Daytime Dozing: Unraveling The Mystery Of All-Day Sleepers

Sleeping all day could be a sign of hypersomnia, a condition where people fall asleep repeatedly throughout the day. Hypersomnia is usually caused by inadequate sleep, sleep disorders, medications, or medical and psychiatric illnesses. It is different from feeling tired all the time, as those with hypersomnia may still sleep for long hours at night. Other causes of excessive daytime sleepiness include sleep deprivation, mental health disorders, and certain medications. In older people, hypersomnia may be a symptom of later-stage dementia.

Sleep Disorders

People with hypersomnia, on the other hand, experience excessive daytime sleepiness and may fall asleep repeatedly throughout the day while still sleeping for long hours at night. Idiopathic hypersomnia is a type of hypersomnia with no known cause, where individuals sleep for long periods and wake up feeling confused, irritable, and unrefreshed.

Certain medical and mental health conditions are associated with sleep issues and excessive daytime sleepiness. These include neurodegenerative diseases such as dementia, Parkinson's disease, and Alzheimer's disease, as well as mental health disorders like depression, bipolar disorder, PTSD, and anxiety. Sleep disorders can also be caused by medications, caffeine, alcohol, and irregular schedules, such as working night shifts.

Consequences of sleep disorders and lack of sleep can include fatigue, decreased energy, irritability, problems with focus and decision-making, and mood alterations. Additionally, lack of sleep has been linked to various chronic health problems, including heart disease, diabetes, and obesity.

Medical and Psychiatric Illnesses

Excessive daytime sleepiness is often a symptom of an underlying health issue. The most common causes are sleep deprivation and disorders like sleep apnea and insomnia. However, there are several medical and psychiatric illnesses that can cause excessive sleepiness.

Neurological Conditions

Narcolepsy is a neurological condition in which the brain cannot properly regulate the sleep-wake cycle. Those with narcolepsy are prone to falling asleep rapidly, even at inopportune times. Narcolepsy is characterised by excessive daytime sleepiness, sudden muscle weakness triggered by emotions (cataplexy), vivid dream-like hallucinations before falling asleep, and muscle weakness during periods of strong emotion.

Other neurological conditions that can cause excessive sleepiness include traumatic brain injury, concussions, brain tumours, and infections such as meningitis and encephalitis.

Neurodegenerative Diseases

Neurodegenerative diseases such as dementia, Parkinson's disease, and Alzheimer's disease are associated with sleeping difficulties and daytime drowsiness, especially in the later stages of these illnesses. As these diseases progress, the damage to the brain becomes more extensive, and patients gradually become weaker and frailer, finding simple tasks exhausting.

Mental Health Disorders

Depression, bipolar disorder, post-traumatic stress disorder (PTSD), and general anxiety disorder are associated with sleeping problems that may lead to excessive daytime sleepiness. Nearly 80% of people with major depression experience excessive daytime sleepiness.

Other Medical Conditions

Other medical conditions that can cause excessive sleepiness include metabolic problems such as diabetes and hypothyroidism, as well as anemia, abnormal blood sodium levels, and electrolyte imbalances. Chronic pain conditions such as arthritis, fibromyalgia, and chronic painful conditions can also disrupt sleep, leading to daytime drowsiness.

Additionally, certain medications, especially sedatives, and the withdrawal from some drugs can cause excessive sleepiness. Alcohol consumption can also lead to drowsiness and is a common cause of excessive daytime sleepiness.

Medication

• Antipsychotics
• Antidepressants
• Antihistamines
• Sleeping pills
• Alcohol
• Caffeinated drinks
• Tranquilisers
• Painkillers
• Antihypertensive drugs
• Anti-epileptic drugs
• Anti-parkinsonian agents
• Skeletal muscle relaxants
• Opiates
• Cannabis
• Barbiturates
• Benzodiazepines
• Melatonin
• Sleeping aids
• Stimulant drugs

If you are concerned about the side effects of your medication, consult your doctor or pharmacist.

Dementia

It is common for people with dementia to sleep a lot during the day and night, especially in the later stages of the disease. This can be distressing for family and friends, who may worry that something is wrong. However, it is important to know that this is a typical symptom of the progression of dementia.

As dementia advances, the damage to a person's brain becomes more extensive, and they gradually become weaker and frailer. This can make even simple tasks, like communicating or eating, very exhausting. As a result, people with dementia may find themselves sleeping more during the day as their symptoms worsen.

Additionally, certain medications can contribute to sleepiness, including antipsychotics, antidepressants, antihistamines, and sleeping pills. Sleeping disorders unrelated to dementia, such as sleep apnoea, can also lead to longer sleep durations.

It is recommended to speak to a doctor if your loved one's sleep patterns change suddenly, as this could indicate a problem with medication, an illness, or another complication. While sleeping more than usual is common in the later stages of dementia, it is important to ensure that your loved one is not uncomfortable or distressed due to their sleep.

• Establish a healthy sleep routine, which can help the person feel better, be less confused, and have more energy during the day.
• Consult a GP to rule out any infections or conditions that could be affecting sleep.
• Consider a medication review with a GP or pharmacist, as medication side effects can contribute to sleep disturbances.

Causes of Excessive Sleep in Dementia

Progression of Dementia

As the disease progresses, the damage to the brain becomes more extensive, leading to increased frailty and exhaustion from even simple tasks.

Medication

Certain medications, such as antipsychotics, antidepressants, antihistamines, and sleeping pills, can cause drowsiness.

Sleeping Disorders

Unrelated sleeping disorders, such as sleep apnoea, can also contribute to longer sleep durations.

Melatonin Depletion

As dementia progresses, the brain may produce less melatonin, a hormone crucial for regulating sleep/wake cycles.

Low Sleep Pressure

People with dementia may experience long periods of low activity or boredom during the day, not building up enough "sleep pressure" to feel tired at night.

Sundowning

People with dementia often experience confusion and a worsening of symptoms at night, known as sundowning, which can disrupt their sleep schedule.

Treating Excessive Sleepiness in Dementia

Routine Changes

Try strategies to improve nighttime sleep, such as avoiding caffeine, establishing a relaxing nighttime routine, and creating a quiet, comfortable bedroom environment.

Daytime Activity

Increase daytime activity and light exposure to help regulate sleep. If the person spends a lot of time indoors, consider doing more outdoor activities.

Melatonin

If routine changes are ineffective, low doses of melatonin or mirtazapine (an antidepressant) may help with sleep.

Medication Changes

If sleepiness is a medication side effect, consult a doctor about adjusting the dosage or changing the medication.

Excessive sleep in people with dementia is often a result of the progression of the disease and the associated physical and cognitive exhaustion. While it can be concerning for caregivers, it is typically not harmful to let a person with dementia sleep during the day, as long as they are checked on periodically to prevent physical ailments. However, sudden changes in sleep patterns or other concerning symptoms should be discussed with a doctor.

Lifestyle Factors

There are several lifestyle factors that can contribute to excessive sleepiness and sleeping all day. These include:

• Shift work: Working shifts, especially night shifts, can disrupt the body's natural sleep-wake cycle, known as the circadian rhythm. This can make it difficult for individuals to get adequate and quality sleep.
• Family demands and social life: Responsibilities at home, such as caring for a new baby, or a busy social life can result in inadequate sleep.
• Lack of a consistent sleep schedule: Not having a regular sleeping routine can impact the body's internal clock, making it challenging to fall asleep and wake up at consistent times.
• Environmental factors: Noisy neighbours, an uncomfortable mattress, or a snoring partner can cause broken sleep.
• Mental states: Anxiety and depression can impact sleep. Anxiety may keep a person awake at night, leading to daytime sleepiness, while depression can sap energy and contribute to prolonged sleep.
• Substance use: Alcohol, caffeine, and nicotine are stimulants that can disrupt sleep patterns and contribute to daytime sleepiness.
• Medications: Certain medications, such as sedatives, antidepressants, antihistamines, and painkillers, can cause drowsiness and disrupt sleep patterns.
• Physical health conditions: Conditions such as hypothyroidism, oesophageal reflux, nocturnal asthma, and chronic pain can impact sleep quality and contribute to excessive sleepiness.
• Sleep disorders: Disorders such as sleep apnea, insomnia, and restless leg syndrome can cause sleep disruption and daytime drowsiness.

Frequently asked questions