Ashwin Lewis
Feeling sleepy all the time is known as excessive daytime sleepiness (EDS) and is often a symptom of an underlying problem. One of the most common causes of EDS is sleep deprivation, which can be caused by a variety of factors, including insomnia, sleep apnea, restless leg syndrome, and circadian rhythm sleep-wake disorders. In some cases, EDS can be a symptom of a neurological condition such as narcolepsy, Kleine-Levin syndrome (KLS), or a neurodegenerative disease. Certain medications, injuries, infections, and mental health conditions can also contribute to EDS. If you are experiencing excessive daytime sleepiness, it is important to consult a healthcare professional to determine the underlying cause and explore treatment options, which may include lifestyle adjustments, medication, or therapy.
| Characteristics | Values |
|---|---|
| Condition | Hypersomnia, Kleine-Levin syndrome (KLS), Narcolepsy, Idiopathic hypersomnia, Delayed sleep phase syndrome, Insomnia, Restless legs syndrome, Circadian rhythm sleep-wake disorder, Sleep apnea |
| Symptoms | Extreme sleepiness during the day, Sleeping longer than usual (11-20 hours), Daytime naps are not refreshing, Falling asleep suddenly, multiple times during the day, Difficulty staying awake or alert, Feeling confused or irritable after waking up, Sleep paralysis, Cataplexy (sudden muscle weakness) |
| Causes | Alcohol, Drugs, Mental health conditions (depression, anxiety), Physical health conditions (hypothyroidism, oesophageal reflux, nocturnal asthma, chronic pain), Medication, Sleep deprivation, Traumatic brain injuries, Neurological conditions, Age, Lifestyle habits, Sleep disorders |
| Treatment | Medication, Lifestyle adjustments (exercise, diet, sleep habits, relaxation), Sleep studies and tests, Visiting a sleep disorder clinic |
| Impact | Difficulty with work, school, and personal relationships, Higher risk of accidents and injuries, May indicate underlying medical conditions (heart disease, diabetes, depression) |
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What You'll Learn
Hypersomnia and its causes
Hypersomnia is a condition characterized by excessive sleepiness during the day. People with hypersomnia feel extremely sleepy during the day, even after getting a healthy amount of rest at night. They may fall asleep several times during the day, often without meaning to, and may struggle to stay awake or alert. This condition can affect one's ability to work or go to school and can also impact personal relationships. It can also increase the risk of accidents, especially motor vehicle accidents.
There are several different forms of hypersomnia, including primary and secondary hypersomnia. Primary hypersomnia occurs without any other condition causing it, while secondary hypersomnia is triggered by another health condition or issue. Idiopathic hypersomnia, the most common type, is a form of primary hypersomnia and is characterized by excessive night-time sleeping and daytime napping. There is no known cause for idiopathic hypersomnia.
Secondary hypersomnia, on the other hand, can be caused by various factors. Certain medications, such as sedatives, muscle relaxers, or antipsychotics, can lead to hypersomnia. Additionally, alcohol consumption and the use of recreational drugs like cannabis or opiates can also contribute to this condition. Underlying health conditions, particularly those affecting the muscles, brain, or central nervous system, can trigger secondary hypersomnia. Mental health conditions, such as depression, anxiety, and stress, have also been linked to this form of hypersomnia.
In some cases, hypersomnia may be caused by insufficient or inadequate sleep. This could be due to long working hours, family demands, or social activities that interfere with sleep duration and quality. Sleep disorders, such as sleep apnea, can also disrupt sleep and lead to hypersomnia. Additionally, neurological conditions like narcolepsy, Kleine-Levin syndrome (KLS), and neurodegenerative diseases, including dementia and Parkinson's disease, can contribute to excessive sleepiness.
It is important to note that hypersomnia is not a condition in itself but rather a symptom of an underlying problem. Working with a healthcare provider to identify the specific causes and improve sleep habits can help enhance daily productivity, mood, and overall health. Treatment options may include medication to stay awake, addressing specific causes, and making lifestyle adjustments to improve sleep quality.
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Narcolepsy and cataplexy
Excessive daytime sleepiness is not a condition in itself but a symptom caused by an underlying problem. Hypersomnia, insomnia, and narcolepsy are some of the conditions that can cause excessive daytime sleepiness.
Narcolepsy is a chronic neurological condition that disrupts normal sleep patterns, resulting in excessive sleepiness. People with narcolepsy experience "sleep attacks," where they fall asleep suddenly, usually for less than an hour, and may feel refreshed when they wake up. It is caused by the brain's inability to regulate the sleep-wake cycle. Narcolepsy occurs with or without cataplexy.
Cataplexy is a sudden loss of muscle tone and power triggered by strong emotions such as laughter, fear, anger, stress, or excitement. It is believed to be caused by the intrusion of REM sleep into wakefulness. During an attack, the person remains fully conscious but is unable to move or speak, and their eyes may remain open. Cataplexy can last from a few seconds to several minutes and usually resolves on its own. It can be mild, involving only minor weakness in a few muscles, or severe, resulting in a total body collapse. In about 10% of cases, cataplexy is the first symptom of narcolepsy, and it is present in around 70% of narcolepsy patients.
Narcolepsy with cataplexy is diagnosed by detecting low levels of hypocretin (also known as orexin), a natural chemical that helps the body stay awake and controls REM sleep. It is also diagnosed when a person shows excessive daytime sleepiness during a special nap test. Narcolepsy without cataplexy is characterized by excessive daytime sleepiness but typically does not include cataplexy, and patients usually have less severe symptoms and normal hypocretin levels.
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Sleep apnea and breathing disorders
Excessive daytime sleepiness is not a condition in itself but a symptom of an underlying problem. Sleep apnea is a breathing disorder that can cause excessive daytime sleepiness. It is characterized by brief pauses in breathing during sleep, creating fragmented sleep that typically causes daytime drowsiness. Obstructive sleep apnea (OSA) occurs when the muscles in the throat relax, causing the surrounding tissue to press on the windpipe and block airflow. Central sleep apnea (CSA) happens when the brain fails to send signals to keep the breathing-related muscles working during sleep. Mixed or complex sleep apnea is a combination of both types. Sleep apnea can cause serious, even life-threatening complications if left untreated, such as stress on the heart. However, it is manageable with the help of a healthcare provider, who can create a treatment plan to help improve sleep and prevent complications.
A healthcare provider will diagnose sleep apnea by asking about symptoms and medical history. They may recommend overnight testing, known as a polysomnogram, which involves wearing sensors that monitor heart rate, breathing, blood oxygen levels, and brain waves. There is also a home version of a sleep study, although it cannot diagnose central sleep apnea. Video and audio recordings of a person sleeping can also help a healthcare provider diagnose sleep apnea.
Other conditions that can cause excessive daytime sleepiness include Kleine-Levin syndrome (KLS), which involves sleeping for unusually long periods (16 to 20 hours a day), and narcolepsy, a neurological condition where the brain cannot regulate the sleep-wake cycle, causing people to fall asleep rapidly and unexpectedly. Secondary hypersomnia is caused by health conditions, mental health issues, injuries, or insufficient sleep. Certain medications, alcohol, and drugs can also contribute to hypersomnia.
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Restless leg syndrome
RLS is a movement condition, as people with RLS are forced to move their legs to find relief from symptoms. They may need to pace the floor or constantly move their legs while sitting. Symptoms typically occur when the individual is inactive and sitting for extended periods, such as during a plane trip or while watching a movie. Leg movement or walking typically provides temporary relief from the discomfort, but the sensations often return as soon as movement ceases.
RLS symptoms may vary from day to day and from person to person. With moderately severe RLS, symptoms might only occur once or twice a week but often make it very difficult to fall asleep and cause some problems with function during the day. RLS can severely interrupt sleep, making it difficult to fall asleep or return to sleep after waking up. Events or activities that further reduce sleep may also worsen RLS symptoms. People with RLS commonly feel symptoms in the late afternoon or evening hours.
Most people with RLS also experience periodic limb movement during sleep (PLMS). During sleep, PLMS causes involuntary leg (and sometimes arm) twitching or jerking movements. These movements typically happen every 15 to 40 seconds and can last throughout the night. While many individuals with RLS have PLMS, most people with PLMS do not have RLS. RLS can develop at any age, although it most often begins in middle age. The condition occurs in men and women but is more common in women.
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Circadian rhythm disorders
The body's circadian rhythm is influenced by environmental cues, such as light and darkness, meal times, and physical activity. When this rhythm is disrupted, individuals may experience difficulty sleeping, and the quality of their sleep may be negatively impacted. These disruptions can be temporary, caused by factors such as changes in routine, travel across time zones, or shift work, or they may be long-term, influenced by factors such as aging, genetics, or medical conditions.
There are several types of circadian rhythm disorders, including advanced or delayed sleep-wake phase disorder, irregular or non-24-hour sleep-wake rhythm disorder, and shift work or jet lag disorder. Advanced sleep-wake phase disorder (ASWPD) can make it challenging for individuals to stay awake in the early evening, resulting in early morning awakenings that interfere with daily routines. On the other hand, delayed sleep-wake phase disorder (DSWPD) causes individuals to fall asleep later than desired and struggle to wake up on time in the morning, impacting work, school, or social responsibilities.
Jet lag disorder, a temporary condition that occurs after travelling across multiple time zones, is characterized by feeling sleepy or alert at inappropriate times. Shift work disorder affects those who work at night or on rotating schedules, leading to insomnia, extreme tiredness, and sleepiness during work hours.
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Frequently asked questions
Excessive daytime sleepiness is not a condition in itself but a symptom of an underlying problem. This could be a sleep disorder such as insomnia, sleep apnea, restless leg syndrome, Kleine-Levin syndrome, or narcolepsy, or it could be a symptom of a mental or physical health problem, or a side effect of medication.
Hypersomnia is a group of conditions that share symptoms of excessive sleepiness during the day. This can include sleeping much longer than usual (11+ hours) but still feeling sleepy and needing to nap during the day. Hypersomnia can affect your ability to work or go to school, and it can be dangerous if you need to drive.
Narcolepsy is a neurological condition in which the brain cannot properly regulate the sleep-wake cycle. People with narcolepsy are prone to falling asleep rapidly, often at inopportune times. It can be managed with treatment and by practicing good sleep hygiene.
