Sleeping All Day: Understanding The Underlying Causes

Sleeping all day could be a sign of hypersomnia, a condition in which a person feels extreme sleepiness during the day despite getting an adequate amount of nighttime sleep. Hypersomnia can affect a person's ability to function at work and socially and can increase the risk of accidents. It can be caused by various factors, including sleep disorders such as sleep apnea, narcolepsy, and restless leg syndrome, as well as medical conditions like hypothyroidism, depression, and anxiety. If you are experiencing excessive daytime sleepiness, it is important to consult a healthcare professional for proper diagnosis and treatment.

Hypersomnia

There are two main types of hypersomnia: secondary hypersomnia and primary hypersomnia. Secondary hypersomnia is caused by other factors, such as medical conditions, medications, alcohol, or inadequate sleep. Medical conditions that can cause secondary hypersomnia include epilepsy, hypothyroidism, encephalitis, multiple sclerosis, Parkinson's disease, obesity, obstructive sleep apnea, and more. Primary hypersomnia, on the other hand, is its own condition and is not caused by other factors. Four types of primary hypersomnia are recognised: narcolepsy type 1, narcolepsy type 2, Kleine-Levin syndrome, and idiopathic hypersomnia.

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

To diagnose hypersomnia, a sleep specialist will ask about symptoms, medical history, sleep history, and current medications. They may also ask the patient to keep a sleep diary and wear an actigraphy sensor to track sleep-wake patterns. Other tests include polysomnography, multiple sleep latency tests, and sleep questionnaires.

Treatment for hypersomnia depends on the underlying cause and can include medication and lifestyle changes. Medications used to promote wakefulness include modafinil, armodafinil, and pitolisant. Psychostimulants such as amphetamine and methylphenidate may also be prescribed, although these have more abuse potential and side effects. Lifestyle changes recommended for people with hypersomnia include maintaining a regular sleeping schedule, avoiding stimulants like caffeine and nicotine, and creating a comfortable sleeping environment.

Sleep disorders

There are several sleep disorders that can cause excessive sleepiness, including hypersomnia, sleep apnea, restless leg syndrome, and narcolepsy. These disorders can impact your daily life and increase your risk of accidents, so it is important to seek help if you are experiencing any of the associated symptoms.

Hypersomnia

Hypersomnia is a condition characterised by excessive sleepiness during the day, even after getting a full night's sleep. People with hypersomnia may nap frequently during the day and still sleep for long hours at night. They may also experience symptoms such as difficulty waking up in the morning, confusion, irritability, and slow thinking. Hypersomnia can affect your ability to function at work and socially and can be caused by various factors, including medical conditions, medications, and lifestyle habits.

Sleep Apnea

Sleep apnea is a potentially serious condition where breathing repeatedly stops and starts during sleep. This interruption in breathing can lead to fragmented sleep and excessive sleepiness during the day. Other symptoms of sleep apnea include loud snoring and gasping for air while sleeping, as well as attention and concentration challenges. Obstructive sleep apnea occurs when the tissue in the back of the throat relaxes and partially covers the airway, while central sleep apnea happens when the brain fails to send the correct signals to the muscles controlling breathing during sleep.

Restless Legs Syndrome (RLS)

Restless Legs Syndrome (RLS) is a disorder characterised by unpleasant sensations in the legs and a strong urge to move them. It can also cause jerky leg movements throughout the night, interrupting sleep and leading to sleepiness during the day. RLS may be related to low iron levels, problems with the brain's basal ganglia, or other factors.

Narcolepsy

Narcolepsy is a sleep disorder that causes excessive daytime sleepiness and other symptoms, such as brief uncontrollable moments of sleep or "sleep attacks." It is related to the REM (rapid eye movement) period of sleep, which can occur throughout the day in people with narcolepsy. They may also experience sudden loss of muscle control (cataplexy), vivid dreams or hallucinations, and temporary paralysis during sleep. Narcolepsy is often misdiagnosed as a psychiatric disorder.

If you are experiencing excessive sleepiness or other symptoms of sleep disorders, it is important to consult a healthcare professional for proper diagnosis and treatment.

Mental health disorders

There is a close relationship between sleep and mental health. Living with a mental health problem can affect how well you sleep, and poor sleep can have a negative impact on your mental health.

Anxiety

Anxiety can cause racing or repetitive thoughts, and worries that keep you awake. You may also have panic attacks while you're trying to sleep.

Depression

Depression and seasonal affective disorder (SAD) can make you sleep more, including staying in bed for longer or sleeping more often. Depression can also cause insomnia. Insomnia is a risk factor for depression, and people with insomnia are twice as likely to develop depression as those without sleep problems.

Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) can cause nightmares or night terrors. These may wake you up and/or make you feel anxious about falling asleep. People with PTSD are more likely to have sleep disorders.

Mania

Mania often causes feelings of energy and elation, so you might not feel tired or want to sleep. Racing thoughts can also keep you awake and cause insomnia. Poor sleep can also cause symptoms of mania, with research suggesting that changes in the normal sleep cycle preceded the onset of a manic episode in 25-65% of participants.

Paranoia and Psychosis

Paranoia and psychosis may make it difficult to sleep. You may hear voices, or see things you find frightening or disturbing. Poor sleep can trigger psychosis or paranoia, or make existing symptoms worse.

Psychiatric Medication

Psychiatric medication can cause side effects including insomnia, disturbed sleep, nightmares, and oversleeping. Stopping psychiatric drugs can also cause sleep problems.

Autism Spectrum Disorder

Children and adults with autism spectrum disorder often experience difficulties with sleeping. Sleep problems are also thought to increase the risk of developing the disorder.

Schizophrenia

Disturbed sleep appears to be closely linked to schizophrenia. It may also be an early sign before the onset of the illness. Insomnia is the sleep disorder most frequently experienced by those with schizophrenia.

Bipolar Disorder

Sleep disturbances are very common among people with bipolar disorder. Such problems can include insomnia, irregular sleep-wake cycles, and nightmares.

Physical health issues

Oversleeping can be a symptom of underlying physical health issues. If you find yourself sleeping more than nine hours in a 24-hour period, it may be a sign of a sleep disorder, mental health disorder, or other health issue.

Sleep Disorders

Circadian rhythm sleep-wake disorders are related to misalignments between sleep-wake cycles and light-darkness cycles. Hypersomnolence disorder or hypersomnia causes excessive sleepiness and longer sleep periods. Narcolepsy is a sleep disorder where a person feels the need to sleep or falls asleep throughout the day. Obstructive sleep apnea (OSA) is a sleep-related condition where people experience interruptions in their breathing while they sleep, causing issues like snoring or breathing pauses. Restless leg syndrome (RLS) causes an individual to feel like they need to move their legs as they experience tingling, creeping, burning, or other sensations in the legs.

Mental Health Disorders

Depression and anxiety can cause both oversleeping and difficulty sleeping. Several studies have shown a higher rate of depression in long sleepers. People with anxiety disorders are also more likely to experience long sleep, which causes them distress.

Other Health Issues

Conditions affecting your physical health may also cause oversleeping. Health conditions like chronic pain, diabetes, fibromyalgia, and hypothyroidism may make it hard for you to stay awake for longer.

Medication

Some medications may cause you to sleep longer than normal due to their sedating effects or drowsiness. Certain types of painkillers and medications that treat mental health disorders can have this effect.

Lifestyle factors

• Avoid cigarettes, alcohol, and caffeine near bedtime: These substances can disrupt your sleep. It is advisable to refrain from consuming them a few hours before bedtime.
• Follow a relaxation routine: To prevent nighttime anxiety, engage in relaxing activities such as meditation, deep breathing, or listening to soothing music.
• Exercise regularly and maintain a healthy weight: Regular physical activity can improve your sleep quality and overall health. Maintaining a weight that is appropriate for your height is also beneficial.
• Eat a well-balanced diet: A nutritious diet can help prevent nutritional deficiencies that may contribute to sleep problems.
• Reduce environmental disturbances: Create a peaceful sleep environment by minimising noise, light, and distractions in your bedroom. Avoid watching television in bed, and ensure your bedroom is comfortable, well-ventilated, and maintained at a pleasant temperature.
• Stick to a regular sleep schedule: Go to bed and wake up at the same time each day. This helps regulate your body's internal clock and improves sleep quality.
• Only go to bed when you feel sleepy: Avoid forcing yourself to sleep if you don't feel tired. This can help ensure that your body associates your bed with sleep, improving sleep efficiency.
• Take brief 'power' naps during the day: Short naps can enhance alertness and vigilance. However, daytime napping is generally not recommended if improved sleep at night is possible, as it can reduce your drive to sleep at night.
• Seek professional help: Consult a healthcare professional or a sleep disorder clinic if you continue to experience excessive sleepiness. They can help identify any underlying conditions and provide personalised advice and treatment options.

Frequently asked questions