From the Research
Management of daytime drowsiness in a 74-year-old female with Sjögren's syndrome should prioritize a comprehensive evaluation of potential causes, including medication side effects, sleep apnea, and fatigue related to the autoimmune condition itself, as recommended by the most recent study on excessive daytime sleepiness 1. The evaluation process should involve a thorough sleep, medical, and psychiatric history, as well as targeted clinical examinations and appropriate use of diagnostic tools such as actigraphy, polysomnography, and multiple sleep latency testing 2. Key considerations in the management of daytime drowsiness include:
- Non-pharmacological approaches such as maintaining consistent sleep schedules, practicing good sleep hygiene, and scheduling brief 20-30 minute daytime naps if needed
- Medication management with wakefulness-promoting agents like modafinil, starting at 100mg in the morning, with potential titration up to 200mg if needed and tolerated 3
- Alternative options such as methylphenidate, starting at 5mg twice daily, not exceeding 20mg daily in elderly patients, with careful consideration of cardiovascular risk assessment due to the patient's age
- Addressing underlying Sjögren's symptoms that contribute to fatigue with hydroxychloroquine 200mg twice daily, and managing dry eyes and mouth with artificial tears and sugar-free lozenges or saliva substitutes to improve sleep quality
- Treatment of coexisting depression or anxiety with an SSRI like sertraline 25-50mg daily to improve energy levels, as supported by the latest clinical review on excessive daytime sleepiness 2. It is essential to recognize that excessive daytime sleepiness can persist despite optimal management of underlying conditions, and a tailored approach considering the individual's specific needs and health status is crucial, as emphasized in the recent Delphi consensus study on obstructive sleep apnoea 1.