Sleepiness during the day (EDS or excessive daytime sleepiness) is one of the hallmark symptoms of sleep apnea.  It is documented by a Sleepiness Questionnaire. The questionnaire most commonly used is called the Epworth Sleepiness Scale, which most patients fill out (or the provider does).  It’s very helpful if the patient is quite sleepy, but many patients underestimate their sleepiness or are very good at covering it up. Sometimes they confuse it with fatigue.  Often, the spouse or another person is a more reliable source of information and can describe the sleepiness better than the patient.  With treatment, the sleepiness usually improves, though this may take days to months. 

Lack of daytime sleepiness does not rule out sleep apnea, and patients may deny sleepiness altogether — particularly those patients with heart or lung disease or active lifestyles.  Often it is only after treatment when the patients are able to compare the difference that they finally acknowledge their sleepiness and fatigue before treatment.

It is sometimes very difficult to distinguish sleepiness from fatigue or just being plain tired.  If patients actually fall asleep when they are relaxed and passive (after lunch in their recliner, for example), then sleepiness is indeed involved. Otherwise, it can be difficult to distinguish.

Daytime sleepiness can be caused by many disorders, including sleep apnea, insomnia of any cause, Restless Legs Syndrome/Periodic Leg Movement Disorder, drugs and medications, psychiatric (depression) and psychological (boredom) conditions, sleep deprivation,  neurological conditions (narcolepsy), and circadian rhythm disorders (shift work, sleep phase disorders).   It is the responsibility of the physician to tease out the cause, prove it (diagnose), manage it, and improve the patient.

Snoring is the second hallmark symptom of obstructive sleep apnea when it arises in the back of the throat.  Snoring can also arise in the nose.  It is usually worsened by alcohol, colds, allergies, sleeping on the back (supine), gaining weight, and aging.  Women snore less loudly than men and admit it less, but are more prone to it during pregnancy and after menopause.  It should be emphasized that snoring is not a major symptom of central sleep apnea.  Using PAP therapy usually completely eliminates the snoring in obstructive sleep apnea, and thus the bed partner is very thankful.  Throat surgery ameliorates the snoring but does not necessarily treat the sleep apnea.  Snoring is difficult to document, but in the lab snoring sensors are used.

General medical and sleep questionnaires are also necessary for the patient with suspected sleep disorders.  (See the FORMS tab). As noted above, there are multiple causes of sleepiness and snoring, while almost any disease and drug can impact sleep and its disorders.

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