Sleep All Day: Understanding The Science Behind It

Sleep is an essential part of our lives, and getting the right amount of sleep is crucial for our health and well-being. However, for some people, sleeping too much can be a problem. Oversleeping, or long sleeping, is typically defined as regularly sleeping for more than nine hours per night. While it can sometimes be a result of catching up on lost sleep or short-term sleep deprivation, frequent oversleeping may indicate an underlying health condition or a sleep disorder known as hypersomnia. Hypersomnia is characterised by excessive daytime sleepiness, with people falling asleep repeatedly throughout the day despite getting adequate or more than adequate nighttime sleep. This condition can affect various aspects of an individual's life, including work, social life, and overall quality of life. Understanding and addressing the causes of oversleeping are important to improve sleep quality and overall health.

Sleep disorders

Insomnia involves problems with falling and staying asleep. To be diagnosed with insomnia, sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school, or other daily functions. About one-third of adults report symptoms of insomnia, and 4-22% meet the criteria for insomnia disorder.

Sleep apnea is a breathing disorder characterised by pauses in breathing during sleep, which can last for 10 seconds or more. This interrupted sleep leads to daytime sleepiness and fatigue.

Parasomnias involve acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating.

Narcolepsy is a rare sleep disorder characterised by involuntary napping, sleep paralysis, vivid hallucinations, and muscle weakness during strong emotions.

Restless leg syndrome involves an urge to move one's legs, accompanied by uncomfortable sensations. The symptoms occur at least three times a week and last for at least three months, causing significant distress or problems in daily life.

Other sleep disorders include circadian rhythm sleep-wake disorders, non-rapid eye movement sleep arousal disorders, nightmare disorder, rapid eye movement sleep behaviour disorder, hypersomnolence disorder, and sleep-related hypoventilation.

Medical conditions

Excessive daytime sleepiness can be caused by a wide range of medical conditions. Here are some of the most common causes:

Sleep Disorders

Sleep disorders are a common cause of excessive daytime sleepiness. These include:

• Sleep apnea: A breathing disorder that causes brief pauses in breathing during sleep, leading to fragmented sleep.
• Restless legs syndrome: A brain disorder causing an urge to move the legs when at rest.
• Narcolepsy: A rare sleep disorder characterised by involuntary napping, sleep paralysis, hallucinations, and muscle weakness during strong emotions (cataplexy).
• Idiopathic hypersomnia: A disorder causing excessive night-time sleeping and daytime napping without cataplexy or sleep paralysis.
• Insomnia: While not a direct cause, insomnia can be a symptom of another condition causing excessive daytime sleepiness.
• Kleine-Levin syndrome: Recurring episodes of extreme hypersomnia with mental, behavioural, and psychiatric disturbances.

Various medical conditions can disrupt sleep or cause excessive daytime sleepiness. These include:

• Hypothyroidism (underactive thyroid gland)
• Encephalitis
• Epilepsy
• Multiple sclerosis
• Parkinson's disease
• Obesity
• Obstructive sleep apnea
• Delayed sleep phase syndrome
• Nocturnal asthma
• Chronic painful conditions
• Head trauma
• Tumours
• Central nervous system diseases
• Genetic disorders
• Mood disorders (including depression, bipolar disorder, seasonal depression)

Medications and Substances

Certain medications and substances can also cause excessive daytime sleepiness:

• Sedating medications: Benzodiazepines, barbiturates, melatonin, sleeping aids, etc.
• Alcohol
• Antihypertensive drugs
• Anti-epileptic drugs
• Anti-parkinsonian agents
• Skeletal muscle relaxants
• Antipsychotics
• Opiates
• Cannabis
• Caffeine
• Withdrawing from stimulant drugs

Lifestyle and Environmental Factors

Lifestyle and environmental factors can also contribute to excessive daytime sleepiness:

• Inadequate sleep due to long working hours, shift work, family demands, or social life.
• Environmental disturbances, such as a snoring partner, noisy neighbours, or an uncomfortable mattress.
• Jet lag or changes in time zones.
• Mental states like anxiety and depression.

It is important to note that the causes of excessive daytime sleepiness can vary from person to person, and a combination of factors may be at play. If you are experiencing this issue, it is recommended to consult a healthcare professional for proper diagnosis and treatment.

Mental health

Sleep and mental health are closely connected. Quality sleep is crucial for good mental health, but sleep issues can worsen mental health conditions, and vice versa. Poor sleep can make it harder to cope with stress, impact your emotional responses, and impair your judgement. It can also increase the risk of mental health disorders such as anxiety and depression.

The Impact of Sleep on Mental Health

Sleep helps to maintain several cognitive skills, including attention, learning, and memory. A lack of sleep can make it much more difficult to cope with even minor stressors and can even impact your ability to perceive the world accurately. Poor or insufficient sleep has been found to increase negative emotional responses to stressors and decrease positive emotions.

Not getting enough sleep or poor-quality sleep can increase the risk of mental health disorders. While insomnia can be a symptom of psychiatric disorders, it is now recognized that sleep problems can also contribute to the onset and worsening of different mental health problems, including depression, anxiety, and even suicidal ideation.

Bidirectional Relationship

Research has shown that there is a bidirectional relationship between sleep and mental health, with sleep problems being both a cause and consequence of mental health issues. This relationship is particularly evident in people with bipolar disorder, where sleep patterns change considerably depending on their emotional state. During manic periods, they usually feel less need to sleep, but during depressed periods, they may sleep excessively.

Treatment Options

Addressing and treating sleep problems is critical to alleviating the severity of psychiatric disorders. Cognitive-behavioural therapy for insomnia (CBT-I) is a recognized first-line treatment for insomnia and has been proven to reduce symptoms of many mental health conditions. Other treatment options include stimulus control, sleep restriction, relaxation techniques, and medication.

Improving Sleep Habits

In addition to professional treatment, there are several habits and practices that can help improve sleep quality:

• Having a set bedtime and maintaining a steady sleep schedule
• Finding ways to wind down, such as with relaxation techniques or a calming activity, as part of a standard routine before bedtime
• Avoiding alcohol, tobacco, and caffeine in the evening
• Dimming lights and putting away electronic devices for an hour or more before bed
• Getting regular exercise and natural light exposure during the day
• Creating a comfortable and supportive sleeping environment
• Blocking out excess light and sound that could disrupt sleep

Lifestyle factors

Sleep Environment

Creating a peaceful and comfortable sleep environment is essential. This includes maintaining a well-ventilated, cool, dark, and quiet bedroom with a comfortable mattress, pillows, and bedding. Reducing disturbances, such as avoiding watching television in the bedroom, can also help improve sleep quality.

Sleep Schedule

Maintaining a consistent sleep schedule is crucial. This means going to bed and waking up at the same time each night and morning. It's important to establish a regular sleeping routine so that your body recognises when it's time to sleep. Additionally, avoiding working late into the night can help prevent sleep disruption.

Substance Consumption

It's advisable to avoid consuming caffeine, alcohol, and tobacco/nicotine products, especially close to bedtime. Caffeine and nicotine are stimulants that can interfere with sleep, while alcohol can cause disruptions and impair sleep quality despite its initial sedative effects.

Diet and Exercise

Following a well-balanced diet and maintaining a healthy weight for your height are recommended. Nutritional deficiencies can impact overall health and energy levels, which may contribute to sleep issues. Regular exercise is also important, with at least 30 minutes of daily physical activity suggested to promote better sleep.

Shift Work

Shift work can significantly impact sleep patterns, leading to sleepiness during work hours and insomnia during designated sleep times. This disruption to the body's internal clock, or circadian rhythm, can result in sleep deprivation and impaired alertness. If possible, adjusting work schedules or seeking treatment options, such as timed bright light exposure and behavioural modifications, may help mitigate these effects.

Medication

Many common medications can affect your sleep, including prescription drugs and over-the-counter remedies. Here are some of the most common culprits:

• Antidepressants: These can have varying side effects, even within the same drug class. For example, fluoxetine (Prozac) can be stimulating and make it hard to fall asleep, while paroxetine (Paxil) can be sedating.
• Beta-blockers: These medications, such as metoprolol (Lopressor, Toprol XL) and atenolol (Tenormin), are used to treat high blood pressure or an irregular heartbeat. They can decrease the body's natural levels of melatonin, which may cause trouble falling or staying asleep.
• Decongestants: Phenylephrine and pseudoephedrine can be stimulating and cause insomnia in some people. They are not recommended for those with heart problems, a history of stroke, or high blood pressure.
• Diuretics: While diuretics do not directly affect sleep, they can interrupt sleep by causing nighttime urination.
• Smoking-cessation drugs: Nicotine replacement products and prescription medications like varenicline (Chantix) and bupropion (Wellbutrin) can cause unusual dreams or nightmares and disrupt sleep.
• Steroids: Oral steroids like prednisone stimulate the production of cortisol, the stress hormone, which can disrupt the sleep cycle.

If you are struggling with sleep issues, there are several types of medications that can help. However, it is important to consult a healthcare professional before starting any new medication. Here are some options:

• Wakefulness-promoting agents: These include modafinil (Provigil®), armodafinil (Nuvigil®), pitolisant (Wakix®), and solriamfetol (Sunosi®). These medications are typically tried first for hypersomnia.
• Psychostimulants: Amphetamine, methylphenidate (Ritalin®, Daytrana®, Methylin®, Concerta®), or dextroamphetamine (Procentra®, Dexedrine®, Zenzedi®) are examples of psychostimulants. However, they have more abuse potential and side effects than first-line agents.
• Other drug options: If other medications fail, your doctor may prescribe sodium oxybate (Xyrem® or Xywav®), flumazenil (Romazicon®), or clarithromycin (Biaxin®).
• Sleeping pills: Sleeping pills can help treat insomnia by making you feel drowsy and relaxed. They are available over the counter, as natural supplements, or by prescription. However, it is important to use them cautiously as they can cause side effects and may be addictive.
• Melatonin: Melatonin is a natural hormone that regulates the sleep-wake cycle. It is available as a supplement and is generally considered safe, with few side effects.

Frequently asked questions