mise à jour du
29 septembre 2009
A clinical case
Yawning attacks
Diabete self-management
september/oktober 2009;26(5):54-55


I am a 55-year-old, obese man with Type 2 diabetes. I have also been treated for hemochromatosis. My problem is what I describe as violent yawning attacks. Anywhere from two to five hours after meals, I yawn forcefully for 5-10 minutes. What could be causing these yawning episodes, and what can I do to stop them?
There are a number of possible causes for your yawning episodes. As an older, obese man with diabetes, the most likely explanation is poor sleep due to sleep apnea, resulting in daytime tiredness.
Sleep apnea is a disorder in which breathing stops for at least 10 seconds five or more times an hour while a person is asleep, sometimes happening hundreds of times a night. Research has shown an association between sleep apnea and Type 2 diabetes. Excessive yawning, which is defined as a cluster of 10 to 30 yawns occurring many times a day, can be the result of sleep deprivation caused by episodes of apnea.
One way to determine whether sleepiness may be causing your yawning attacks is to evaluate your level of tiredness using a tool known as the Epworth Sleepiness Scale.
If your result is 10 or higher, you should consult your doctor about having a polysomnography, or sleep study, done in a sleep lab to determine whether you do in fact have sleep apnea. (During a polysomnography, a person is wired up to various machines while he sleeps to measure factors such as the level of oxygen in his blood and the electrical activity in his heart.)
Another possibility to consider is that one of your medicines may be causing your yawning episodes. For instance, a class of antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs) is a common cause of excessive yawning.
Yawning caused by these drugs tends to stop within a few days of reducing the dose or stopping the medicine. A variety of other drugs can also cause excessive yawning. If you suspect that a medicine may be the culprit in your case, be sure to speak with your doctor before making any changes in your drug treatment.
Since you have diabetes, it is also worth noting that yawning may be a sign of hypoglycemia, or low blood glucose. If this is the cause, your yawning attacks will likely also be accompanied by symptoms such as sweating, trembling, dizziness, confusion, headache, and irritability.
Lastly, if the yawning occurs for only a short period , it may indicate anxiety or hyperventilation, a vasovagal reaction (in which the involuntary nervous system causes the heart to slow and blood pressure to drop). One of various neurological disorders, such as migraine, epilepsy, or a brain tumor must be also investigated. If a polysomnography indicates that you do not have sleep apnea, it might be worth discussing a CT scan or MRI of the head with your health-care provider to rule out a neurological condition.
Olivier Walusinski, M.D., France