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Topics:
Ethics • General Internal Medicine • Neurology • Pulmonology • Sleep Medicine • Psychiatry • General Primary Care
When would you consider prescribing a wakefulness promoting agent for excessive daytime sleepiness from insufficient sleep?
I.e. no sleep disorder diagnosis, unsuccessful behavioral interventions for improved sleep
Answer from: at Academic Institution
I would never consider prescribing an alerting medication for someone with insufficient sleep. Behaviorally insufficient sleep is a diagnosis in and of itself. The treatment for excessive daytime sleepiness in the case of insufficient sleep is changing behavior to allow for more time in bed. I would...
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Answer from: at Community Practice
I would start by administering the Epworth Sleepiness Scale as the first-line screening step. If the score suggests pathological daytime sleepiness, I would proceed with a sleep consultation and formal sleep study to evaluate the differential diagnoses: narcolepsy, obstructive sleep apnea (OSA), and...
Answer from: at Community Practice
I would explore and correct the nighttime poor sleep first.
If that does not improve the daytime sedation, then explore further into the reasons for the disturbance and treat the underlying cause.
If that fails, only then will I consider providing them with an agent to awaken them.
I will try wor...
Answer from: at Community Practice
If their job involves driving or extended shifts including a lot of shift work, late night driving, e.g., public bus driver or Uber/Lyft or limo driver, etc. then I would prescribe a limited number of wake promoting pills (10-15) so that if they feel sleepy, at least they do not put themselves or ot...