Which clinical conditions are responsible for impaired alertness?

Many people feel they are too sleepy during the day. Many people would like to be more alert. Where is the line between being sleepy as an inconvenience and excessive sleepiness as a medical condition?

Medical causes of daytime sleepiness include many medical and psychiatric disorders and patient behaviors. The list of possibilities spans virtually every major area of medicine, neurology and psychiatry. For a doctor to conclude the sleepiness is a medical problem, the doctor usually does a clinical interview and direct observation. Other factors could include subjective self-reports, objective physiological and behavioural measures, and performance tests.

When patients bring this issue to a doctor, they might complain about ‘tiredness’ or ‘fatigue’ rather than a direct reference to impaired alertness or performance.

Increased understanding of the neurological basis of alertness and sleepiness will undoubtedly lead to improved treatments.

The International Classification of Sleep Disorders (ICSD) includes 85 sleep disorders under eight major categories: (1) insomnias, (2) sleep-related breathing disorders, (3) hypersomnias not due to a breathing disorder, (4) circadian rhythm sleep disorders, (5) parasomnias, (6) sleep-related movement disorders, (7) other sleep disorders, and (8) isolated symptoms, apparently due to adverse effect of drugs, medications and biological substances.

This system helps physicians identify sleep disorders and may help them determine when a patient needs Provigil or another medication.

Related: Provigil and weight

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