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What do you Need to Know about Excessive Daytime Sleepiness
What do you Need to Know about Excessive Daytime Sleepiness
25 Jan 2023

What do you Need to Know about Excessive Daytime Sleepiness

Understanding your sleep

It is not completely known or understood exactly what happens when we are asleep. However what is known is that our brains use the time when we are asleep to get rid of toxins that have accumulated. One such toxin, beta amyloid has been implicated in the development of Alzheimer's disease.

Our sleep is made-up of different cycles through the night, starting with stage one and progressing to stage 3 following which we will have a cycle of REM sleep. This cycle will then be repeated throughout the night. One cycle of this sleep is slow wave sleep, a crucial fat burning, healing muscle repairing and building cycle that occurs in stage three of our sleep just before we go into REM sleep.

If somebody is only able to sleep for few hours every night then they will not be sleeping long enough for their mind and body to be repaired. The ideal is considered to be 8 to 9 hours sleep every night. Being in a deep sleep is also critical for restoring our mind’s ability to process and to learn.

Having enough sleep is not just about being naturally tired from a day's work and needing sleep, it is also very crucial to our health and to our well-being. If somebody is not getting enough sleep it has been established that they are more likely to suffer from diabetes, obesity and even certain types of cancer.

A lot of people will protest that they do not have enough time to be asleep for 9 hours each night but the truth is that without the proper sleep, our ability to act on information that we need to process will compromise what we call ‘executive function’. Surprisingly, perhaps this can happen after even just one sleep deprived night.

The longest anyone has ever gone without sleep is 11 days but this is definitely not advised especially if anyone is going to workout or make other demands in their organs because it is during sleep that the organs are rested and repaired.

Concerned about any of the issues raised in this article? It's well worth undergoing a full body health screening to check for underlying issues, with 4 GP appointments included in all Advanced and Elite MOTS throughout 2023.

What Causes excessive sleepiness during the daytime?

Being excessively sleepy during the daytime is also sometimes called 'daytime somnolence' and is often an indication that sleep quality is poor, that a sleep disorder is present or another health condition is causing a problem. Although daytime somnolence is not considered a disorder, if you are excessively sleepy during the daytime you need to take this as a sign that you need to discover the cause of your excessive day time sleepiness, so that you can treat it.

What are the symptoms of sleep inadequacy?

Because sleep plays such an important part In memory consolidation, restoration of our immune systems and other process is vital to our well-being there can be several symptoms that indicate that something is wrong although they may not always immediately be obviously sleep related. You may not feel particularly sleepy but there may be a problem with your sleep quality if you have any of the following symptoms:

  • difficulty in staying alert
  • feeling irritable
  • suffering from memory difficulties
  • finding it difficult to focus
  • find it hard to grasp a new concept is a problem
  • problems with decision making
  • reaction times that are noticeably slower
  • behaviours are risk-taking in nature

What can cause extreme sleepiness?

Extreme sleepiness is not always the result of having no sleep at all. People who need to get up several times in the night to use the bathroom or for other reasons are having their sleep disrupted and this will have an impact on restorative slow wave sleep. Not taking enough exercise and smoking as well as other lifestyle habits, can also be responsible for interfering with our quality of sleep and leading to sleepiness during the day.

Sometimes people who feel very sleepy during the day do not have any trouble sleeping at night and if this is the case then the symptoms of excessive sleepiness may indicate they have another health condition or a sleep disorder that needs investigating

Some Sleep-Wake Disorders

Disorders that are recognised such as (OSA) obstructive sleep apnoea,  periodic limb movement or restless leg syndrome can give rise to interrupted sleep. Even if the person does not realise it they are actually waking up enough to disrupt their healing pattern of sleep.

Some other so-called ‘sleep-wake’ disorders that effect our neurological mechanisms. These mechanisms regulate our sleep cycle and the type of condition that may affect them would be idiopathic hypersomnia or narcolepsy because they affect the hormones that lead to wakefulness, and this will eventually cause sleepiness during the day. If a person has a disorder of their circadian rhythm their body clock is not working to indicate the times that they need to be wakeful and they may suffer from excessive sleepiness because they are affected with insomnia at night.

Other Conditions that may cause sleep inadequacy

There are some medical and mental health conditions that are chronic and can cause sleepiness during the day. Some of the most likely culprits would be anxiety, depression, lupus, Parkinson's disease, schizophrenia, chronic pain, obesity, multiple sclerosis, hyperthyroidism and cancer, amongst others.

If somebody does not sleep well then then any recovery from injury or illness will be affected. A future diagnosis of health issues such as Parkinson’s disease may also be a prediction. Some more recent research has suggested that those who feel sleepy during the daytime may also have a genetic predisposition to this condition.  Some medications that patients are on may also be responsible for them feeling sleepy during the day. Intake of narcotics or alcohol can also have an effect on daytime alertness.

Daytime Sleepiness: Some Lower Risk Causes of Sleepiness During the Day

These causes of daytime sleepiness are once it will usually be self-limiting and will not require any medical intervention.

1. Being sleep deprived

The expression ‘sleep deprivation’ is the term that we use to describe the fact that somebody is not getting sufficient sleep. This might be some body who has pulled a one-off all-nighter right through to someone who regularly has problems getting sufficient sleep.

Over the years researchers generally said that people need to sleep between 7 to 9 hours each night. If they do not and especially if this happens several times a week they are likely to start to suffer from feeling excessively sleepy during the day. The answer was seemed to be obvious - they should simply sleep more.

2. Poor sleep hygiene

The term sleep hygiene does not mean, as you might think, taking a bath or brushing your teeth before you go to bed. In fact this is a term that we used to describe the habits that have a direct effect on your sleep quality. Getting adequate sleep is the only way to avoid being sleepy during the day. Sometimes, however we will develop habits that will interfere with our sleep quality. Some of these might be:

  • Having an irregular sleep schedule. If you go to bed at the same time each night and wake up at the same time every morning even at the weekend you will develop a good quality of sleep and that daytime sleepiness will become a thing of the past.
  • Drinking caffeinated drinks such as coffee late in the evening or late in the afternoon can interfere with your sleep quality because the caffeine that you ingest will be in your system for eight or more hours and this will have a direct effect on your sleep quality and even your ability to fall asleep.
  • Having an alcoholic drink is also detrimental to a good night's sleep
  • Although taking a sleeping pill may seem like a good solution, you will never get as good quality sleep from a sleeping tablet than you will if you fall asleep in the natural way.
  • If you use any device that emits a blue light, such as a mobile phone or computer this can affect your sleep quality if you do this within the hours before bedtime.
  • Though it may be very tempting to take a nap in the afternoon especially if it's a long nap this may very well effect your quality of sleep over the night ahead. Napping for around 30 minutes or less is the best idea so that your night-time sleep is not negatively impacted.
  • You should avoid doing any kind of workout in the evening before you go to bed even afternoon exercise might make it more difficult for you to sleep. This is because exercise will raise your heart rate and adrenaline will be surging through your system which can have an impact on your quality of sleep. Taking your regular exercise in the morning or early afternoon, however, will actually improve your quality of sleep because a lack of exercise can make you feel generally sluggish and sleepy during the day.
  • Although people traditionally like to take a book to bed, this is another thing to be avoided if you want to guarantee yourself a good night's sleep.Treat your bedroom as a place only for sleep and certainly do not sit up on your phone or reading when you could be getting that restorative sleep.
  • It is never a good idea to eat before bed and you should leave at least two hours after you last eat before you go to bed. Doing this might also help you avoid suffering from heartburn.

Likely self-limited condition, but that could need medical care

3. Women suffering with premenstrual syndrome

Sometimes women may suffer from insomnia when they are having their monthly period or in the time just before their period. This is because levels of melatonin, a hormone that is produced in the pineal gland and helps to regulate sleep, decrease during this time in a woman's menstrual cycle this and can make a woman feel tired all day.

4. Long sleeping disorder (Idiopathic hypersomnia)

The word idiopathic means but there is no identifiable cause for a problem and chronic sleepiness during the day can be a symptom of idiopathic hypersomnia. This condition typically sees the sufferer wanting to sleep for very lengthy periods, sometimes for 10 hours or more at a time.However even although they've had such a lot of sleep, people suffering from idiopathic hypersomnia feel sleepy all the time because the sleep they've had has not been restorative. This extreme sleepiness comes from a disorder within the nervous system although at the present time an exact cause of this disorder has not been identified and because of this at the moment idiopathic hypersomnia has no cure.

Times idiopathic hypersomnia is confused with the disease sleeping sickness which is in fact African trypanosomiasis. That does have a known cause and arises from a parasite infection and will in fact make the patient sleep continuously. If anyone does suffer from this condition they will most likely recover but there will be lingering abnormalities that affect their sleep cycle.

5. Insomnia

Insomnia is classified in different types. For instance if you feel very tired but are unable to sleep this is classified as onset insomnia. If you are someone who falls asleep without any problem but then cannot stay sleeping this is known as maintenance insomnia.However if your difficulty sleeping is insomnia, it will inevitably make you feel sleep during the day.  Insomnia of one sort or another is extremely common and in general causes will include:

  • some problems with a medical base such as reflux or suffering chronic pain
  • depression or anxiety or other psychiatric problems
  • those Who do shift work and he work at different times and have to sleep at different times
  • habits concerned with our lifestyle
  • eating too close to the time you go to bed
  • taking caffeine drinking alcohol or smoking
  • drinking water before going to bed so that you wake frequently to go to the toilet

Of course we would all expect that during our life, small stressful events we would experience a certain amount of insomnia. If we travel abroad to a different time zone we expect that our sleep will be disturbed until we get acclimatised to the new time zone. These types of insomnia will generally sort themselves out and need no treatment. If, however, you find yourself struggling with sleep more than three nights in the week over a period of three months then it's time to seek a medical opinion. It could be that the insomnia is treated simply with a lifestyle modification or it may require some medication, either way persistent insomnia will always benefit from medical opinion.

Some of the causes of moderate risk daytime tiredness

If the following conditions are causing you insomnia you will probably need medical intervention

6. if you suffer from the condition fibromyalgia

Fibromyalgia affects its sufferers with pain that is generalised as well as  fatigue and malaise.  It will often cause emotional distress and sleeping problems. When someone suffers from this condition they will often have problems trying to fall asleep, staying asleep or they may wake far too early.

This condition will also disrupt sleep cycle phases. The deep sleep will be effected and decreased when a patient is suffering from fibromyalgia.  As this time of sleeping deeply is widely believed to be the phase of restorative sleep, if you do not spend enough time in this phase of sleep you will wake feeling unrefreshed and as though you haven't slept very well.

Even if you have managed to be asleep for seven or eight hours you will feel as though you have not had enough rest. There are various medications you can take to help you with sleep if you suffer from fibromyalgia, and your doctor will discuss these with you.

At the moment there is no cure for the condition of fibromyalgia but you can certainly receive relief for the pain that it causes. Your healthcare provider should help you alleviate some of your symptoms of fatigue pain or distress while a rheumatologist who is a specialist in auto immune diseases could help to moderate symptoms as well.

7. The condition hypothyroidism

Our thyroid glands are positioned just behind our windpipe or trachea and is responsible for the hormones that moderate and regulate our metabolism and temperature. The condition hypothyroidism can be caused by hyperthyroidism that has been over treated but might also be  caused by a deficiency of iodine or an autoimmune disorder.  Women are affected by this disorder more than men.

If you suffer from hypothyroidism you may feel sleepy and sluggish and be very sensitive to cold even if people around you are feeling quite warm. You may also have difficulty in concentrating and other known symptoms are constipation and weight gain. Once a diagnosis of hypothyroidism has been made it is easy enough to treat with appropriate medication. There is not any specific diet to follow for hypothyroidism and no scientific evidence to support any natural remedies that might be offered to treat this condition although some of the complementary therapy offerings might help with alleviating some of the symptoms although it certainly will not cure the condition.

8. Those suffering with a mild form of anaemia

Anaemia will be diagnosed if a patient is found to have low levels of haemoglobin, a protein that contains iron in our red blood cells. Haemoglobin carries oxygen from our lungs to every part of our body but in anaemia the tissues of our body are not supplied with sufficient oxygen either as a result of having insufficient red blood cells or because some other condition is affecting the levels of haemoglobin in your blood.

In this event, our hearts will have to work a lot harder so that our tissues get oxygen. When you are putting this type of strain on your heart you will inevitably tire more easily and no amount of sleep will make you feel any better.

The reasons that haemoglobin may below could be because you have lost a significant amount of blood, your diet does not contain enough iron or your body is not absorbing the iron you take in, properly. Anaemia arising from iron deficiency is the most common form of this condition and it is possible to help the situation by eating things like chicken, other meats, eggs, fish and legumes and prunes which all contain good levels of iron.It is important, however if you suspect you may have anaemia, that you get a proper medical diagnosis of this.

9. Mild to moderate depression

Feeling sleepy during the day can be a symptom that you are depressed especially if you have other symptoms such as a loss of interest in the things you normally enjoy doing, a feeling of having no energy, finding it difficult to concentrate, feeling hopeless and having problems sleeping, waking up a lot during the night, having nightmares and experiencing other disturbances of sleep. The tiredness that is associated with being depressed can be physical and mental and might or might not be a result of the difficulty in sleeping that is common in those suffering depression.

Whether depression is mild or moderate, is short term or acute or long term, chronic medication can be given to help and there are also things that you can do yourself to help you feel less depressed and to combat that sleepy feeling during the day. Spending your time outside and doing exercise can lift your mood and talking with a family member or friend that you trust can also be very helpful.

10. Premenstrual dysphoric disorder

 (PMDD) Premenstrual dysphoric disorder is a more extreme type of what is known as (PMS) premenstrual syndrome. Just like PMS, PMDD is only symptomatic during the days before a woman has her period known as the luteal phase.  A woman who suffers from this condition may feel perfectly normal half of each month while during the other half she feels as though she's losing control.  Bloating is also fairly common at this time.

If someone is suffering so badly from PMDD that they are feeling sleepy during the day and finding it hard to function then it is definitely worth going to see a medical professional about the problem. Medications can be prescribed that will reduce the symptoms considerably and stop a person feeling so exhausted and help them feel more alert during the daylight hours.

11. Chronic fatigue syndrome

It is really awful to feel tired most of the time and when somebody is suffering from chronic fatigue syndrome the fatigue that they feel will be persistent and will very likely interfere with their day-to-day activities this syndrome often comes after an infection although this is not always case.

It can also be due to a viral infection such as Lyme disease or an experience that has been traumatic, either psychologically or physically. The evidence surrounding the cause of CFS is not consistent but unfortunately what is known is that full recovery from this condition is not very common.

For people who are affected by fibromyalgia and chronic fatigue syndrome they will find themselves affected by very similar symptoms and it's very important that they receive medical attention for either of these complaints although neither is likely to result in very serious medical outcome

12. Narcolepsy

Of course all of us have, from time to time, found herself dozing off while we're watching a film or listening to a particularly boring speech but most of us would not typically fall asleep well we're in the middle of having a conversation with someone or having our meal, or even worse, driving. For those people who suffer from narcolepsy this is their everyday life and they can fall asleep very unpredictably and inconveniently.

The symptoms of narcolepsy are

  • feeling excessively sleepy during the day
  • falling asleep very suddenly in unusual places and circumstances
  • experiencing sleep paralysis
  • having dreams that are so vivid that they feel as though they are real
  • loss of muscle control (cataplexy)

There is no cure at the moment but there are certain medications which will help with the drowsiness that this condition causes and most certainly maintaining good sleep habits will also help can be physical activity can offer relief from narcolepsy.

13. PLMD (periodic limb movement disorder)

Although we are not aware that we're doing it, we do quite frequently move our legs in voluntarily and to a lesser extent our arms while we sleep at night. This is quite normal but it can become a problem if the movements are significant enough to wake you up. Although they may not wake you up completely they will interrupt your sleep cycle causing havoc.

And people who suffer from PLMD will often complain that they feel tired during the day. It is not known what the cause of this condition is but it may have a link to anaemia it may be genetic or might have links to problems in the central nervous system. Once again, good sleep habits will help but as well as that you should see your doctor or a health professional about this complaint.

14.(RLS) Restless legs syndrome

The condition of restless leg syndrome can be a big contributor to sleep inadequacy. In this condition the leg twitching sensation is hard to describe accurately. It is an overwhelming feeling that you have to move your leg and often the sensation in the legs will not get better until you get up and walk around, obviously not a great idea in the middle of the night. Although this syndrome may sound similar to periodic limb movement disorder and indeed both can be responsible for you losing sleep,they are different but result in the same feeling that you are struggling through the day, unrested from your nights sleep.

Pregnancy is a time when restless leg syndrome can be quite common and it has also been linked to taking certain medications such as SSRI's or allergy medications as well as medication that is used to treat depression. Drinking alcohol and smoking as well as drinking caffeine may contribute to restless leg syndrome. Try lifestyle changes and adopt good sleeping habits and there is also restless leg treatment available which you can ask your doctor about.

Some causes of feeling sleepy during the day that carry a high risk is and that you should see your doctor for because leaving them untreated can lead to serious outcomes.

15. Severe anaemia

There is a big difference between mild anaemia and severe anaemia because in the most severe form anaemia can require a blood transfusion. When the condition is severe tiredness,symptoms may be accompanied by very worrying symptoms such as chest pain, headache, dizziness, shortness of breath and even in very severe cases, fainting.

Sometimes when anaemia is severe the heart can be put under so much pressure that it departs from its normal rhythm in a condition called arrhythmia. This condition can be life threatening. This type of severe anaemia very often results from a serious injury or accident or if there's been chronic loss of blood such as prolonged and very heavy menstrual periods internal bleeding in the intestines or a cancer is causing bleeding.

16. Severe depression

When some people have very severe depression they may observe to have unusual energy bursts although it is far more common that the person will suffer from a loss of energy that will continue even if the person seems to have slept the required number of hours.

When a person suffers from mild depression this condition will be time limited and will normally be as a result of something like a death of a loved one or other traumatic personal event. Major depression on the other hand is a chronic depressive condition and will continue even when it appears that all aspects of your life are problem free. If you have thoughts about hurting someone else or yourself then you need to get immediate help

17. Obstructive sleep apnoea

When we sleep we go into a period of restoration and relaxation both physically and mentally. All our muscles relax and our tongue and some of the soft tissues in our throat will do so too. In the condition obstructive sleep apnoea the airway will become blocked because the tongue and other parts of your upper airway have become relaxed and slack.  if your airway is blocked you will stop breathing it may only be for a couple of moments but during this time you will wake up even although you won't remember this.

Even brief waking of this sort will interrupt a normal restorative sleep cycle. When you miss out on the benefits of a good night's sleep people wake up feeling unrefreshed and feel sleepy throughout the rest of the day. You should see your health professional if you think you have sleep apnoea because this will increase the risk of you developing dangerous high blood pressure as well as heart disease and your doctor will have treatment to offer for this condition.

Some of the treatments offered for sleep apnoea will include:

  • continuous positive airway pressure (CPAP) –this is a machine that will keep air that is pressurised moving into the airway and this will stop any interruption to your sleep.
  • there are some dental devices you can use that will keep the airway open
  • as the last as a last resort surgery can be tried

18. Post-traumatic brain injury syndrome

If somebody sustains an injury to their brain after a fall or a car accident or maybe an injury related to sports the sleep cycle might be changed. As that injury improves the condition should also improve. As their sleep cycles improve they will find themselves feeling more alert and feeling sleepy during the day will become a thing of the past.

Of course in the case of a traumatic brain injury most people will be seen in accident and emergency and treated there. More and more is being learned about unrecognised trauma to the head from sports activity and from concussion and medical professionals are now very adept at identifying even the slightest of head injuries. Any head injury should immediately be reported  to a health professional

The importance of having good quality and adequate sleep cannot be overplayed. Those researching in the fields are continuing to uncover more benefits of good sleep. Even although a young person may think that it doesn't matter if their sleep is not the best and that they pull a few all nighters, lack of sleep will impact every system of our bodies and can have a very serious effect on physical and mental health.

Are you experiencing any of the symptoms outlined in this article?

Contact the clinic today for a same-day GP appointment.

Daytime Somnolence - The consequences

it is not just being sleepy that is the worst risk to us from not having good sleep there can be some very serious consequences if we are not alert during the day.

  • an increased risk of having an accident at work or while driving a car
  • a detrimental impact on our academic or work performance
  • decreased work productivity or academic performance
  • impact on our quality of everyday life
  • emotions and mood are hard to regulate
  • relationships and social life can suffer

Particularly for young adults, long distance drivers, medical staff and shift workers excessive feelings of being sleepy can be extremely dangerous. As well as that, it has been proved that people are at a greater risk of developing the condition diabetes, heart disease, obesity and some other chronic ailments if they do not have good sleep patterns daytime sleepiness can actually affect how they develop and in older adults if a person is sleepy during the day they're at a greater risk of falling suffering memory loss or other cognitive impairment.

When should I see my Doctor

If you feel tired all the time you should definitely see a doctor especially if that tiredness is affecting your activities in your daily life or if you think it might be a sign of some other ailment. When you see your doctor you will most likely find that he or she will ask you about your habits when you sleep to try to find out while you are experiencing sleepiness during the day. They may also ask whoever you sleep with whether you snore or gasp or perhaps move your legs in a restless way while you are asleep. Your doctor may also decide to refer you to a sleep specialist to get a more accurate picture of what is going on.

The treatment that you are given will depend on the cause of your daytime sleepiness and will start often with the doctor checking and advising on the sleeping habits that can help you to get more sleep. They may also look at the medication you are taking and identify any disorders that have been undiagnosed and might need to be treated as well.