Table 11.

Management options for excessive daytime sleepiness and unintended sleep episodes238, 242

Ensure correct diagnosis: rule out syncope, seizures, cardiac disorder
Assess with validated sleepiness scale (e.g., Epworth)
Counsel patients on risks for potential daytime drowsiness and possibility of falling asleep
Consider need for polysomnography and possibility of sleep disorder (e.g., sleep apnea, RLS) and treat when appropriate
Teach patients how to improve sleep hygiene
Improve management of parkinsonian motor symptoms with dopaminergic agents
Reduce, eliminate, or reschedule concomitant sedating medications (e.g., benzodiazepines, antidepressants) or medications that interfere with drug metabolism (e.g., cimetidine)
Use lowest dose of dopaminergic agent that provides satisfactory clinical response
Reduce dosage of dopaminergic agent if patient has evidence of excessive daytime sleepiness
Evaluate for possible contributing medical conditions (e.g., hypothyroidism)
Evaluate for depression and treat accordingly