Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hypersomnia


Related Terms

  • Excessive Daytime Sleepiness
  • Idiopathic Hypersomnia
  • Narcolepsy
  • Sleep Apnea

Differential Diagnosis

Specialists

  • Family Physician
  • Neurologist
  • Psychiatrist
  • Pulmonologist

Comorbid Conditions

Factors Influencing Duration

Factors that may influence disability include age, sex, response to treatment, severity of the condition, presence of any underlying conditions, specific job duties and accommodations available at work.

Medical Codes

ICD-9-CM:
780.53 - Hypersomnia with Sleep Apnea, Unspecified
780.54 - Hypersomnia

Overview

Hypersomnia is excessive, involuntary, and constant sleepiness during waking hours. An individual with hypersomnia has difficulty staying awake and has problems with motor control and concentration.

One of the main causes of hypersomnia is sleep apnea, which occurs when the back of the throat blocks the air to the lungs during sleep, causing the individual to gasp for air. The three different kinds of sleep apnea are obstructive, central, and mixed. Obstructive sleep apnea (OSA) is the most common form of apnea. When the collapse of the back of the throat blocks the airway, the individual gasps for air but does not fully awaken. Breathing may stop hundreds of times at night, usually for periods of 10 seconds or longer. Central sleep apnea is less common and is caused by failure of the brain to signal the muscles to breathe. This awakens the individual because oxygen levels in the blood drop abruptly. Mixed sleep apnea refers to both obstructive and central sleep apneas occurring together.

Hypersomnia is also associated with narcolepsy, which causes sleepiness during the day, usually at inappropriate times. More than half of individuals with narcolepsy may experience an abrupt loss of muscle tone and weakness (cataplexy) triggered by sudden emotion, as well as sleep paralysis in which they are momentarily unable to move or speak when they awaken. About half of individuals with narcolepsy go through dream-like states between sleep and wakefulness (hypnagogic hallucinations). Narcolepsy is caused by low levels of chemical messengers in the brain (dopamine and norepinephrine) and genetic factors.

Incidence and Prevalence: It is estimated that 80% of people with sleep apnea are not diagnosed; the condition affects about 4% of men and 2% of women (Rowley).

It is estimated that about 0.02% to 0.18% of the population suffers from narcolepsy, but the condition frequently is not diagnosed (Baker).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for sleep apnea include a family history of apnea, snoring, smoking, obesity, sleeping on the back rather than on the side, and medical conditions such as heart failure and gastroesophageal reflux disease (GERD). Blacks are at higher risk than other ethnic groups in the US. Risk factors for narcolepsy have a genetic component, and the condition typically starts in the second or third decade of life. The risk factors for hypersomnia are obesity, night-shift work, major depression, and long-haul truck driving. For forms of hypersomnia other than sleep apnea, women are more at risk than men.

Source: Medical Disability Advisor



Diagnosis

History: The individual may report headaches in the morning, unrefreshing sleep, trouble with mental or emotional functioning, excessive sleepiness during the daytime, and fatigue. In sleep apnea, the sleep partner may report gasping for air or snoring during sleep. In narcolepsy, individuals and their families may report falling asleep at inappropriate times, loss of postural and motor control when excited (cataplexy), dreamlike visions while falling asleep (hypnagogic hallucinations), and the momentary inability to move or speak upon awakening (sleep paralysis). Drug and medication history are important to rule out daytime sleepiness associated with substance use.

Physical exam: The exam may reveal upper airway problems, including soft palate abnormalities or enlarged tonsils. Obesity, wide neck, and distinctive heartbeat are indicators of sleep apnea. Measurements of body mass, neck circumference, and areas inside the mouth assist in diagnosis of sleep apnea.

Tests: Polysomnography is an overnight test in which monitoring devices hooked up to the individual assess various sleep stages for the electrical activity of the brain (electroencephalogram, or EEG), the heart (electrocardiogram), and movements of the muscles (electromyogram) and eyes (electro-oculogram). Oxygen levels in the blood and changes in breathing are also monitored. Multiple sleep latency test (MSLT) measures the time it takes to fall sleep during the day in a quiet room. Other tests may include the maintenance of wakefulness test and the Epworth sleepiness scale.

Source: Medical Disability Advisor



Treatment

Treatment for hypersomnia depends on the underlying cause. Treatment of sleep apnea includes changes in sleeping habits, such as trying to roll over on the side and using a special pillow that helps to stretch the neck. Weight loss and other lifestyle changes such as quitting smoking and avoiding alcohol within 4 hours of sleep are recommended. Continuous positive airway pressure (CPAP) is another treatment for obstructive sleep apnea.

Other treatments include the use of dental devices similar to sports mouth guards, an orthodontic treatment called rapid maxillary expansion, and oxygen therapy. Thyroid hormone, asthma, and gastroesophageal reflux disorder medications may also be used. Removal of soft tissue on the back of the throat and palate (uvulopalatopharyngoplasty) or a procedure in which an opening is created in the neck into the windpipe and a tube inserted (tracheostomy) may be performed.

Treatment for narcolepsy includes regularly scheduled naps several times a day and the use of medications such as stimulants, modafinil, antiseizure drugs, opiates, and some monoamine oxidase inhibitors.

Source: Medical Disability Advisor



Prognosis

The outcome depends on the method of treatment and compliance. Because many of the treatment methods are cumbersome, the compliance rate is often low. Rolling over to one side and using nasal strips while sleeping may reduce snoring and improve sleep. Use of CPAP can result in improvements in memory, mood, concentration, and health. Dental devices work very well for mild to moderate apnea. In general, medications are not very successful in treating sleep apnea. Tracheostomy is used in life-threatening circumstances and has a high success rate. Uvulopalatopharyngoplasty is successful in 40% to 60% of cases (Silverberg).

Taking regularly scheduled naps during the day helps reduce abrupt sleepiness and improves narcolepsy.

Source: Medical Disability Advisor



Complications

Accidents may occur as a result of individuals falling asleep while driving. Individuals deprived of sleep may eat more and exercise less, which can lead to obesity. A rise in the pressure inside the blood vessels of the lungs (pulmonary hypertension) can develop in individuals with sleep apnea. Higher carbon dioxide and lower oxygen levels in the blood at night may increase the risk of high blood pressure, stroke, heart attack, heart failure, diabetes, and kidney failure. Sleep apnea may affect higher brain functions such as memory and concentration. It may also cause headaches and irregular menstrual periods in females.

Psychological and social dysfunction in all aspects of life is common in individuals with narcolepsy. Other complications include depression, headaches, injury caused by sudden falls, and stimulant dependence or abuse.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals who work with heavy machinery or work at heights may need to be reassigned. Individuals who stand up during work may need to do their work sitting down to prevent falls. More breaks may be needed for these individuals to take naps or change work routine to stay awake. Driving, especially for long distances, should be avoided. Narcoleptic individuals with cataplexy should not have to deal with emotionally charged situations or those that could provoke excitement.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have a history of sleep apnea or narcolepsy? A history of neurological or psychiatric disorders?
  • Is individual using medications that could aggravate symptoms?
  • Does individual have headaches in the morning, nonrestorative sleep, heartburn, trouble with mental or emotional functioning, loss of urine control (incontinence), sleepiness during the daytime, and fatigue?
  • Does individual's sleep partner report that individual gasps for air, chokes, or snores during sleep?
  • Does individual or family report that the individual falls asleep at inappropriate times, loses postural and motor control when excited (cataplexy), has dreamlike visions while falling asleep (hypnagogic hallucinations), or is momentarily unable to move or speak upon awakening (sleep paralysis)?
  • Does individual ingest caffeine and alcohol or work different shifts?
  • Was polysomnography done? CT or MRI?
  • Was diagnosis of hypersomnia confirmed?

Regarding treatment:

  • Is any underlying condition being treated appropriately?
  • Were nasal strips used for sleep apnea?
  • Is individual a candidate for surgery for sleep apnea?
  • Was narcolepsy treated with stimulants or antidepressants? Were these medications effective, or are other medications being considered?
  • Has individual implemented appropriate behavioral changes and good sleep hygiene?
  • Is individual avoiding shift work, alcohol, and caffeine?

Regarding prognosis:

  • Is individual complying with the prescribed treatment plan?
  • Does hypersomnia persist despite treatment? Could other factors be causing the symptoms?
  • Does the diagnosis need to be revisited?
  • If hypersomnia is caused by alcohol or drug abuse, would the individual benefit from participation in a chemical dependency program?

Source: Medical Disability Advisor



References

Cited

Baker, Matthew J., and Selim R. Benbadis. "Narcolepsy." eMedicine. Eds. Carmel Armon, et al. 3 Mar. 2004. Medscape. 11 Oct. 2004 <http://emedicine.com/neuro/topic522.htm>.

Rowley, James. "Sleep Apnea." eMedicine. Eds. Gregory Tino, et al. 24 Feb. 2004. Medscape. 11 Oct. 2004 <http://emedicine.com/med/topic2697.htm>.

Silverberg, D., et al. "Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Sleep." American Family Physician 65 2 (2002): 229-236.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.