If you’ve got obstructive sleep apnea (OSA), you might also have excessive daytime sleepiness (EDS), but not always. If you’ve got EDS, you might also have OSA, but not always.
EDS is a common symptom of OSA, but not everyone with OSA has this symptom. On the flipside, OSA is a common cause of EDS, but not the only possible cause.
Here’s the breakdown:
What Is Obstructive Sleep Apnea?
OSA is a common but potentially serious chronic sleep disorder. When you have it, your throat muscles relax too much while you’re sleeping and narrow your airway. This blocks the passage of air through your throat, which causes loud snoring and choking or gasping for air. It also decreases the oxygen supply to your blood.
People with OSA may wake up repeatedly throughout the night as they gasp for air. This fragmented sleep can leave you feeling tired in the morning even though you think you got a full night’s sleep.
What Are the Symptoms of OSA?
If you have OSA, besides snoring loud, gasping in your sleep, and waking up often, you may also have:
- A dry mouth when you wake up
- Headaches in the morning
- Trouble staying asleep
- Trouble focusing during the day
- Excessive daytime sleepiness (EDS) or hypersomnia
What Is Excessive Daytime Sleepiness?
EDS, which doctors also call hypersomnia, is the inability to stay awake or alert during the daytime hours, even if you got a full night’s sleep. You can have primary or secondary hypersomnia.
In primary hypersomnia, the EDS itself is a condition on its own. There are three types of primary hypersomnia:
- Idiopathic hypersomnia, which is EDS with no known cause
- Kleine-Levin syndrome, a rare condition that makes you so sleepy that you sleep for 16 to 20 hours at a stretch during flares
- Narcolepsy, which interferes with your brain’s ability to control when you sleep and when you wake, making you fall asleep uncontrollably throughout the day
In secondary hypersomnia, EDS happens as a result of another problem that you might be able to treat or address, such as:
- Recreational drug and alcohol abuse
- Side effects of some prescription medications, including sedatives, muscle relaxers, and antipsychotics
- Certain health conditions that affect your brain, muscles, or central nervous system
- Mental health conditions like depression
- Regularly getting less than seven hours of sleep a night
- Regularly getting poor quality sleep because of frequent interruptions, which can be caused by bright light, noise, or OSA
What Are the Symptoms of EDS?
When you have EDS, besides that all-day drowsiness or constant need to nap, you may have:
- Anxiety, irritability
- Low energy
- Trouble waking up from a full night’s sleep or a nap, known as “sleep drunkenness”
- Confusion or anger when waking up
- Hallucinations
- Headaches
- Memory loss
- Sleep paralysis
- Sleeping 11 hours or more at a stretch
- Trouble focusing
- Daytime naps that don’t feel restful
OSA, EDS, or Both? And Why It Matters
OSA can be one cause of secondary hypersomnia or EDS, but OSA doesn’t always cause EDS. In fact, doctors may classify your OSA as “with-” or “without excessive daytime sleepiness.” Because EDS can be such a burdensome part of OSA, some researchers are even exploring whether to consider OSA with EDS an entirely separate medical condition from OSA without EDS.
If you don’t already have a diagnosis of OSA, and you see a doctor about your EDS, the doctor will want to know what’s behind the EDS.
They might have you complete:
- A sleep study in which you are monitored while you sleep overnight in a lab
- A multiple sleep latency test to see how long it takes you to fall asleep
- A questionnaire on your symptoms
These tests could reveal that OSA is the likely cause of your EDS. Or you might already know you have OSA, and EDS is one of your symptoms. Either way, research shows that OSA with EDS is a more severe form of the condition that needs more urgent treatment than OSA without EDS.
People who have OSA with EDS may not live as long as those who have OSA without EDS, making it even more critical to get treatment not only for the symptom of EDS but also for OSA, if that’s the underlying cause.
Treatment for OSA With EDS
Doctors need to find the underlying cause of your EDS, whether it’s OSA or something else, so they can give you the right treatment.
Treatments for OSA depend on the severity of the condition and may include:
- Avoiding sleeping on your back
- Losing weight or maintaining a healthy weight
- Wearing a mouth guard
- Using a CPAP (continuous positive airway pressure) machine
- Surgery
If you have OSA with EDS, it’s most likely moderate to severe. The standard treatment for moderate to severe OSA is a CPAP machine. This device attaches to a mask you wear while you’re sleeping. It sends air into your mouth and/or nose continually so your airway stays open throughout the night. This helps correct your nighttime breathing so that you’re no longer snoring, gasping for air, and waking up repeatedly in the night.
For many people, sleep quality surges with a CPAP, and they stop feeling sleepy during the day. This is one example of why it’s so important to find and treat the underlying cause of EDS, rather than just treating the symptom of daytime sleepiness.
But a CPAP doesn’t wipe out daytime sleepiness for everyone. According to some estimates, as many as half the people with OSA with EDS still have some degree of daytime sleepiness even after starting on a CPAP machine.
If you’re still too sleepy during the day though you’re using a CPAP as directed by your doctor, the doctor might want to examine you to see if some other health condition or lifestyle factor is making you sleepy during the day. In this case, treating the condition or making a lifestyle change could help.
If there’s no other treatable cause of your EDS, your doctor might prescribe wake-promoting medication to help you stay awake during the day.
Treatment for EDS Without OSA
If you have EDS, but you don’t have OSA, a CPAP machine wouldn’t treat your symptoms. Your doctor will focus on a different treatment path.
Depending on the underlying cause, your doctor may recommend a combination of some of the following:
- Treatment of an underlying condition that’s making you sleepy during the day
- Wake-promoting medications to help you stay alert during the day
- Lifestyle changes to help you stay alert during the day and sleep better at night
- Talk therapy to address stress, anxiety, depression, or other mental health concerns that might be interrupting your sleep at night
If you have primary EDS — hypersomnia without a separate underlying cause that can be treated or reversed — there’s not a cure. But these treatments will help reduce your daytime sleepiness as much as possible so you can live your life.
What If I Think I Have OSA or EDS?
If you think you have OSA, or if you just can’t stay awake and alert during the day when you should be up, your first stop should be your primary care provider. Your doctor will ask questions about your sleep patterns and other possible symptoms of OSA or EDS. They will also ask questions about your lifestyle, medical history, and the medications you take.
The path to diagnosis may also include:
- A sleep study in a lab or a home sleep study
- A referral to a sleep medicine specialist
- A referral to an otolaryngologist (ear, nose, and throat specialist, or ENT)
Don’t delay getting a diagnosis and treatment for your sleep troubles. Sleep disorders of all kinds are major risk factors for many chronic diseases. OSA and EDS are treatable. Getting them under control and regaining a healthy sleep pattern will have far-reaching effects on your overall health and your quality of life.
Show Sources
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SOURCES:
Mayo Clinic: “Sleep Apnea.”
Cleveland Clinic: “Hypersomnia,” “Obstructive Sleep Apnea,” “CPAP Machine.”
Frontiers in Neurology: “Obstructive Sleep Apnea With or Without Excessive Daytime Sleepiness: Clinical and Experimental Data-Driven Phenotyping.”
Sleep: “Objective, but not subjective, daytime sleepiness predicts mortality in obstructive sleep apnea.”
Harvard Medical School: “Treating mild sleep apnea: Should you consider a CPAP device?”
Neurology and Therapy: “Current Management of Residual Excessive Daytime Sleepiness Due to Obstructive Sleep Apnea: Insights for Optimizing Patient Outcomes.”
UCHealth: “Sleep apnea.”
