Sleep All Day: A Sign Of Depression Or Something More?

Sleep is an essential part of our lives, but what happens when we can't stop sleeping? Hypersomnia is a condition characterised by excessive daytime sleepiness, where people fall asleep repeatedly throughout the day, even if they've had a full night's rest. This can have a significant impact on one's quality of life, affecting their ability to function at work and socially, and increasing the chance of accidents. While the exact cause of hypersomnia remains unknown in many cases, it is often associated with other medical conditions, medications, or lifestyle factors. Treatment options include medications, lifestyle changes, and support groups.

Sleep disorders

Insomnia

Insomnia is a common sleep disorder that involves difficulty falling or staying asleep. It can be episodic, persistent, or recurrent, and it can be caused by specific life events or situations. Insomnia is often treated with a combination of sleep medications and behavioural techniques such as cognitive-behavioural therapy.

Sleep Apnea

Sleep apnea is a breathing disorder characterised by interruptions in breathing during sleep, which can last for 10 seconds or longer. This disorder can cause snoring, snorting, gasping, or choking sounds, and it is often diagnosed through a clinical sleep study. Sleep apnea can be treated with lifestyle changes, such as weight loss, sleeping on one's side, or using a custom-fit plastic mouthpiece. For more severe cases, a physician may prescribe a CPAP (continuous positive airway pressure) device.

Restless Leg Syndrome (RLS)

RLS involves a tingling or prickly sensation in the legs, along with a powerful urge to move them. The symptoms occur at least three times a week and can cause significant distress or problems with daily functioning. RLS typically begins in a person's teens or twenties and affects up to 3% of the population. Treatment options include iron or vitamin B12 supplements, certain medications, and lifestyle changes such as regular exercise and a healthy diet.

Hypersomnia

Hypersomnia is a condition where individuals experience extreme daytime sleepiness despite getting adequate or more than adequate amounts of nighttime sleep. It can affect work life, social life, and overall quality of life, increasing the risk of accidents. Hypersomnia can be caused by various factors, including insufficient sleep, sleep disorders, medications, and medical or psychiatric illnesses. Treatment options include medications, non-drug options, education, and support groups.

Circadian Rhythm Disorders

Circadian rhythm disorders are problems with the sleep-wake cycle, making it difficult for individuals to sleep and wake at the right times. These disorders can be caused by internal factors, such as a person's body clock being out of sync with the light-dark cycle, or external factors like shift work or jet lag.

Parasomnia

Parasomnia involves acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating. This can include sleepwalking, sleep terrors, nightmare disorder, and REM sleep behaviour disorder.

Medication and substance use

Medication

Hypersomnia can be caused by sedating medications, such as benzodiazepines, barbiturates, melatonin, and sleeping aids. It can also be caused by anti-hypertensive drugs, anti-epileptic drugs, anti-parkinsonian agents, skeletal muscle relaxants, antipsychotics, opiates, and cannabis.

Substance Use

Substance use can also cause hypersomnia. This includes the use of illegal drugs, such as amphetamines, cocaine, heroin, and methamphetamines. Alcohol use can also cause hypersomnia, as it is a depressant that relaxes the muscles, including those in the throat, which can cause breathing difficulties and interrupted sleep.

Additionally, hypersomnia can be caused by the use of prescription, non-prescription, and over-the-counter medications, such as blood pressure medicine, some antidepressants, pseudoephedrine, and nicotine.

Medical conditions

There are several medical conditions that can cause excessive daytime sleepiness. These include:

• Sleep Disorders: Sleep disorders are a common cause of excessive sleepiness. These include sleep apnea, narcolepsy, restless legs syndrome, sleep walking, and insomnia. Sleep apnea, for example, occurs when the upper airway collapses during sleep, interrupting breathing and causing micro-awakenings. Narcolepsy is a rare sleep disorder characterised by excessive daytime sleepiness and sudden muscle weakness triggered by emotions.
• Chronic Medical Conditions: Various chronic medical and mental health conditions are associated with daytime sleepiness. These include depression, anxiety, schizophrenia, lupus, Parkinson's disease, multiple sclerosis, cancer, chronic pain, obesity, and hypothyroidism.
• Vitamin and Mineral Deficiencies: Deficiencies in certain vitamins and minerals, such as vitamin D and vitamin B12, have been linked to feelings of sleepiness during the day.
• Medications: Certain medications can cause drowsiness as a side effect. These include sedatives, blood pressure medications, anti-epileptic drugs, skeletal muscle relaxants, antipsychotics, and opiates. Additionally, withdrawing from stimulant drugs, such as ADHD medication, can lead to excessive sleepiness.
• Substance Use: The use of substances such as alcohol, tobacco, and narcotics can contribute to excessive daytime sleepiness. Alcohol, despite being a sedative, can cause awakenings and is often associated with nightmares and sweats.
• Genetics: There may also be a genetic component to excessive sleepiness. Research suggests that a family history is present in up to 39% of people with idiopathic hypersomnia, indicating a possible genetic link.

Lifestyle factors

Maintain a consistent sleep schedule: Establishing a regular sleep routine is crucial. Aim to go to bed and wake up at the same time each day, including weekends. This helps regulate your body's internal clock and promotes better sleep.

Create a relaxing bedtime routine: Engage in calming activities before bed to ease anxiety and promote sleep. This could include reading, listening to soothing music, practising meditation or deep breathing, or taking a warm bath.

Optimise your sleep environment: Ensure your bedroom is quiet, dark, well-ventilated, and maintained at a comfortable temperature. Reduce noise, light, and distractions to create a peaceful atmosphere conducive to sleep.

Exercise regularly: Incorporate regular physical exercise into your daily routine. However, avoid strenuous workouts too close to bedtime, as this may increase alertness and make it harder to fall asleep.

Maintain a healthy diet: Adopt a well-balanced diet rich in plants, whole grains, and healthy fats. Increase your protein intake for longer night sleep and reduce your consumption of sugar and saturated fats, which can contribute to daytime sleepiness.

Limit stimulants and sedatives: Avoid caffeine, nicotine, and alcohol, especially close to bedtime. Caffeine and nicotine are stimulants that can disrupt sleep, while alcohol may cause fragmented sleep and increase sleep disturbances.

Practise good sleep hygiene: This includes avoiding screens, limiting exposure to bright lights, and refraining from working or engaging in stimulating activities late into the night. Instead, opt for relaxing activities that promote sleepiness.

Power naps: If necessary, incorporate brief 'power naps' during the day to enhance alertness. However, keep these naps short and avoid napping too close to bedtime, as it may interfere with your nighttime sleep.

Address environmental disturbances: Minimise potential interruptions to your sleep. For example, if you sleep with a partner who snores, consider using earplugs or white noise to mitigate the noise. Similarly, if you have noisy neighbours, try using a fan or earplugs to reduce the impact of the noise.

Prioritise comfort: Ensure your bed, pillows, sheets, and blankets are comfortable and that you don't get too hot or cold while sleeping.

Seek professional help: If excessive sleepiness persists despite your best efforts, consult a healthcare professional. They can help identify any underlying conditions, provide guidance, and recommend treatments to improve your sleep quality.

Genetic factors

Genetics can play a role in sleep disorders, with studies on twins indicating the role of genetic factors in these disorders. Monozygotic twins have very similar sleep patterns, and a higher prevalence of some sleep disorders is reported in relatives of patients with these disorders. While the cause of most cases of hypersomnia remains unknown, researchers have identified specific genes that may trigger the development of sleep problems.

A 2018 study of the human genome confirmed that insomnia is at least partially genetic in nature, with specific variants on chromosome 7 linked to insomnia in the studied population. In people of European descent, there were also differences on chromosome 9. The variant on chromosome 7 is close to AUTS2, a gene linked to alcohol consumption and others that relate to brain development and sleep-related electric signalling.

Insomnia is comorbid with other disorders, meaning it exists simultaneously with other medical conditions. Depression and anxiety are two of the leading mental disorders today, and insomnia is one of the symptoms these disorders can cause. Both conditions have moderate heritability, meaning people with these diagnoses are two to three times more likely to have family members who also have them.

Diabetes can also be inherited and is another condition that can cause insomnia. Sleep loss can also intensify a person's diabetes, creating a vicious cycle.

Narcolepsy is another sleep disorder with a strong genetic component. Close relatives of people with narcolepsy have about a 1-2% probability of having the condition, a rate 10-40 times higher than the general population. The disorder has the highest association with the Human Leukocyte Antigen (HLA) DR2/DQW1 gene.

Other sleep disorders with a genetic component include Restless Leg Syndrome, which has a familiar pattern in more than half of cases, and Sleep Walking, which has a strong genetic pattern suggested.

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