The Sleepyhead Syndrome: Sleeping All Day Explained

Sleeping all day is a condition called hypersomnia, which is characterised by excessive daytime sleepiness and the need for long sleep. People with hypersomnia may sleep for long hours at night and still feel the need to nap during the day. This condition can affect work life, social life, and home life, and can increase the risk of accidents. Hypersomnia can be caused by a variety of factors, including sleep disorders, medications, and medical or psychiatric illnesses. Treatment options include medications, non-drug options, and lifestyle changes to improve sleep quality.

Hypersomnia

Symptoms

The symptoms of hypersomnia include:

• Sleeping longer than average (10 or more hours) yet still feeling sleepy during the day.
• Difficulty waking up in the morning or after daytime naps, sometimes appearing confused or combative.
• Daytime naps that don't lead to improved alertness.
• Anxiety and irritability.
• Slow thinking, slow speech, inability to focus/concentrate, and memory problems.

Causes

The cause of most cases of hypersomnia is unknown. However, researchers have explored the potential roles of neurotransmitters in the brain and cerebrospinal fluid, including hypocretin/orexin, dopamine, histamine, serotonin, and gamma-aminobutyric acid (GABA). There may also be a genetic link, as a family history is present in up to 39% of people with idiopathic hypersomnia.

Treatment

The treatment for hypersomnia depends on the underlying cause. It can include medication approaches, such as wakefulness-promoting agents like modafinil (Provigil®) or psychostimulants like amphetamine. Lifestyle changes, such as maintaining a regular sleeping schedule and avoiding stimulants like caffeine and nicotine, can also help improve sleep quality.

Sleep disorders

Excessive daytime sleepiness, or hypersomnia, is a condition where people fall asleep repeatedly during the day, even if they have had a full night's sleep. This can be dangerous, as it increases the risk of accidents, especially while driving. People with hypersomnia may also experience "sleep drunkenness", where they feel confused or combative after waking up.

Hypersomnia can be caused by a variety of factors, including:

• Sleep disorders such as sleep apnea, insomnia, and narcolepsy
• Medical conditions like hypothyroidism, oesophageal reflux, nocturnal asthma, chronic pain, vitamin deficiencies, and more
• Mental health disorders, such as depression and anxiety
• Certain medications and substances, including alcohol, caffeine, tranquilizers, sleeping pills, and antihistamines
• Environmental factors, like a snoring partner or noisy neighbours
• Shift work, which disrupts the body's internal clock
• Genetic factors, with a family history present in up to 39% of people with idiopathic hypersomnia

There are two main types of hypersomnia: secondary hypersomnia and primary hypersomnia. Secondary hypersomnia is caused by an underlying condition, such as those mentioned above. Primary hypersomnia, on the other hand, is its own condition and is not caused by another disorder.

Primary hypersomnia can be further divided into four subtypes:

• Narcolepsy type 1: caused by low levels of hypocretin (orexin), a chemical in the brain and cerebrospinal fluid. It is associated with sudden muscle weakness triggered by emotions (cataplexy).
• Narcolepsy type 2: similar to type 1, but with milder symptoms and normal levels of hypocretin.
• Kleine-Levin syndrome: a rare disorder that occurs mostly in teenage males, causing extreme bouts of hypersomnia that can last from a few days to a few weeks.
• Idiopathic hypersomnia: hypersomnia without a known cause.

Treatment for hypersomnia depends on the underlying cause and can include medications, lifestyle changes, or a combination of both. Medications may include stimulants, antidepressants, or newer drugs such as Wakix and Xywav. Lifestyle changes can involve improving sleep hygiene, such as maintaining a regular sleep schedule, avoiding caffeine and alcohol, and creating a peaceful sleeping environment.

Mental health disorders

Excessive daytime sleepiness, or hypersomnia, can be a symptom of mental health disorders such as depression and anxiety. People with depression often experience both oversleeping and difficulty sleeping. Several studies have shown a higher rate of depression in long sleepers. Anxiety can also keep a person awake at night, making them prone to daytime sleepiness.

Hypersomnia can also be caused by mood disorders, including bipolar disorder, which involves mood swings that range from extreme highs (mania) to extreme lows.

If you are experiencing symptoms of hypersomnia, it is important to consult a doctor or healthcare professional. They may ask about your sleep habits, emotional state, and any medications you are taking. They may also recommend keeping a sleep diary or referring you to a sleep specialist. Treatment options can include medication and lifestyle changes, such as improving sleep hygiene and avoiding substances that can disrupt sleep.

Health issues

Excessive daytime sleepiness, or hypersomnia, can be a symptom of an underlying health issue. It can be caused by a wide range of factors, including sleep disorders, medications, medical or psychiatric illnesses, vitamin deficiencies, and genetic factors. Hypersomnia can also be caused by insufficient or inadequate sleep, which may be due to long working hours, shift work, family demands, or environmental factors such as noise or temperature.

Sleep Disorders

Sleep disorders that can cause hypersomnia include sleep apnea, insomnia, restless leg syndrome, sleepwalking, narcolepsy, and idiopathic hypersomnia. Sleep apnea, for example, causes interruptions in breathing during sleep, leading to fragmented sleep. Narcolepsy is characterised by involuntary napping, muscle paralysis, hallucinations, and muscle weakness during strong emotions. Idiopathic hypersomnia is hypersomnia without a known cause.

Medical and Psychiatric Illnesses

Medical and psychiatric conditions that can lead to hypersomnia include hypothyroidism, oesophageal reflux, nocturnal asthma, and chronic pain. Conditions such as anxiety and depression can impact sleep quality and contribute to hypersomnia.

Medications and Substances

Certain medications and substances can also induce hypersomnia. These include alcohol, caffeine, tranquilizers, sleeping pills, antihistamines, and prescription drugs such as blood pressure medications and anti-epileptic drugs. Additionally, the use of stimulants or withdrawal from stimulant drugs can result in hypersomnia.

Genetic Factors

Genetics may also play a role in hypersomnia, as there is a higher occurrence of the condition among individuals with a family history of it. Research suggests that specific genes related to the circadian rhythm may be implicated in hypersomnia.

Impact on Health

Hypersomnia can have a significant impact on overall health. It can increase the risk of accidents, especially motor vehicle accidents. Additionally, it can affect mental health, leading to frequent mental distress. Research also suggests that hypersomnia may be associated with an increased risk of coronary heart disease and other chronic diseases.

Lifestyle factors

• Maintain a consistent sleep schedule: 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.
• Establish a relaxing bedtime routine: Engage in activities that help you unwind and prepare for sleep. Avoid screens and electronic devices a few hours before bedtime, as the blue light emitted by these devices can disrupt sleep. Instead, opt for relaxing activities such as reading, listening to soothing music, or practising meditation or deep breathing exercises.
• Optimise your sleep environment: Create a bedroom that is conducive to sleep. Ensure your bedroom is cool, dark, quiet, and comfortable. Minimise noise, light, and any other distractions that may interfere with your sleep.
• Exercise regularly: Incorporate daily physical activity and exposure to sunlight. Exercise helps to tire the body and improve sleep quality. However, avoid strenuous exercise close to bedtime, as it may increase alertness and make it difficult to fall asleep.
• Nap wisely: If necessary, take short power naps during the day to boost alertness. However, avoid napping too late in the afternoon, as it may disrupt your nighttime sleep.
• Avoid stimulants and alcohol: Refrain from consuming caffeine, nicotine, and alcohol close to bedtime. Caffeine and nicotine are stimulants that can interfere with your sleep, while alcohol may disrupt your sleep later in the night.
• Maintain a healthy diet: Eat a well-balanced diet rich in plants, whole grains, and healthy fats. Increase your protein intake and reduce your consumption of sugar and saturated fats. Certain dietary changes can help improve sleep quality and prevent daytime sleepiness.
• Address environmental disturbances: Minimise external disturbances as much as possible. For example, avoid watching television in bed, and ensure your bedroom is comfortable and free from distractions.
• Manage stress: Stress and anxiety can disrupt sleep. Consider incorporating relaxation techniques such as deep breathing, meditation, or yoga into your daily routine to help manage stress levels.
• Seek professional help: If you continue to struggle with hypersomnia, consider consulting a sleep specialist or a mental health professional. They can provide personalised advice and guidance to help improve your sleep habits and address any underlying mental health concerns.

Frequently asked questions