Pharmacologic Management of Daytime Sleepiness

Excessive daytime sleepiness and abnormal sleep-wake patterns are becoming increasingly pervasivein modern society. The major causes of excessive daytime sleepiness include pathologic abnormalitiesof the central nervous system, such as narcolepsy and idiopathic hypersomnia; deficiencies inquality or quantity of sleep, such as those caused by sleep apnea and poor sleep hygiene; disturbancesto the body's natural circadian rhythm, such as those caused by shift work or jet lag; and drugs, whichcan increase sleepiness either therapeutically or as a side effect. Determining the cause of daytimesleepiness is the first step in treating it. Setting appropriate and realistic treatment goals with the patientand initiating treatment are the next steps. Although the medications available to improve daytimewakefulness (e.g., amphetamines, methylphenidate, pemoline, and modafinil) are effective, theyare not a substitute for sleep. Finally, timely follow-up is necessary to monitor treatment adherence,response, and side effects.