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What should I do about this problem?

-First, get a diagnosis!--since it's easier to treat problems once their cause is known.

-Overnight monitoring is usually necessary to identify underlying abnormalities in sleep, and to test possible treatments for such common findings as breathing abnormalities.

-A daytime multiple sleep latency test (MSLT) may be indicated: particularly if narcolepsy is suspected, and if the problem does not appear entirely due to sleep apnea. In all cases, diagnostic testing should be tailored to the needs of the individual patient.

-The second step is specific treatment for the cause of the problem--combined with scrupulous avoidance of all aggravating factors that could render such treatment less effective. Such is particularly important for patients who will require stimulant medication--which, while very helpful, also can have side effects, particularly if given in higher doses. Also, the more potent stimulants frequently lose effectiveness over time. Those patients who do best at minimizing their sleepiness tend to be those who use common sense measures, to make themsleves optimally responsive to the lowest dosages of the mildest available medications.

What factors should I know about that could make my treatment less effective?

1. Poor sleep habits

-Either inadequate sleep or irregular sleep habits must be avoided.

-How much sleep do I need? While requirements vary, most people need 7-8 hours per night. Trial and error may help determine what is best in your case. Less than six hours/night is rarely adequate, and too much sleep (for example over 9 hours) will make many people feel worse.

-What about naps? They're often extremely beneficial as long as they aren't taken too close to bedtime (which can cause difficulty falling asleep, result in delayed bedtimes, and worsen sleep quality). If you are on a regular day shift schedule, naps in the early afternoon often work best, and they should be avoided after 6:00 P.M. Naps usually should be restricted to an hour or less. Longer naps make many people feel worse.

-Erratic sleep habits should be avoided. Most people do best if they do to bed and get up at fairly consistent times.

2. Dietary factors

Many patients report that certain foods--even in small amounts&emdash; make their sleepiness much worse, and they often describe cravings for those particular foods! While not confirmed by formal studies, it is difficult to ignore similar complaints voiced by people who don't know eachother. Hence, if you crave some specific food, it may be worthwhile avoiding to see if it was making you sleepier. Common reported "offenders" that you perhaps should try to avoid entirely--at least until you're doing well--are the following:

-Sweets (candy, cake, pie, cookies, etc.), regular pop, and other foods high in sugar--including honey. It has been shown that sugar increases entry of tryptophan (a sedating amino acid found in proteins) into the brain. Thus, it does seem logical to suspect that sweets would prove sedating, rather than giving one energy--at least for any length of time!

-Peanuts (are high in tryptophan) and peanut butter (most brands also contain sugar).

-Other foods high in tryptophan (such as turkey, dairy products). It may be best to take them before bedtime.

-Apples and apple-containing foods have been reported by a number of patients to increase their sleepiness: for uncertain reasons, since apples are not high in tryptophan. It may be worth trying to take them only before bedtime.

-Other patients describe being sensitive to still other foods that may be a unique problem in their particular case. If you've been doing well and suddenly have problems, see if they correlate with certain foods you've eaten

In general, it is best to eat regularly, and to avoid eating lunch late, near the time of maximal mid-afternoon sleepiness.

Obesity should be avoided and/or corrected by appropriate changes in eating habits (not by 'crash diets' or weight loss pills that may interact with prescribed stimulant medications). Such is particularly crucial if you have breathing abnormalities in sleep.

3. Sedating drugs and alcohol.

Many prescribed and over the counter medications are sedating! Review any new medications with your doctor in this regard, and note whether your sleepiness worsened at the time you began taking them. Alcohol can make sleep quality worse and can aggravate sleep apnea---with increased sleepiness that may not be evident until the following day.

4. Not taking medications properly.

If you are started on medication for your sleepiness, you should receive instructions on how and when to take it. The timing and dosages may require adjustment. Timing is very important!! For instance, if you are taking a stimulant during the daytime, waiting to take a dose until after you've become sleepy or have eaten a meal may be 'too late'. The medication, which your body needs time to absorb, will have placed at a disadvantage-similar to trying to jump over a hurdle without the benefit of a 'running start'.

Some drugs accumulate in the body over several weeks, such that their effectiveness and/or side effects will increase gradually. Patience is needed to avoid excessively rapid dosage increases. On the other hand, it is important to avoid becoming discouraged if an initially effective medicine loses its effect. Your body may have become more efficient in breaking it down and a minor dosage change may solve the problem. Your physician should work with you on adjustments. You should follow recommendations on your medication consistently. Do not change your dosage without instructions to do so.

5. Infections.

Even if seemingly minor (colds, flu, sinusitis, etc.), infections can produce marked worsening in some people. We suggest you contact your family doctor for possible antibiotic treatment particularly if you note yellow or greenish mucous drainage or sputum.

6. Emotional state.

Some emotions, especially depression or reactions to being confronted with difficult and/or unpleasant situations, can worsen sleepiness. This fact is important to recognize. Otherwise, increased sleepiness can provoke depression over one's inability to function, which worsens sleepiness, ...and so on.

7. Menstrual cycles.

Some women report increased daytime sleepiness before menses and/or ovulation.

8. Physical activity.

Physical inactivity, either in your lifestyle or related to monotonous, repetitive desk tasks, can make alertness difficult to maintain. If possible in your work situation, arrange to do 'boring' tasks during your times of peak alertness (for most people, usually mornings) and your more active tasks during 'slump' times. Also, increased alertness may result from adoption of a moderate fitness lifestyle (e.g.-walking, swimming, gardening). Check with your family doctor first regarding any restrictions on your ability to exercise.

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