Drowsiness and Fatigue

Pathophysiology of drowsiness and fatigue

Insufficient duration and quality of sleep

How is degree of sleepiness determined?

Homeostatic process (increased sleepy as day progressed), Circadian process - alertness varies throughout the 24hr day

What are recognized assessment methods to evaluate drowsiness in patients?

Stanford Sleepiness Scale, Epworth Sleepiness Scale

What are the treatment goals of drowsiness?

Identify and eliminate the underlying cause to improve mental alertness and productivity

What are exclusions for self-treatment of drowsiness?

Chronic symptoms, even with 7-8 hours of sleep per night

What are non-pharmacologic therapies of drowsiness?

Good Sleep Hygiene

What are pharmacologic treatments of drowsiness?

Caffeine - Not substitutes for good sleep hygiene

Caffeine MOA

Inhibits phosphodiesterase causing increased levels of 3’5’ cyclic adenosine monophosphate, in turn preventing apnea

Since caffeine is a stimulant, what does that mean?

It increases sensitivity to CO2, stimulating central inspiratory drive and enhancing contraction of skeletal muscles (ex. The diaphragm)

Suggested caffeine dosing in adults / child 12+

100 to 200 mg every 3-4 hours as needed

Caffeine side effects

Decreased fine motor coordination, headache, nervousness, dizziness

Caffeine onset

15 min after 1st dose

Caffeine peak concentration

30 to 120 minutes

Caffeine Half-life

5 hours in adults and kids over 9

Caffeine mild withdrawal effecs

Headache, fatigue, decreased concentration, irritability

Caffeine-Drug Interactions

Cigarette Smoke - If you quit, cut caffeine intake by half

Ciprofloxacin, hormonal contraceptives, and other meds interacting with CYP1A2 enzyme. Caffeine intake should be limited

Complementary therapies for drowsiness

Ginseng

What does ginseng do for drowsiness?

Boosts physical and mental energy and produce sense of well-being

When does caffeine tolerance build in individuals consuming it?

Builds when people consume 100 to 200 mg daily

What is considered safe caffeine intake in pregnancy?

AAP - 300 mg

How should caffeine be used while breast feeding?

Limit while breastfeeding and ingest it directly AFTER breastfeeding to limit exposure

When should a patient seek medical attention for drowsiness and fatigue?

Drowsiness/Fatigue that persists even with limited caffeine use and have good sleep and hygiene practices for 7 to 10 days

What is good sleep hygiene?

Use bed for sleep and intimacy only, establish regular sleep patterns, avoid electronics before bed, avoid eating within 2 hours of sleep (if hungry try light snack), if unable to fall asleep after more than 20 min, get out of bed, try a relaxing activity, and get back in bed when tired