Sleep: A Day-Long Affair

Feeling sleepy all day could be a sign of hypersomnia, a condition characterised by extreme daytime sleepiness despite getting adequate or more than adequate sleep at night. People with hypersomnia may nap during the day, fall asleep during the day, and still sleep for long hours at night. Hypersomnia can affect your ability to function at work and socially, impacting your quality of life and increasing your risk of accidents. It is more common in females than males and usually affects people in their adolescence or young adulthood.

Sleep disorders such as sleep apnea, restless legs syndrome, and narcolepsy

Sleep disorders are a common cause of excessive daytime sleepiness. Three examples of sleep disorders are sleep apnea, restless legs syndrome, and narcolepsy.

Sleep apnea is a condition where a person's breathing stops or becomes shallow during sleep, sometimes as often as every minute. The brain registers the breathing problem and briefly rouses the person so that they can resume breathing. This process interrupts the person's sleep, causing them to feel tired during the day.

Restless legs syndrome (RLS), also known as Willis-Ekbom Disease, is a neurological condition that causes an irresistible urge to move the legs. People with RLS experience uncomfortable sensations in their legs, such as aching, throbbing, pulling, itching, crawling, or creeping. These sensations occur when the individual is resting or trying to sleep, and the only way to find relief is to move the legs. As a result, RLS can severely interrupt sleep, leading to daytime sleepiness.

Narcolepsy is a rare sleep disorder characterized by excessive daytime sleepiness, sometimes to the point of involuntary napping. Other symptoms of narcolepsy include muscle weakness during strong emotions (cataplexy), vivid dream-like hallucinations before falling asleep, and muscle paralysis during sleep (sleep paralysis).

If you are experiencing excessive daytime sleepiness, it is important to seek advice from a healthcare professional or a sleep disorder clinic, as there may be underlying causes that need to be addressed.

Underlying conditions like thyroid issues or cancer

Feeling sleepy all day can be a symptom of an underlying health issue. Thyroid issues, for example, can cause sleep problems. The thyroid, a small, butterfly-shaped gland located at the front of the neck, produces hormones that regulate how the body uses energy. These hormones affect most organs and are vital to a wide range of physiological processes, including breathing, heart rate, digestion, and body temperature.

An imbalance in thyroid hormones can interfere with the production of thyrotropin, a hormone that stimulates the thyroid. This can disrupt the body's circadian rhythm, which is regulated by the master circadian clock located in the brain. Hypothyroidism, or an underactive thyroid, occurs when the thyroid does not produce enough hormones, while hyperthyroidism, or an overactive thyroid, is the overproduction of thyroid hormones. Both conditions are considered risk factors for certain sleep disorders.

People with hypothyroidism often experience trouble tolerating cold temperatures at night and joint or muscle pain that disrupts sleep. Studies have linked hypothyroidism to poor sleep quality, longer sleep onset, and shorter sleep duration. It can also cause hypersomnia, or the irrepressible need to sleep, and can be mistaken for sleep-related hypoventilation, or slow and shallow breathing during sleep. Additionally, hypothyroidism is considered a leading cause of hypersomnia due to an endocrine system disorder.

On the other hand, hyperthyroidism can cause difficulty sleeping due to arousals from nervousness or irritability, muscle weakness, and constant feelings of tiredness. It may also lead to night sweats and frequent urination, which can further disrupt sleep. An overactive thyroid is also considered a predisposing factor for night terrors, a type of sleep disorder characterized by sudden, terrified outbursts during the night.

Thyroid issues can be caused by various factors, including underlying autoimmune disorders, pregnancy, and iodine intake. Conditions such as Graves' disease and Hashimoto's disease can affect thyroid function, and type 1 diabetes is a risk factor for both types of thyroid dysfunction. Pregnancy has also been linked to thyroid problems, and women with pre-existing thyroid issues are urged to treat their condition before becoming pregnant. Additionally, inadequate or excessive iodine intake can contribute to thyroid disease, as the thyroid gland uses iodine to produce hormones.

Cancer-related fatigue is another underlying condition that can cause excessive daytime sleepiness. It is a common symptom, affecting almost 65% of people with cancer. This fatigue can be a result of the cancer itself or a side effect of treatment. It can affect individuals physically, emotionally, and mentally, and its severity and duration vary from person to person. Cancer-related fatigue can cause a lack of energy, a constant need for rest, sleeping problems, difficulty concentrating, and negative feelings. It can last for several weeks, months, or even years after treatment.

Lifestyle choices, e.g. diet, exercise, and substance use

Lifestyle choices, such as diet, exercise, and substance use, can have a significant impact on sleep. Here are some ways these factors can influence how sleepy you feel throughout the day:

Diet:

The food and drinks you consume can affect your sleep quality and duration, which in turn influences your daytime sleepiness. Here are some dietary considerations:

• Caffeine: While caffeine can help you stay awake during the day, it's important to be mindful of your intake, especially closer to bedtime. It's not just coffee and tea—caffeine can be found in energy drinks, decaffeinated coffee and tea, non-cola sodas, chocolate, ice cream, and breakfast cereals.
• Alcohol: Although alcohol may help you fall asleep initially, it can disrupt your sleep later in the night, impacting the restorative stages of sleep. It can worsen sleep apnea, increase the likelihood of sleepwalking and sleep talking, and contribute to memory problems.
• Spicy foods: Eating spicy foods close to bedtime can cause heartburn and acid reflux, which can disrupt your sleep, especially if you have sleep apnea.
• Red pepper: Consuming red pepper can increase your core body temperature, making it harder for your body to transition to the cooler temperature required for sleep.
• High-fat and high-protein foods: A high-fat diet has been linked to more fragmented sleep and excessive daytime sleepiness. High-protein foods take longer to digest, so eating a large steak or chicken dinner close to bedtime can disrupt sleep.
• Complex carbohydrates: Eating complex carbs like whole-wheat toast or oatmeal before bed can trigger the release of serotonin, the sleepy hormone, and they are easier to digest.

Exercise:

Regular exercise plays a crucial role in promoting better sleep and reducing daytime sleepiness. Here's how:

• Improves sleep quality: Exercise helps tire out your body, making it easier to fall asleep and improving overall sleep quality.
• Reduces stress and anxiety: Regular exercise is a natural stress reliever, helping to reduce anxiety that may otherwise keep you awake at night.
• Regulates body clock: Exercise can help regulate your body's internal clock, known as the circadian rhythm, which plays a crucial role in sleep-wake cycles.

Substance Use:

The use of certain substances can significantly impact your sleep and contribute to daytime sleepiness:

• Drugs of abuse and alcohol: These substances disrupt sleep by interfering with the ease of falling asleep, increasing the difficulty of maintaining sleep, and altering the cycling of sleep stages from non-rapid eye movement (NREM) sleep to rapid eye movement (REM) sleep. This can lead to increased daytime sleepiness and impaired alertness.
• Stimulants: The use of stimulants, such as caffeine and nicotine, can provide a temporary boost in alertness but may contribute to a cycle of disrupted sleep and increased daytime sleepiness.
• Sedatives: While substances like alcohol and sedative-hypnotics may initially help induce sleep, especially for those with insomnia, they can lead to tolerance and dose escalation, contributing to substance abuse and disrupted sleep patterns.

Mental health, including anxiety and depression

Sleep and mental health are closely related. Poor sleep can negatively impact mental health, and vice versa. Mental health issues can affect sleep quality and duration, and sleep problems can worsen mental health issues.

Anxiety and Depression

Anxiety and depression are common mental health issues that can impact sleep. Anxiety can cause racing or repetitive thoughts and worries that keep you awake at night. It may also lead to panic attacks while trying to sleep. Depression can cause insomnia, making it difficult to fall or stay asleep. It can also lead to hypersomnia, or excessive daytime sleepiness, resulting in increased sleep duration.

People with insomnia have a tenfold higher risk of developing depression than those who get a good night's sleep. About 75% of people with depression have trouble falling or staying asleep. Depression can sap energy, leading to increased sleep duration. It can also disrupt the amount of restorative slow-wave sleep a person gets each night, further impacting their overall sleep quality.

Additionally, daily stresses and worries can contribute to nighttime wake-ups and difficulty falling back asleep for individuals with depression. Seasonal Affective Disorder (SAD), a type of depression that occurs during specific times of the year with less sunlight, can also lead to increased sleep duration.

Treatment and Management

Treating sleep problems can help alleviate symptoms of anxiety and depression. Cognitive-behavioral therapy for insomnia (CBT-I) has been shown to improve sleep in people with depression and may increase the chances of remission. Other treatments for depression, such as selective serotonin reuptake inhibitors and other medications, may improve mood and outlook but may not be sufficient to address sleep issues.

Lifestyle adjustments, such as maintaining a regular sleep schedule, avoiding substances like alcohol and caffeine, and creating a peaceful sleeping environment, can also help improve sleep quality. Exercise, a well-balanced diet, and stress management are also important factors in improving sleep and managing mental health.

Seeking Professional Help

If you are experiencing sleep problems and mental health issues, it is important to seek professional help. A healthcare provider can help determine the underlying causes and recommend specific treatments or lifestyle changes. Keeping a sleep diary and filling out a sleep questionnaire can be helpful tools to bring to a doctor's appointment to aid in diagnosis and treatment planning.

It is important to take sleep problems seriously and address them early on, as they can have a significant impact on overall mental health and well-being.

Medication side effects

Excessive sleepiness, or hypersomnia, can be caused by a variety of factors, including medications. Medications that can cause drowsiness and excessive sleepiness as a side effect include those that treat nasal congestion (antihistamines) and nausea and vomiting (antiemetics).

Over-the-counter sleep aids and supplements, such as antihistamines, melatonin, and valerian, can also cause side effects like drowsiness, confusion, and sleepwalking. It is important to consult a doctor before taking any sleep aids, as they can interfere with other medications or worsen existing health conditions.

Prescription sleeping pills can have more severe side effects and are typically recommended for short-term relief only. These may include benzodiazepines and Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta). Side effects of prescription sleep medications can include:

• Constipation or diarrhea
• Digestive problems, including gas, heartburn, and nausea
• Worsening of snoring and sleep apnea
• Parasomnia, or disruptive sleep disorders, such as sleepwalking, sleepeating, and sleep-driving
• Dependence and addiction
• "Hangover" effect, causing drowsiness, impaired focus, and balance problems the next day

If you think your medication is causing excessive sleepiness, it is important to consult your doctor before discontinuing or changing your dosage. They may recommend tapering off the medication, changing the dosage, or switching to a different medication.

Frequently asked questions