Highlights
- Innovative treatments and therapies for daytime sleepiness are transforming patient care in 2025.
- Comprehensive management, blending pharmacological and non-pharmacological approaches, enhances treatment effectiveness.
Summary and Causes of Daytime Sleepiness
Excessive daytime sleepiness (EDS) impairs daily functioning and arises from various causes including sleep disorders (narcolepsy, obstructive sleep apnea, idiopathic hypersomnia), psychiatric and neurologic conditions, and medication effects. EDS poses public safety risks, notably in driving. Pharmacological treatments remain central in 2025, featuring stimulants, wakefulness-promoting agents, sodium oxybate, and newer drugs like pitolisant and solriamfetol, with promising emerging therapies targeting narcolepsy’s root causes. Non-pharmacological methods such as cognitive behavioral therapy for insomnia (CBT-I), chronotherapy, and lifestyle changes complement drug therapies, aided by digital and hybrid behavioral interventions.
Sleep disorders causing EDS include obstructive sleep apnea, restless leg syndrome, and central hypersomnias like narcolepsy and idiopathic hypersomnia. Psychiatric disorders (depression, anxiety) and neurological diseases (stroke, Parkinson’s) also contribute. Certain medications, including benzodiazepines and opiates, can worsen sleepiness.
Diagnosis and Clinical Guidelines
Diagnosis combines clinical history with objective tests like the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) to identify causes and guide treatment. The American Academy of Sleep Medicine (AASM) provides guidelines emphasizing individualized care, public safety concerns, and the role of pharmacotherapy after conservative approaches fail. Recent expert consensus has refined management recommendations for EDS, particularly in sleep apnea.
Pharmacological Treatments
Treatment includes stimulants (methylphenidate, amphetamines), wakefulness-promoting agents (modafinil, armodafinil, solriamfetol), sodium oxybate formulations, and antidepressants for mood-related sleepiness. Sodium oxybate improves nighttime sleep and reduces cataplexy but requires careful monitoring due to side effects and misuse risk. New formulations like once-nightly FT218 and low-sodium Xywav improve compliance and safety. New agents such as solriamfetol and pitolisant offer effective alternatives with favorable safety profiles. Antidepressants and experimental drugs like reboxetine may aid cases linked to mood disorders.
Non-Pharmacological and Technological Interventions
Non-pharmacological treatments, including CBT-I, motivational interviewing, chronotherapy, and lifestyle modifications, improve sleep quality and reduce sleepiness. These are especially effective in adolescents and those with psychiatric comorbidities. Physical activities and good sleep hygiene also help. Digital CBT-I programs and hybrid therapies combining behavioral techniques and light therapy enhance accessibility and adherence, though scalability challenges remain. Emerging technologies, such as wearable brain-modulating devices and combined interventions like sauna blankets with CBT-I, are under investigation.
Comparative Effectiveness and Safety
Combining pharmacological and behavioral therapies yields better outcomes than single approaches. Novel agents like Axsome’s AXS-12 and Takeda’s TAK-861 show promising efficacy, with TAK-861 receiving FDA Breakthrough Therapy designation. Safety concerns include stimulant dependence and cardiovascular effects, and sodium oxybate’s psychiatric risks require monitoring. Clinical guidelines stress personalized treatment balancing efficacy and safety, with objective testing guiding management.
Current Practice and Emerging Therapies
Pharmacotherapy remains the cornerstone of EDS management in 2025, guided by AASM recommendations. Wakefulness-promoting agents are preferred first-line treatments, with stimulants and sodium oxybate used as indicated. New drugs targeting specific wakefulness pathways are advancing through clinical trials, aiming to improve outcomes while minimizing side effects. Nonpharmacologic methods are integrated into comprehensive care, especially for younger patients. Challenges include lack of biomarkers, high trial costs, and regulatory barriers, but ongoing research and innovation continue to expand therapeutic options.
The content is provided by Blake Sterling, Scopewires
