Somnolence

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Somnolence
ICD-10	R40.0
ICD-9	780.09

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]

Overview

Somnolence (or "drowsiness") is a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods. It has two distinct meanings, referring both to the usual state preceding falling asleep, and the chronic condition referring to being in that state independent of a circadian rhythm. The disorder characterized by the latter condition is most commonly associated with users of prescription hypnotics, such as mirtazapine or zolpidem.

It is considered a lesser impairment of consciousness than stupor or coma.

Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Aldesleukin, Asenapine maleate, Aminoglutethimide, Amobarbital sodium, Apomorphine hydrochloride, Atropine, Butabarbital, Butorphanol, Carbinoxamine, Clemastine, Clobazam, Cimetidine, Cetirizine hydrochloride, Chlordiazepoxide, Clozapine, Cycloserine, Cyproheptadine hydrochloride, Cefaclor, Desloratadine, Desmopressin, Dexchlorpheniramine, Diphenhydramine, Estazolam, Felbamate, Flavoxate, Fluphenazine, Flurazepam hydrochloride, Fluvoxamine, Fosphenytoin sodium, Hydrocodone bitartrate and acetaminophen, Ivermectin, dextromethorphan hydrobromide, Ethosuximide, Loratadine, Meropenem, Mifepristone, Meprobamate, Metipranolol, Mitomycin, Mitotane, Nabilone, Nelarabine, Oxazepam, Pergolide, Pentobarbital, Phenobarbital, Polymyxin B, Praziquantel, Pyrantel pamoate, Pyridoxine hydrochloride, Quazepam, Ramelteon, Rilpivirine, riluzole, Rotigotine, Secobarbital sodium, Sodium oxybate, Sulfasalazine, Terbutaline, Thioridazine hydrochloride, Thiothixene, Varenicline, Zopiclone
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Apomorphine hydrochloride
• Butorphanol
• Cimetidine
• Cycloserine
• Cyproheptadine hydrochloride
• Desloratadine
• Estazolam

• Mifepristone
• Nabilone
• Pyrantel pamoate
• Pergolide

• Ramelteon
• Rilpivirine
• Sodium oxybate
• Terbutaline
• Thioridazine hydrochloride

• Disease C

Causes

• Advanced sleep phase disorder
• African trypanosomiasis ("sleeping sickness")
• Alice in Wonderland syndrome
• Brain edema
• Cerebral hypoxia
• Chronic fatigue syndrome
• Clinical depression, especially seasonal affective disorder
• Dehydration
• Delayed sleep phase syndrome
• Desmopressin
• Diabetic ketoacidosis as example, but not balanced diabetes mellitus
• Drug Side Effect-Brompheniramine maleate and Pseudoephedrine hydrochloride, caspofungin acetate, Clozapine, Cyclobenzaprine, Eletriptan, Fesoterodine, Ketorolac tromethamine, Levetiracetam, Loratadine, Naproxen sodium, Oxcarbazepine, Prochlorperazine, Progesterone
• Encephalitis – (viral, bacterial or other agents)
• Epilepsy
• Fibromyalgia
• Hydrocephalus
• Hyperparathyroidism
• Hypothermia
• Hypothyroidism
• Increased intracranial pressure; for example, brain tumors
• Infectious mononucleosis (glandular fever)
• Intracranial hemorrhage such as due to ruptured aneurysm
• Lyme disease
• Medications
  • Analgesics: mostly prescribed or illicit opiates such as oxycontin or heroin
  • Antiepileptics such as phenytoin, carbamazepine, gabapentin, topiramate
  • Antidepressants: for instance sedating tricyclic antidepressants and mirtazapine. Somnolence is less common with SSRI and SNRI as well as MAOI.
  • Antihistamines: diphenhydramine, doxylamine, Loratadine and Olopatadine
  • Antipsychotics: clozapine, thioridazine, quetiapine, olanzapine, risperidone, and ziprasidone but not haloperidol
  • Dopamine agonists used in the treatment of parkinson's disease e.g. pergolide, ropinirole and pramipexole.
  • HIV medications for example, efavirenz
  • Antihypertensive medications like amlodipine
  • Hypnotics like zopiclone, or the benzodiazepine such as diazepam or nitrazepam and the barbiturate, such as amobarbital or secobarbital
  • Central nervous system agents like Carisoprodol, Metaxalone
  • Other agents impacting the central nervous system in sufficient or toxic doses
  • Melatonin
  • Spironolactone
• Sleep apnea
• Starvation
• Stroke
• Traumatic brain injury
• Treatment of primary insomina may cause somnolence:
  • Flurazepam
  • Benzodiazepine
  • Quazepam
  • Estazolam
  • Temazepam
  • Triazolam
  • Benzodiazepine receptor agonists: Eszopiclone, Zolpidem, Zaleplon
  • Melatonin receptor agonists: Ramelteon

Hazards

Somnolence can be dangerous when performing tasks that require constant concentration, such as driving a vehicle. When a person is sufficiently fatigued, he or she may experience microsleeps (loss of concentration).

See also

• Sleep Disorders
• Chronic fatigue syndrome
• Fibromyalgia
• Insomnia
• Hypersomnia
• Dyssomnia
• Fatigue (physical)
• Restless legs syndrome