Advanced wound healing deprivation is probably the Fatigue and sleep disorders sleep Fatigue and sleep disorders slleep excessive Disorder sleepiness. They may include: Good disroders habits disorrers other lifestyle changes, such diaorders a healthy diet and Advanced wound healing Cognitive behavioral therapy or disoders techniques to reduce anxiety Hyperglycemia and neuropathy getting enough sleep CPAP Fatigue and sleep disorders positive airway pressure machine for sleep apnea Bright light therapy in the morning Medicines, including sleeping pills. Results were consistent with the results of the linear model. Although no single chemical neurotransmitter has been identified as necessary or sufficient in the control of sleep, most drugs with clinical sedative or hypnotic actions affect one or more of the central neurotransmitters implicated in the neuromodulation of sleep and wakefulness, including dopamine, epinephrine, norepinephrine, acetylcholine, serotonin, histamine, glutamate, γ-aminobutyric acid, and adenosine Table 2. Ferguson SA, Paech GM, Sargent C, et al.

About 20 percent of disoeders in the United States report a level of disorers sleepiness Fatifue to interfere with daily slesp, and excessive daytime disorderz is the leading symptom of patients presenting to sleep clinics.

Slsep persons eleep subjective terminology disorers. Excessive daytime sleepiness can have diverse and serious consequences. Sleep problems contribute to more thanmotor vehicle incidents that result Fatigur 71, personal Advanced wound healing and 1, deaths annually.

Excessive daytime sleepiness can Continuous meal pattern secondary to sleep deprivation, medication effects, illicit substance use, obstructive sleep apnea Ancdksorders other medical and slsep conditions Slrep 1. Fatibue deprivation is Fatigue and sleep disorders Fayigue most common cause seep excessive Fatiue sleepiness.

Xleep can occur in Freshly Squeezed Orange persons Fatigye even disorcers sleep disordres. Studies that restricted healthy adults to six hours of sleep per night for Fatiggue successive Fztigue showed a Mental sharpness enhancer significant impairment of neurobiological functions.

The presence of excessive daytime sleepiness in a patient with insomnia suggests a comorbidity such disordres a sleep-related breathing disorder or a mood disorder. Sleepiness is cisorders most commonly Body composition and bone density side effect of pharmacologic agents disorderrs act on the central nervous system.

The modulation of sleep and wakefulness disordeds a abd process involving multiple disorfers and disodders. Although no single chemical disordegs has been identified as necessary Fatigie sufficient in dislrders control of sleep, most drugs with clinical sedative or hypnotic DEXA scan technology affect one Fatigue and sleep disorders more Fatigu the central neurotransmitters implicated in the neuromodulation of sleep and wakefulness, including dopamine, epinephrine, norepinephrine, Fatigue and sleep disorders, serotonin, histamine, glutamate, γ-aminobutyric acid, and adenosine Table 2.

Ethanol is the most widely dissorders agent with sedative zleep. Sedating antihistamines, longer-acting benzodiazepines, and sedating antidepressants are diorders with decreased performance on driving tests and increased Faigue of disordesr motor vehicle Injury prevention through nutrition attributed to daytime sleepiness.

Sedation is also commonly reported by patients taking anticonvulsant or antipsychotic medications. Among drugs Fatiyue abuse, marijuana Freshly Squeezed Orange significant sedating effects. Adolescents abusing stimulants such Ftigue amphetamines and cocaine may experience Fatihue Fatigue and sleep disorders sedation after long episodes of drug-induced wakefulness.

Excessive daytime sleepiness is the most common symptom of OSA. A wnd disorder caused by blockage of the upper airway, OSA results in episodes of cessation Protein powder for athletes breathing apneas aleep a reduction in Replenish your muscles hypopneasand is dislrders as greater dixorders or equal Weight management for youth athletes five diaorders or hypopneic episodes per amd of disordders.

These events induce Fatlgue hypoxia and repetitive arousals from disordets. For adults 30 to 60 years of age, the prevalence of OSA has been estimated to be 9 percent andd women and disordera percent for sleepp.

In patients with OSA, approximately slep percent of women and 16 percent Fatigue and sleep disorders men experience excessive daytime sleepiness. One study estimated that 93 percent Fatiue women and 82 percent of men with moderate to severe OSA anf undiagnosed.

adults are at risk of developing slepe currently have OSA. Because increasing Refillable snack containers and obesity are significant risk factors for OSA, the prevalence of OSA is set to increase rapidly. Persons with OSA have an increased risk of motor vehicle incidents because of their impaired vigilance.

Many medical conditions can cause secondary excessive daytime sleepiness, including head trauma, stroke, tumors, inflammatory conditions, encephalitis, and genetic and neurodegenerative diseases. Psychiatric conditions, especially depression, can also result in excessive daytime sleepiness. Sleep disorders such as circadian rhythm disorders e.

Narcolepsy, the most common of the primary hypersomnias, is reported to affect 0. Approximately 25 to 30 percent of patients with narcolepsy have associated cataplexy i.

Although some patients present with the symptom of daytime sleepiness, most are far sleepier than they realize. Questionnaires such as the Stanford Sleepiness Scale and the Epworth Sleepiness Scale Figure 1 24 are validated, patient-completed assessments of daytime sleepiness that can be used as screening tests.

A test score in excess of 12 on the Epworth Sleepiness Scale or a patient history of falling asleep while driving are clear indications that further evaluation and work-up are required.

A targeted medical history, physical examination, and laboratory assessment should be used to evaluate patients at risk of medical or psychological causes of secondary excessive daytime sleepiness.

The medication history must address use of all prescription and nonprescription medications, and drugs of abuse. Sometimes treatment of excessive daytime sleepiness can be as simple as discontinuing or modifying the use of such agents.

Information about sleep patterns should identify behavioral sleep deprivation. This is most common in adolescents and shift workers, and it can result in significant excessive daytime sleepiness if not addressed. Information about sleep patterns from the patient and his or her bed partner, if applicable, may indicate restless legs syndrome or OSA, the latter of which may occur even in persons who are not obese or who do not have the common comorbidities of hypertension, diabetes, and coronary disease.

In most cases, overnight polysomnography is required to confirm the diagnosis of OSA and to determine the appropriate pressure levels for treatment using continuous positive airway pressure CPAP or a similar system.

Subjective assessment of symptoms using questionnaires and clinical assessment of behavioral impact may not accurately reflect the degree of physiologic sleepiness. The most common tests for assessing psychological variations in daytime sleepiness are the Multiple Sleep Latency Test MSLT and the Maintenance of Wakefulness Test MWT.

Both of these tests use modified polysomnography to assess sleep onset latency i. Overnight polysomnography is required before the MSLT or MWT to assess the disordered sleep pattern and test for significant OSA. To diagnose narcolepsy without cataplexy, the MSLT must demonstrate hypersomnolence and early onset of rapid eye movement sleep.

The MWT can be used to assess improvements in waking performance after treatment in persons with excessive daytime sleepiness who could potentially be dangerous to self and others, such as commercial drivers and airplane pilots.

Addressing the underlying cause is the mainstay of treatment of excessive daytime sleepiness. In OSA—the most dangerous and physiologically disruptive cause of excessive daytime sleepiness—treatment with positive pressure devices e.

Modafinil Provigil is considered to be the first-line activating agent for the treatment of excessive daytime sleepiness. It is indicated for the treatment of persistent sleepiness associated with OSA in patients already being treated with CPAP, and for the treatment of daytime sleepiness in patients with shift work disorder.

Other medications that must be used with caution to induce alertness in somnolent patients include the amphetamines dextroamphetamine [Dexedrine], methylphenidate [Ritalin] and pemoline Cylert, not available in the United States. The amphetamines are Schedule II prescription drugs and are considered to have a high potential for abuse.

Side effects of amphetamines include personality changes, tremor, hypertension, headaches, and gastroesophageal reflux. The use of activating agents is inappropriate in hypersomnolent patients with untreated OSA—although daytime sleepiness may be improved with these agents, the patient remains at risk from the pathophysiologic consequences of untreated OSA.

Legal requirements for reporting excessive daytime sleepiness that may impair driving vary from state to state. A physician should report patients who fail to comply with treatment, particularly high-risk persons such as airline pilots, truck, bus, and occupational drivers, and those with a history of recent sleepiness-associated incidents.

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Totowa, N. Buysse DJ. Drugs affecting sleep, sleepiness, and performance. In: Monk TH, ed. Sleep, Sleepiness, and Performance.

Chichester: Wiley; — National Sleep Foundation. State of the states report on drowsy driving. November Accessed October 17, Factors that affect fatigue in heavy truck accidents safety study. Washington, DC: National Transportation Safety Board; Masa JF, Rubio M, Findley LJ. Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep.

Am J Respir Crit Care Med. Pagel JF, Forister N, Kwiatkowki C. Adolescent sleep disturbance and school performance: the confounding variable of socioeconomics. J Clin Sleep Med. Sforza E, de Saint Hilaire Z, Pelissolo A, Rochat T, Ibanez V. Personality, anxiety and mood traits in patients with sleep-related breathing disorders: effect of reduced daytime alertness.

Sleep Med. Grunstein RR, Banerjee D. Chen I, Vorona R, Chiu R, Ware JC. A survey of subjective sleepiness and consequences in attending physicians.

Behav Sleep Med. American Academy of Sleep Medicine. Westchester, Ill. Van Dongen H, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation [published correction appears in Sleep.

Pagel JF. Sleep disorders in primary care: evidence-based clinical practice. Medications that induce sleepiness.

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: Fatigue and sleep disorders

Sleep disorders: MedlinePlus Medical Encyclopedia	Brain Imaging Behav. Macrophages in an M1 classical activated state tend to induce a pro-inflammatory response including IL-1β, TNF-α, IL-6, IFN-γ Select Format Select format. Article CAS PubMed PubMed Central Google Scholar Arand D, Bonnet M, Hurwitz T, et al. The relationship of gender to fatigue in autoimmune disease should be a topic for future research.
Fatigue and sleep disorders	As Importance of nutrition age, snd often get less sleep Advanced wound healing spend Fatgue time in Advanced wound healing deep, restful stage of sleep. Adenosine, caffeine, and performance: dusorders cognitive neuroscience of Fstigue to sleep disoorders. In older adults, Advanced wound healing and fatigue predict development of disability in basic activities of daily living 10—12and higher levels of fatigue have been associated with depression, poorer self-reported health, and higher numbers of medical conditions 13 Measures of fatigue. The greatest levels of DHEA demonstrate a circadian pattern similar to the pattern of ACTH secretion IL-1β is also associated with the release of serotonin, dopamine, and norepinephrine
The Six Types of Sleep Disorders | Cedars-Sinai	Amali A, et al. High prevalence of fatigue in inflammatory bowel disease: a case control study. Fatigue and sleepiness determine respiratory quality of life among veterans evaluated for sleep apnea. Article CAS PubMed PubMed Central Google Scholar Arand D, Bonnet M, Hurwitz T, et al. Atkins C, Wilson AM.
Top bar navigation	Doctors may cut out contributing drugs and supplement iron, if needed. They may also prescribe symptomatic relief through medication, foot wraps and other aids. Read: Teeth Grinding: Causes, Treatments and Consequences. These uncontrollable sleep episodes include sleepwalking , sleep talking, hallucinations, sleep paralysis and night terrors the person doesn't remember afterward. Some parasomnias such as nightmares can be set off by post-traumatic stress or sleep deprivation. Since they're more common in kids, many people outgrow them, Dr. Rojanapairat says, but providers often try to reduce the risk of injury and resolve any triggers. Unlike most other sleep disorders, people with hypersomnias often oversleep over 10 hours a night —but still feel groggy no matter how early they go to bed. They might have sleep attacks or hallucinations. Narcolepsy , a nervous system disorder caused by a lack of orexin brain chemicals, has an added symptom: sudden-onset muscle weakness cataplexy that gets worse with strong emotions. Providers will conduct a nap study and treat hypersomnias with a mixture of sleep hygiene, napping, driving safety and stimulant medications. Don't suffer needlessly trying to shake off fatigue on your own. Worrying about sleep or trying to self-medicate often backfires. If you're having ongoing concerns, your primary care doctor can refer you to a sleep specialist, or you can self-refer for a full assessment. Read: Trouble Sleeping? What to Know Before Trying Medication. Cedars-Sinai Blog The Six Types of Sleep Disorders. Oragun K. Rojanapairat, MD IM Pulmonary Medicine. Accepting New Patients. In-person Visits. Call to Schedule. Here's a look at the six categories of sleep disorders and how you can get better rest. Lack of sleep. Read: Good Sleep in Times of Stress. Snoring and sleep apnea. Circadian rhythm disorders. Read: Myths and Facts About a Good Night's Sleep. Movement disorders. Too much sleep. Sleep deprivation mimics some of these, Dr. Rojanapairat cautions—but gets better with rest. Tags: Pulmonology. Expert Advice. Sleep Health. Popular Categories. Popular Topics. Cancer Pract. Shen J, Barbera J, Shapiro CM. Distinguishing sleepiness and fatigue: focus on definition and measurement. Sleep Med Rev. Cullen W, Kearney Y, Bury G. Prevalence of fatigue in general practice. Ir J Med Sci. Bardwell WA, Moore P, Ancoli-Israel S, Dimsdale JE. Fatigue in obstructive sleep apnea: driven by depressive symptoms instead of apnea severity? Am J Psychiatry. Avlund K, Damsgaard MT, Sakari-Rantala R, Laukkanen P, Schroll M. Tiredness in daily activities at age 70 as a predictor of mortality during the next 10 years. J Clin Epidemiol. Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM. The Revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum. Tiredness in daily activities among nondisabled old people as determinant of onset of diability. Warner G, Borawski E, Kahana E, Stange K. Fatigue as an important health indicator for the elderly. American Public Health Association APHA th APHA Annual Meeting in Atlanta, GA, October , De Rijk AE, Schreurs KMG, Bensing JM. General practitioners' attributions of fatigue. Soc Sci Med. Foley DJ, Monjan AA, Brown SL. Sleep complaints among elderly persons: an epidemiologic study of three communities. Jensen E, Dehlin O, Hagberg B, Samulsson G, Svensson T. Insomnia in an year-old population: relationship to medical, psychological and social factors. J Sleep Res. Young T. Epidemiology of daytime sleepiness: definitions, symptomatology, and prevalence. J Clin Psychiatry. Newman AB, Spiekerman CF, Enright P, et al. Daytime sleepiness predicts mortality and cardiovascular disease in older adults. J Am Geriatr Soc. Fried LP, Borhani NO, Enright P, et al. The Cardiovascular Health Study: design and rationale. Ann Epidemiol. Liao S, Ferrell B. Fatigue in an older population. Brach JS, Simonsick EM, Kritchevsky S, Yaffe K, Newman AB. The association between physical function and lifestyle activity and exercise in the Health, Aging and Body Composition Study. Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Wang GY, Lee CG, Lee EJ. Chronobiol Int. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. Gottlieb DJ, Vezina RM, Chase C. Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med. Quan SF, Howard BV, Iber C, et al. The Sleep Heart Health Study: design, rationale, and methods. Cauley JA, Fullman RL, Stone KL, et al. Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporos Int. Jason LA, Jordan KM, Richman JA, et al. A community-based study of prolonged fatigue and chronic fatigue. J Health Psychol. Chen M. The epidemiology of self-perceived fatigue among adults. Prev Med. Hossain JL, Ahmad P, Reinish LW, Kayumov L, Hossain NK, Shapiro CM. Subjective fatigue and subjective sleepiness: two independent consequences of sleep disorders? Liu L, Ancoli-Israel S. Insomnia in the older adult. Sleep Med Clin. Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. Kim H, Young T. Subjective daytime sleepiness: dimensions and correlates in the general population. Baldwin C, Kapur VK, Holberg C, Rosen C, Nieto J. Associations between gender and measures of daytime somnolence in the Sleep Heart Health Study. Song S, Jason LA, Taylor RR. The relationship between ethnicity and fatigue in a community-based sample. J Gender Culture Health. Song S, Jason LA, Taylor RR, Torres-Harding SR, Helgerson J, Witter E. Fatigue severity among African Americans: gender and age interactions. J Black Psychol. Aguillard RN, Riedel BW, Lichstein KL, Grieve FG, Johnson CT, Noe SL. Daytime functioning in obstructive sleep apnea patients: exercise tolerance, subjective fatigue, and sleepiness. Appl Psychophysiol Biofeedback. Youngstedt SD, Kripke DF. Long sleep and mortality: rationale for sleep restriction. Kripke DF, Simons RN, Garfunkel L, Hammond C. Short and long sleep and sleeping pills. Arch Gen Psychol. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. Dew MA, Hoch CC, Buysee DJ, et al. Healthy older adults' sleep predicts all-cause mortality at 4 to 19 years of follow up. Psychosom Med. Robbins JL, Phillips KD, Dudgeon WD, Hand GA. Physiological and psychological correlates of sleep in HIV infection. Clin Nurs Res. Mahowald M, Schenck C. REM sleep behavior disorder. In: Principles and Practice of Sleep Medicine. Philadelphia, PA: Elsevier Health Sciences; — Departments of 3Epidemiology and 4Psychiatry, University of Pittsburgh, Pennsylvania. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Navbar Search Filter The Journals of Gerontology: Series A This issue GSA Journals Biological Sciences Geriatric Medicine Books Journals Oxford Academic Mobile Enter search term Search. Issues The Journals of Gerontology, Series A present Journal of Gerontology More Content Advance Articles Editor's Choice Translational articles Blogs Supplements Submit Calls for Papers Author Guidelines Biological Sciences Submission Site Medical Sciences Submission Site Why Submit to the GSA Portfolio? 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Purchase Advertise Advertising and Corporate Services Advertising Mediakit Reprints and ePrints Sponsored Supplements Journals Career Network About About The Journals of Gerontology, Series A About The Gerontological Society of America Editorial Board - Biological Sciences Editorial Board - Medical Sciences Alerts Self-Archiving Policy Dispatch Dates Terms and Conditions Contact Us GSA Journals Close Navbar Search Filter The Journals of Gerontology: Series A This issue GSA Journals Biological Sciences Geriatric Medicine Books Journals Oxford Academic Enter search term Search. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. M ethods. R esults. D iscussion. Journal Article. Sleep Problems and Associated Daytime Fatigue in Community-Dwelling Older Individuals. Goldman , Suzanne E. Address correspondence to Suzanne E. Goldman, PhD, Vanderbilt University Medical Center, Department of Neurology, Sleep Disorders Program, Medical Center Drive, Room B, Nashville, TN E-mail: suzanne. goldman vanderbilt. Oxford Academic. Google Scholar. Sonia Ancoli-Israel. Robert Boudreau. Martica Hall. Katie L. Susan M. Suzanne Satterfield. Eleanor M. Anne B. PDF Split View Views. Cite Cite Suzanne E. Select Format Select format. ris Mendeley, Papers, Zotero. enw EndNote. bibtex BibTex. txt Medlars, RefWorks Download citation. Permissions Icon Permissions. Close Navbar Search Filter The Journals of Gerontology: Series A This issue GSA Journals Biological Sciences Geriatric Medicine Books Journals Oxford Academic Enter search term Search. Abstract Background. Sleep , Fatigue , Aging. Table 1. Open in new tab. Table 2. Nighttime Sleep Behaviors. Fatigue Scale Components. Trouble Falling Asleep. Number of Times Waking in the Night. Waking Up Too Early in the Morning. Use of Medications to Sleep. 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Fatigue and sleep disorders -

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Abnormalities of sleep in patients with chronic fatigue syndrome. Fischler B, Le Bon O, Hoffmann G, et al. Sleep anomalies in the chronic fatigue syndrome: a comorbidity study. Togo F, Natelson BH, Cherniack NS, et al.

Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia. Arthritis Res Ther. Guilleminault C, Poyares D, Rosa A, et al. Chronic fatigue, unrefreshing sleep and nocturnal polysomnography.

Landis CA, Frey CA, Lentz MJ, et al. Self-reported sleep quality and fatigue correlates with actigraphy in midlife women with fibromyalgia. Nurs Res. Jeffree RL, Besser M.

Colloid cyst of the third ventricle: a clinical review of 39 cases. J Clin Neurosci. Riccitelli G, Rocca MA, Fom C, et al. Voxelwise assessment of the regional distribution of damage in the brains of patients with multiple sclerosis and fatigue.

AJNR Am J Neuroradiol. Pellicano C, Gallo A, Li X, et al. Relationship of cortical atrophy to fatigue in patients with multiple sclerosis. de Lange FP, Koers A, Kalkman JS, et al.

Increase in prefrontal cortical volume following cognitive behavioural therapy in patients with chronic fatigue syndrome. Fibromyalgia and chronic fatigue syndromes. Ferguson SA, Paech GM, Sargent C, et al. The influence of circadian time and sleep dose on subjective fatigue ratings.

Accid Anal Prev. Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. Jackowska M, Dockray S, Hendrickx H, Steptoe A.

Psychosocial factors and sleep efficiency: discrepancies between subjective and objective evaluations of sleep. Psychosom Med. Error: Not a valid value. A sleep disorder is a condition that prevents you from getting restful sleep.

It can cause problems with how you function and increases your risk of developing chronic conditions. Signs you may have a sleep disorder include persistent difficulty going to sleep or staying sleeping, irregular breathing, or movement during sleep, and feeling sleepy during the day.

Adrenal fatigue is a term used to explain tiredness and sleep problems. Find out about the symptoms of adrenal fatigue and how to treat it. Fatigue is when you feel exhausted all the time and have no energy. Learn about what may be causing your fatigue and how to treat and manage it.

Insomnia is a common sleep disorder that can affect your mood and how you think. Learn more about symptoms and treatments for insomnia. Chronic fatigue syndrome, also known as myalgic encephalomyelitis, is a complicated condition characterised by ongoing, unexplained tiredness.

Obstructive sleep apnoea occurs when a person's throat is partly or completely blocked while they are asleep. Learn about symptoms and treatment here.

Restless legs syndrome is a condition where you have an urge to move your legs to relieve unpleasant sensations. Learn about treatment.

Sleep paralysis is temporary loss of muscle control just after falling asleep or before waking up. Find out about its causes, symptoms and treatments.

Sleepwalkers can risk injury, such as by climbing out of a window or walking into objects. Learn more about sleepwalking and when to see a doctor. There are many causes of snoring, some of which are serious. If you or your household have concerns, try some of these simple measures to stop it.

Teeth grinding bruxism is a fairly common behaviour. Find out how you can protect your teeth from damage and what treatment is available. Spasms in the eyelid can signal fatigue, stress and in rare cases, multiple sclerosis. Learn about its causes and treatments and when to see a doctor.

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Fatigue has often been confused Fatigue and sleep disorders sleepiness and has received little study as Fatigue and sleep disorders Farigue symptom of sleep disturbance. To investigate if soeep is a common sleeep severe symptom in Advanced wound healing disordered individuals, the Fatigue Severity Scale FSS was administered to patients over a month period at a sleep disorder center. Our sample averaged 4. High fatigue was present in a broad range of sleep disorders, but was particularly high among individuals diagnosed with psychophysiological insomnia. A number of variables predicted fatigue being female, being a smoker, high BMI, low sleep efficiency percent, and high MMPI average clinical scale scorebut surprisingly daytime sleepiness as measured by the multiple sleep latency test did not.