The drug Xywav can now be used to help treat the rare sleep disorder known as idiopathic hypersomnia. Prostock-Studio/Getty Images
  • Federal regulators have approved the drug Xywav to treat idiopathic hypersomnia, a rare disorder that can result in daytime sleepiness.
  • Xywav has already been approved for use in treating other sleep disorders, but it carries a black box warning due to potential side effects.
  • Experts say sleep disruptions can be caused by mental health and nutritional factors.

People who live with excessive daytime sleepiness may have a new option for treatment, but it’s not without its risks.

Xywav, which is used to help treat the rare sleep disorder known as idiopathic hypersomnia (IH), has been approved by the Food and Drug Administration (FDA).

Although rare, IH is a chronic sleep disorder characterized by never feeling like you’ve had enough sleep or by the feeling of an insatiable need for sleep.

People with IH can sleep regular amounts or even longer than recommended but still not feel rested.

Xywav has been previously approved for other sleep disorders. It’s an oral medication made from:

  • calcium
  • magnesium
  • potassium
  • sodium oxybate, also known as gamma-hydroxybutyrate, or GHB

FDA officials reported that these chemical compounds were shown in a clinical trial involving 154 people from 19 to 75 years old to help reduce excessive daytime sleepiness. 

The recorded side effects included:

  • nausea in 21 percent of study participants 
  • headache in 16 percent
  • dizziness in 11 percent
  • anxiety in 10 percent
  • vomiting in 10 percent

Xywav can only be obtained through a prescribing doctor. The FDA has issued the following black box warnings for the drug:

  • central nervous system depression 
  • abuse
  • misuse

Xywav is subject to strict safety controls on prescribing and dispensing under the FDA’s Risk Evaluation and Mitigation Strategy program due to the potential risks involved.

Reasons for daytime sleepiness

Rare sleep disorders are not the only cause of daytime sleepiness.

A 2016 report from the Centers for Disease Control and Prevention (CDC) states that 1 in 3 people in the United States aren’t getting enough sleep. 

So what’s going on?

Mental health factors

“There are many sleep conditions and mental health disorders that can cause people to feel sleepy during the daytime,” said Sanam Hafeez, PhD, PsyD, a neuropsychologist in New York City and the director of Comprehend the Mind. “Anxiety and depression can cause a person to wake up feeling sluggish and exhausted.”

“Anxiety mentally takes a toll on people as their bodies are constantly on edge. They may not sleep enough during the night due to excessive worrying,” Hafeez told Healthline. “Depression can make your sleep less restful as well, leaving you craving more sleep.” 

The World Health Organization (WHO) suggests that the COVID-19 pandemic has increased the occurrence of anxiety, depression, and sleep difficulties.

“Bereavement, isolation, loss of income, and fear are triggering mental health conditions or exacerbating existing ones. Many people may be facing increased levels of alcohol and drug use, insomnia, and anxiety,” WHO officials stated last year. 

Insomnia is a more common sleep disorder that makes it difficult for people to fall asleep. 

Hafeez said that as a result of experiencing insomnia, people may stay up late at night and never fully get rapid eye movement (REM), or deep sleep.

Nutritional factors

You can also experience excessive daytime sleepiness from some nutritional deficiencies, including iron deficiency.

Iron deficiency anemia is on the rise in the United States due to dietary shifts and higher crop yields per acre, which experts say are reducing the amount of iron in foods that people and animals eat.

“Without sufficient iron, your body cannot produce enough hemoglobin (red blood cells that carry oxygen in your blood), and this leaves the body short of breath and exhausted,” said Hafeez. 

The only way to know for sure if you’re iron deficient is to get your iron levels tested. If necessary, your doctor may suggest supplementation.

How to feel more rested

Hafeez offers some advice on how you can start feeling more awake and refreshed during the daytime hours.

“First off, you need to participate in activities that are restful and prepare you for sleep,” she said.

She also recommends the following:

  • Keep electronics away from your bed for at least an hour before falling asleep.
  • Instead, read a book, listen to light music, or perform meditations. 
  • Try vitamin B supplements to help with energy during the day.
  • Get enough vitamin D, especially in the summer. 
  • Try to exercise in the morning and not within 2 hours of sleep.

“If you’re still tired during the day and nothing seems to help, make an appointment with your doctor for a treatment plan,” Hafeez advised.

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