[Treatment of excessive daytime sleepiness]

Excessive day-time sleepiness (EDS) is in more than 80% of the subjects caused by the sleep apnoe syndrome (SAS), narcolepsy and idiopathic hypersomnia. SAS is treated by continuous positive airway pressure or by uvulopalatopharyngoplasty. Narcolepsy is manifested by imperative sleepiness which may be preceded by a period of non-imperative EDS. In the treatment of narcolepsy "preventive" day-time naps and administration of stimulants are used. EDS cannot be completely eliminated in some narcoleptics. EDS in idiopathic hypersomnia can be usually influenced only by stimulants. The author gives an account of the medication used in 57 patients with narcolepsy (mean age 51.7 years, range 16-75) and experience with this therapy. Ephedrine was used by 45.6% patients (usually combined with phenmetrazine) amphetamines in 26.3%, phenmetrazine in 82.5% and mazindol in 19.3%. Significant phenmetrazine dependence was developed by one patient from a group of more than 200 narcoleptics. Other causes of EDS are illnesses and circumstances which interfere with nocturnal sleep. There it is important to influence at the first place the quality of the nocturnal sleep. Diseases of circadian rhythmicity elicit EDS teo and can be treated using special therapeutical approaches. EDS may be the manifestation of psychiatric diseases.