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23rd February 2010, Tuesday
Former Prime Minister HD Deve Gowda was often seen dozing at official functions showing the characteristic symptoms of hypersomnia i.e. daytime sleepiness. It is important that people understand what daytime sleepiness is, as it is a potentially reversible and treatable condition.
What is daytime sleepiness?
Daytime sleepiness occurs when the person has an irresistible desire to sleep while awake. This can happen due to snoring, chronic sleep deprivation or due to a disease called sleep paralysis or narcolepsy. Individuals who sleep fewer than four or more than ten hours have been reported to have increased rates of mortality.
What is the commonest cause?
The commonest cause of daytime sleepiness is obstructive sleep apnea and is associated with night time snoring. It is also potentially the most dangerous cause.
How serious is mild sleep apnea?
Mild sleep apnea does not impair daily activity or behavior. The daytime sleepiness is usually recognized by family members. Such patients have apnea attacks during sleep of 5 and 15 events per hour. They do not suffer from high BP, right heart enlargement and lack of oxygen during sleep.
How serious is moderate sleep apnea?
These patients are usually aware of their daytime sleepiness and take steps to avoid falling asleep. They continue their daily activities, but at reduced levels. There is also a higher incidence of motor vehicle violations or accidents. Hypertension may exist, but right heart enlargement is usually absent. Such patients generally have apnea attacks during sleep between 15 and 30 events per hour.
What about severe apnea?
In these patients the daytime sleepiness is disabling and interferes with normal daily activities. There are signs of right heart failure, night time heart angina, raised hemoglobin levels as well. Such patients fall asleep during the day, in a sitting posture, and are at risk for accidental injury. These patients generally have more than 30 cessation of respiration attacks per hour of sleep including an oxygen saturation below 90 percent for more than 20 percent of the total sleep time.
What is narcolepsy?
It is the second most common cause of disabling daytime sleepiness. The disease typically begins during the teens and early twenties, but can occur as early as five years of age or even after 40 years of age. The symptoms may worsen during the first few years and then persist for life. Narcolepsy is a disorder of sleep–wake state control in which elements of sleep intrude into wakefulness, and elements of wakefulness intrude into sleep. The net effect is daytime sleepiness with varying amounts of hypnagogic hallucinations, sleep paralysis, and cataplexy. In some, the sleepiness may be so severe that they may doze off with little warning (sleep attacks).
How do we differentiate sleep apnea from narcolepsy?
In contrast to the sleepiness of sleep apnea and other disorders, the sleepiness of narcolepsy often improves temporarily after a brief nap. Patients with narcolepsy often feel rested when they awake in the morning.
What is sleep deprivation?
Sleep deprivation is another cause of daytime sleepiness. It can be partial and cumulative. For example, when a person with a usual nightly sleep quota of eight hours sleeps only seven hours, there is a 1–hour sleep deficit, which is carried over to the next day. A seven-hour sleep debt accrues after seven days of losing one hour of sleep nightly, nearly equivalent to a full night without sleep. In one study, maintaining a nightly sleep quota of six hours or less for 14 days produced cognitive performance deficits equivalent to 48 hours of total sleep deprivation. Cumulative partial sleep deprivation is, equivalent of acute total sleep deprivation, and may be much harder for the patient and clinician to recognize.
Dr KK Aggarwal
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Regardless of the extent of colonic involvement, some patients remain symptomatic despite optimal doses of oral 5–aminosalicylic acid (5–ASA) drugs, topical therapy with either 5–ASA or steroids and systemic corticosteroids. In these patients, additional medical therapy should be considered.
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