Somnolence is a state of sleepiness where you're close to falling asleep, and may not be able to resist the urge to doze off. As someone in treatment for bipolar disorder or another mental illness, this can affect you since many psychiatric medications (and many non-psychiatric medications, too) can cause somnolence. That's why there are so many warnings about not driving until you know how a medication might affect you, or not operating heavy equipment when you're taking these medications. Literally, you could fall asleep in the middle of those activities, even when you're trying hard to stay awake. Somnolence is a medical term, but there are many other terms for the same state of sleepiness including drowsiness, lethargic, insensible and just plain sleepy. Medications are far from the only cause of this problem: Some clinicians estimate that excessive daytime sleepiness may affect up to 20% of the overall population.
Causes
There are a variety of causes of somnolence, and not all are related to your health or to medications you're taking. Perhaps the most common cause is simply not getting enough sleep — studies show that people who work different shifts that interfere with their normal sleep rhythms may be more prone to accidents and mistakes. For example, according to the National Sleep Foundation, the disintegration of the space shuttle Columbia and the grounding and subsequent oil spill from the Exxon Valdez both have been attributed to mistakes made due to fatigue. Shift workers may also be at higher risk for conditions like heart disease and diabetes.
Other possible somnolence causes can involve medical conditions (not treatments). Diabetes, chronic pain, low thyroid function and other conditions may cause excessive sleepiness. In addition, there are disorders specifically related to sleep — sleep apnea, for example, where you literally stop breathing for very short periods during sleep — that can interfere with your rest and cause somnolence when you're awake. To determine what's causing your problem, you may need an evaluation from a doctor who specializes in sleep disorders.
Some causes are:
Sleeping disorders- the sleeping disorders such as excess snoring, sleep apnea, sleep walking, insomnia, narcolepsy could cause somnolence. If the doctors are able to determine that the underlying problem is sleeping disorder then they may probably suggest cognitive behavioral therapy, medications or sleeping aid.
Medical conditions- a person may feel drowsy due to a number of medical conditions. Moreover certain medications can too cause somnolence. This problem can be caused by certain cancer treatments such as chemotherapy. Somnolence can also be caused by certain other medical conditions such as underactive thyroid gland, diabetes, anemia and chronic pain. Somnolence could alternatively be caused by stress, depression, anxiety and boredom. The doctor may try other treatment options if the problem is caused by a certain medical condition.
Hormones- in women, drowsiness can be caused by hormones. This happens especially during childbirth or pregnancy and during menstrual cycle. If a person has an underactive thyroid gland then they would want to sleep more and would need more day time naps.
Diseases- the body can be urged to sleep more by a number of health conditions mostly the chronic diseases such as auto immune disease, diabetes, underactive thyroid, stroke.
Depression- people who are depressed may feel fatigue and low energy levels. Also there is a strong desire to sleep in such people. In the state of depression some people may have to tendency to oversleep, sleep whole day or may experience insomnia.
Biological clock- by people who have a circadian rhythm disorder may also experience drowsiness.
Restless leg syndrome- in the legs there is an unpleasant sensation and there is a strong urge to move the legs. Throughout the night in every 20-30 second, this condition causes jerky movements. Sometimes even other parts of the body are affected. While the person is at rest or sleeping the symptoms of this condition may occur or get worse. The sleep can get interrupted since the symptoms usually become worse at night. Hence the time the person needs to be sleeping that time the person is awake. Sometimes the condition can be misdiagnosed as insomnia since the condition becomes similar to insomnia.
Bipolar Medications That Cause Somnolence
But there's no doubt that medications are a significant cause of somnolence, especially in people being treated for mental health conditions such as bipolar disorder.
- Antidepressants. One of the most common side effects reported for antidepressants is sleepiness, although some types also can cause insomnia. People taking selective serotonin reuptake inhibitors (SSRIs) such as Prozac (generic name: fluoxetine) or serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (generic name: duloxetine) report this problem. Older tricyclic antidepressants also can cause this problem.
- Benzodiazepines. These anti-anxiety drugs, which include Xanax (generic name: alprazolam) and Valium (Generic name: diazepam), also can cause severe somnolence. Medical studies have looked at the effects of caffeine (the equivalent of two or three cups of coffee) in people taking benzodiazepines, and have found it helps in some cases, but not all.
- Lithium. Many patients (but not all) report getting sleepy when taking lithium for their bipolar disorder, and in fact, tiredness and sleepiness are known side effects of the medication. This gets better with time in some people as they adjust to its effects.
- Anticonvulsant and anti-psychotic medications. Many of these medications cause drowsiness.
The medications used to treat bipolar disorder affect different people in different ways. Therefore, if you find that one drug or combination of medications is causing somnolence, talk to your doctor about adjusting your treatment regimen.
Treatments
The best way to treat somnolence is to address the underlying cause. Changes to routine, sleeping habits, sleeping environments, schedule and sleep management is required to be made by such a person.
Some specific treatments can be applied if the person is diagnosed with some sleeping disorder. Using a continuous positive airway pressure machine is the most effective treatment method.
Medications may also be helpful in some people. Some medications maybe prescribed for some people who despite using CPAP feel drowsy. Medications may also be prescribed in case of narcolepsy. Such medications are helpful in keeping the person productive and awake the whole day. Sometimes changing sleeping habits or sleep schedule does not help shift workers.
For such shift workers who feel sleepy during working hours can use medications. It will be effective. For sleep apnea, devices can be used that open the airway such as devices that move the lower jaw, tongue or devices that move the soft palate forward.
By reducing fat deposits and losing weight, the risk of sleep apnea can be lowered in case if the person is obese. Also many of the other risks associated with this condition such as heart disease can be reduced. If other treatments to treat sleep apnea fail then surgery may be recommended.
Drugs that promote wakefulness- two drugs that promote wakefulness are modafinil and armodafinil. These medications change the way certain medications act in the brain. On the brain they have monoaminergic effect. Also certain stimulants may be effective such as methyphenidate. It is important that with the doctor you closely monitor your progress in order to determine which medications is right for you.
However your medical history, sleep schedule, sleep habits, unique situations will determine the treatment plan. Usually based on the cause the treatment plan will be suggested. If somnolence is caused by lifestyle and behavior then the effective solution could be to get rid of distractions and get plenty of rest.
The symptoms of restless leg syndrome can be reduced by moving the legless. If the doctor says that the iron levels are low and recommends them then take iron or vitamin B12 or folate supplements. You can discuss with your doctor as to what is making the condition worse such as medications to treat nausea, allergies, high blood pressure, depression, heart conditions. Keep yourself away from, alcohol, nicotine and caffeine. You need to follow healthy diet, try relaxation techniques and exercise regularly. Also the following medications can help to treat the symptoms of restless leg syndrome:
- Anti seizure drugs- some medications such as gabapentin, carbamazepine and valproate can be helpful. A newer drug used to treat restless leg syndrome is horizant that was not developed to treat seizure.
- Anti-parkinsonian drugs- this includes drugs such as praipexole, carbidopa, pergolide, levodopa and ropinirole.
- Benzodiazepines such as lorazepam, diazepam , temapzepam and clonazepam
- Opiates- this includes medications such as oxycodone, methadone and codeine only if the restless leg syndrome is severe.
The best approach is to start with these drugs one at a time since these drugs have not been compared thoroughly in studies. The doctor may find alternative if the drugs do not work. A combination of drugs can be recommended if the case is severe.
Safety and drug interactions
For the treatment of excessive sleepiness a number of different options are available. However it is important to bear in mind that medications cannot replace healthy sleep. It should be known that by medications other forms of treatment therapies can be complemented. This includes medical and behavioral therapies. Often for people with narcolepsy, stimulants such as methyphenidate are prescribed.
They stimulate the central nervous system and make the person more alert. However with this medication certain side effects are associated. The side effects include irritability, tremors, insomnia and high blood pressure. When taking medications always follow the doctor’s instructions.
