Regarding her daytime sleepiness, the patient is taking a number of long-acting central nervous system acting medications to sedate her and can produce a lasting sedation throughout the daytime.  These include trazodone, Seroquel, and methadone.  Of these medications, the methadone is clearly indicative, given the history of substance abuse.  It would be desirable to reduce or discontinue trazodone and then perhaps consider doing the same with Seroquel.  I brought this possibility up with the patient, and I asked her to discuss this further with her psychiatrist.