interruption can be the origin of excessive daytime sleepiness. PLMD is characterized by increased periodic limb movements during sleep (PLMS), which must coexist with a sleep disturbance or other functional impairment, in an explicit cause-effect relationship. Usually, these involuntary movements come from lower extremities (including toes, ankles, knees, and hips), although they can also be observed in upper extremities, occasionally.
Often, those affected have low levels of the neuropeptide orexin, which may be due to an autoimmune disorder. In rare cases, narcolepsy can be caused by traumatic brain injury, tumors, or other diseases affecting the parts of the brain that regulate wakefulness or REM sleep. Diagnosis is typically based on the symptoms and sleep studies, after ruling out other potential causes. Excessive daytime sleepiness can also be caused by other sleep disorders such as sleep apnea, major depressive disorder, anemia, heart failure, drinking alcohol and not getting enough sleep.
Middle-of-the-night insomnia (MOTN) is characterized by having difficulty returning to sleep after waking up during the night or very early in the morning. This kind of insomnia (sleeplessness) is different from initial or sleep-onset insomnia, which consists of having difficulty falling asleep at the beginning of sleep. The disrupted sleep patterns caused by middle-of-the- night insomnia make many sufferers of the condition complain of fatigue the following day. Excessive daytime sleepiness is reported nearly two times higher by individuals with nocturnal awakenings than by people who sleep through the night.
Otherwise, patients appear healthy, both psychiatrically and medically. (That this condition is often asymptomatic could explain why it is relatively unreported.) However, upon clinical observation, it is found that patients may severely overestimate the time they took to fall asleep—often reporting having slept half the amount of time indicated by polysomnogram or electroencephalography (EEG), which may record normal sleep. Observing such discrepancy between subjective and objective reports, clinicians may conclude that the perception of poor sleep is primarily illusionary. Alternatively, some people may report excessive daytime sleepiness or chronic disabling sleepiness, while no sleep disorder has been found to exist.
The ESS asks participants to rate the likelihood that they would fall asleep while doing eight daily activities (such as sitting and reading or watching television). Participants rate each item from zero (would never doze) to three (high chance of dozing). Pitolisant was approved by the U.S. Food and Drug Administration (FDA) in August 2019. It was granted orphan drug designation for the treatment of narcolepsy, fast track designation for the treatment of excessive daytime sleepiness (EDS) and cataplexy in people with narcolepsy, and breakthrough therapy designation for the treatment of cataplexy in people with narcolepsy.
357 - 364. For instance, Backhaus et al have pointed out that a decline in declarative memory consolidation in midlife (in their experiment: 48 to 55 years old) is due to a lower amount of SWS, which might already start to decrease around age of 30 years old. According to Mander et al, atrophy in the medial prefrontal cortex (mPFC) gray matter is a predictor of disruption in slow activity during NREM sleep that may impair memory consolidation in older adults. And sleep disturbances, such as excessive daytime sleepiness and nighttime insomnia, have been often referred as factor risk of progressive functional impairment in Alzheimer's disease (AD) or Parkinson's disease (PD).
Modafinil and Armodafinil elevate hypothalamic histamine levels, and they are known to bind to the dopamine transporter, thereby inhibiting dopamine reuptake. Modafinil can cause uncomfortable side effects, including nausea, headache, and a dry mouth for some patients, while other patients report no noticeable improvement even on relatively high dosages. They may also "interact with low-dose contraceptives, potentially reducing efficacy, although the scientific data supporting this claim is weak and rests on poorly documented anecdotes." Solriamfetol is the first and only dual- acting dopamine and norepinephrine reuptake inhibitor approved by the FDA to improve wakefulness in adults living with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea.
Stimulants have been used in medicine for many conditions including obesity, sleep disorders, mood disorders, impulse control disorders, asthma, nasal congestion and, in case of cocaine, as local anesthetics. Drugs used to treat obesity are called anorectics and generally include drugs that follow the general definition of a stimulant, but other drugs such as cannabinoid receptor antagonists also belong to this group. Eugeroics are used in management of sleep disorders characterized by excessive daytime sleepiness, such as narcolepsy, and include stimulants such as modafinil. Stimulants are used in impulse control disorders such as ADHD and off-label in mood disorders such as major depressive disorder to increase energy, focus and elevate mood.
Alongside with the additional weight loading on the respiratory system, it increases the risk of pharyngeal collapsibility while reducing the intrathoracic volume and diaphragm excursion. Moreover, excessive daytime sleepiness resulting from sleep fragmentation can decrease physical activity and thus lead to weight gain (by sedentary habits or increased food intake to overcome somnolence). The obesity-related obstruction of upper airway structure has led some authors to distinguish between two types of OSA in children: type I is associated with marked lymphadenoid hypertrophy without obesity and type II is first associated with obesity and with milder upper airway lymphadenoid hyperplasia. The two types of OSA in children can results in different morbidities and consequences.
While meta-analysis have shown no deficits in retention of information for patients with OSA, those impairment in verbal memory may be linked to problems in encoding information. This deficit in encoding of information is also noticed in visuo-spatial memory; however, the visual memory seems to be intact in OSA patients. The cognitive impairments have been suggested to be resulting from sleep fragmentation and sleep deprivation, as well as the excessive daytime sleepiness associated with them. More precisely, attention and memory deficits seem to result from sleep fragmentation, while deficits in global cognitive function (executive function, psychomotor function, language abilities) are more related to hypoxia and/or hypercarbia which accompanies the obstructive events during sleep.
The Epworth Sleepiness Scale (ESS), designed to give an indication of sleepiness and correlated with sleep apnea, or other questionnaires designed to measure excessive daytime sleepiness, are diagnostic tools that can be used repeatedly to measure results of treatment. A sleep diary, also called sleep log or sleep journal, kept by a patient at home for at least two weeks, while subjective, may help determine the extent and nature of sleep disturbance and the level of alertness in the normal environment. A parallel journal kept by a parent or bed partner, if any, can also be helpful. Sleep logs can also be used for self-monitoring and in connection with behavioral and other treatment.
Excessive daytime sleepiness is characterized by persistent sleepiness and often a general lack of energy, even during the day after apparently adequate or even prolonged nighttime sleep. EDS can be considered as a broad condition encompassing several sleep disorders where increased sleep is a symptom, or as a symptom of another underlying disorder like narcolepsy, circadian rhythm sleep disorder, sleep apnea or idiopathic hypersomnia. Some persons with EDS, including those with hypersomnias like narcolepsy and idiopathic hypersomnia, are compelled to nap repeatedly during the day; fighting off increasingly strong urges to sleep during inappropriate times such as while driving, while at work, during a meal, or in conversations. As the compulsion to sleep intensifies, the ability to complete tasks sharply diminishes, often mimicking the appearance of intoxication.
Those who suffer from idiopathic hypersomnia seems to have some common symtoms like Excessive daytime sleepiness, which is characterized by persistent sleepiness throughout the day and often a general lack of energy, even during the day after apparently adequate or even prolonged nighttime sleep. People with EDS are compelled to nap repeatedly during the day; fighting off increasingly strong urges to sleep during inappropriate times such as while driving, while at work, during a meal, or in conversations. Sleep inertia (also known as sleep drunkeness), which is characterized by having extreme difficulty waking up and feeling an uncontrollable desire to go back to sleep. Clouding of consciousness (also known as brain fog or mental fog), which is characterized by inattention, thought process abnormalities, comprehension abnormalities, and language abnormalities.
Sodium oxybate, sold under the brand name Xyrem among others, is a prescription medication used to treat two symptoms of narcolepsy: sudden muscle weakness and excessive daytime sleepiness. It is used sometimes in France and Italy as an anesthetic given intravenously; it is also used in Italy to treat alcohol addiction and alcohol withdrawal syndrome. Index page Sodium oxybate is the sodium salt of γ-hydroxybutyric acid (GHB). The clinical trials for narcolepsy were conducted just as abuse of GHB as a club drug and date rape drug became a matter of public concern; in 2000 GHB was made a Schedule I controlled substance, while sodium oxybate, when used under an FDA NDA or IND, was classified as a Schedule III controlled substance for medicinal use under the Controlled Substances Act, with illicit use subject to Schedule I penalties.
Clinical use of sodium oxybate was introduced in Europe in 1964, as anesthetic given intravenously but it was not widely used since it sometimes caused seizures; as of 2006, it was still authorized for this use in France and Italy but not widely used. The major use of sodium oxybate is in treating two of the symptoms of narcolepsy - cataplexy (sudden muscle weakness) and excessive daytime sleepiness. Reviews of sodium oxybate concluded that it is well tolerated and associated with "significant reductions in cataplexy and daytime sleepiness," and that its effectiveness "in treating major, clinically relevant narcolepsy symptoms and sleep architecture abnormalities" has been established. However, because of the risks of abuse associated with this medication, it is available in the US only through a risk evaluation and mitigation strategy (REMS) program mandated by the FDA.
Competence in sleep medicine requires an understanding of a plethora of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder," such as sleep apnea, narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances. Another common complaint is insomnia, a set of symptoms that can have many causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis. ICSD, The International Classification of Sleep Disorders, was restructured in 1990, in relation to its predecessor, to include only one code for each diagnostic entry and to classify disorders by pathophysiologic mechanism, as far as possible, rather than by primary complaint.
The company's early research efforts were focused on the development of IGF-1, an insulin-like growth factor, in collaboration with Chiron Corporation, toward the development of a treatment for amyotrophic lateral sclerosis (Lou Gehrig's Disease), a candidate that was never approved. Thereafter, the company developed and commercialized products for the treatment of sleep disorders, pain, addiction and cancer, establishing the "wake franchise" on the basis of Provigil (modafinil) and later, Nuvigil, the R-enantiomer of modafinil. In addition to conducting research on kinase inhibitors and other small molecules, Cephalon licensed other compounds, purchased other products, and acquired entire companies, in the latter case, including CIMA Labs, Anesta, and Laboratoire Lafon. It was from Lafon that Cephalon obtained the rights to modafinil, which it marketed under the trade name Provigil, for the treatment of excessive daytime sleepiness associated with narcolepsy, sleep apnea, and shift work sleep disorder.
"Frank Baldino Jr., Founder of Pharmaceutical Company, Dies at 57", The New York Times, December 21, 2010. Accessed September 20, 2011. After leaving DuPont, Baldino co-founded Cephalon in 1987 at the age of 33. Its best known product has been modafinil, which the firm markets under the brand name Provigil, which has been approved by the Food and Drug Administration for use in treating narcolepsy, shift work sleep disorder, and excessive daytime sleepiness resulting from sleep apnea, though the FDA has held off on approving its use for treating jet lag. In marketing Provigil, Baldino emphasized that "there are no warts on this drug" and the product became a best seller for its off-label use by individuals seeking to maintain alertness and combat fatigue without the side effects of caffeine and amphetamines, with off-label uses accounting for 90% of sales by 2004. The current market size of Provigil is over US$1,120 million in 2010 while Nuvigil is expected to reach revenue of US$700 million by 2013 .Staff. "FDA delays decision on Cephalon drug for jet lag", Reuters, December 21, 2009. Accessed December 24, 2010.

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