Daytime Sleep: Friend Or Foe?

Sleep is important for both our physical and mental health and well-being. While it is recommended that we get our sleep at night, there are many reasons why we may need to sleep during the day. This could be due to shift work, a chronic health condition, or simply because we are sleep-deprived.

Daytime sleep can have surprising effects on our health in the long term. While short naps can be beneficial, regularly sleeping during the day can disrupt our natural circadian rhythm and lead to negative side effects such as trouble falling asleep, excessive daytime fatigue, headaches, and memory issues. It can also increase the risk of significant health and safety problems, including insulin resistance, drug and alcohol misuse, and metabolic syndrome, which can increase the risk of heart disease, stroke, and diabetes.

However, daytime sleep is not all bad. Napping for less than 30 minutes can boost mood, creativity, and energy levels, and improve performance and learning ability.

Hypersomnia

The signs and symptoms of hypersomnia include recurrent episodes of extreme sleepiness during the day, sleeping longer than average (10 or more hours), and experiencing difficulty staying awake. Those affected may also have trouble waking up in the morning or after daytime naps, sometimes exhibiting confusion or irritability. These daytime naps do not leave them feeling refreshed or rested. Other symptoms include anxiety, slow thinking and speech, inability to focus or concentrate, and memory problems.

The specific cause of hypersomnia remains largely unknown, although researchers have explored the potential involvement of neurotransmitters in the brain and cerebrospinal fluid, such as hypocretin/orexin, dopamine, histamine, serotonin, and gamma-aminobutyric acid (GABA). There may also be a genetic predisposition, as a family history is observed in up to 39% of people with idiopathic hypersomnia. Certain genes associated with circadian rhythm are also being investigated for their potential role in the disorder.

To diagnose hypersomnia, a sleep specialist will evaluate an individual's symptoms, medical history, sleep history, and current medications. They may recommend maintaining a sleep diary and wearing an actigraphy sensor to monitor sleep-wake patterns. Additional tests, such as polysomnography and multiple sleep latency tests, can help identify underlying sleep disorders.

Treatment for hypersomnia depends on the underlying cause and may include medication and lifestyle changes. Wakefulness-promoting agents, such as modafinil and armodafinil, are often the first line of treatment. Psychostimulants like amphetamine and methylphenidate may also be prescribed, although they carry a higher risk of abuse and side effects. Lifestyle modifications include maintaining a regular sleeping schedule, creating a peaceful sleep environment, and avoiding substances that cause drowsiness, such as alcohol and certain medications.

Sleep Disorders

Sleep is a period during which the brain engages in activities necessary for life and closely linked to quality of life. However, some people struggle with sleep disorders that affect their daily lives. Excessive daytime sleepiness, or hypersomnia, is a condition where people fall asleep repeatedly during the day, even after a full night's rest. This can impact their ability to function at work and socially, affecting their quality of life and increasing the risk of accidents.

There are two main types of hypersomnia: secondary hypersomnia and primary hypersomnia. Secondary hypersomnia is caused by an underlying medical condition, medication, or a lack of sleep. Conditions that can cause secondary hypersomnia include epilepsy, hypothyroidism, encephalitis, multiple sclerosis, Parkinson's disease, obesity, obstructive sleep apnea, and more. Medications that can cause hypersomnia include sedatives, anti-hypertensives, anti-epileptics, anti-parkinsonian agents, skeletal muscle relaxants, antipsychotics, opiates, and alcohol. Primary hypersomnia, on the other hand, is its own condition and is not caused by another medical condition or symptom. The four types of primary hypersomnia are narcolepsy type 1, narcolepsy type 2, Kleine-Levin syndrome, and idiopathic hypersomnia.

There are also several other sleep disorders that can cause excessive daytime sleepiness. These include sleep apnea, restless legs syndrome, insomnia, sleepwalking, and narcolepsy. Sleep apnea is a condition in which a person's breathing stops or is reduced during sleep, causing them to rouse slightly and gasp for air. This can lead to feeling sleepy during the day. Restless legs syndrome causes an uncontrollable urge to move the legs, making it difficult to fall and stay asleep. Insomnia is characterised by difficulty falling or staying asleep. Sleepwalking is an abnormal behaviour during sleep, more common in children than adults. Narcolepsy is a rare sleep disorder characterised by involuntary napping, sleep paralysis, vivid hallucinations, and muscle weakness during strong emotions.

Circadian rhythm sleep disorders occur when the circadian clock in the brain, which regulates daily behavioural and physiological rhythms, is not synchronised with local time. This can result in abnormal sleep patterns, sleep loss, and fatigue. These disorders can be caused by genetics, the environment, or a medical condition. For example, night shift workers often struggle to adapt to their altered sleep schedule, and blind individuals may experience free-running sleep patterns due to the absence of light cues.

Medication and Medical Conditions

Excessive daytime sleepiness can be a symptom of an underlying medical condition or a side effect of medication. It is one of the most common sleep-related symptoms, affecting an estimated 20% of the population.

Medical Conditions

Excessive daytime sleepiness (EDS) can be a symptom of a medical condition, such as:

• Hypersomnia
• Narcolepsy
• Idiopathic hypersomnia
• Kleine-Levin syndrome
• Obstructive sleep apnea (OSA)
• Delayed sleep phase syndrome
• Multiple systems atrophy
• Myotonic dystrophy
• Mood disorders (including depression, bipolar disorder, and seasonal depression)
• Head trauma
• Tumours
• Central nervous system diseases
• Restless legs syndrome
• Chronic fatigue syndrome (CFS)
• Myalgic encephalomyelitis (ME)

Medication

Excessive daytime sleepiness can also be a side effect of medication. The following types of medication can cause sleepiness:

• Sedating medications (e.g. benzodiazepines, barbiturates, melatonin, and sleeping aids)
• Anti-hypertensive drugs
• Anti-epileptic drugs
• Anti-Parkinsonian agents
• Skeletal muscle relaxants
• Antipsychotics
• Opiates
• Alcohol
• Antidepressants
• Anticonvulsants
• Antimuscarinics and antispasmodics
• Beta-adrenergic blocking agents
• Genitourinary smooth muscle relaxants
• Stimulant drugs

Additionally, withdrawal from stimulant drugs can also cause EDS.

Treatment for Excessive Daytime Sleepiness

The treatment for excessive daytime sleepiness depends on its underlying cause. If it is caused by a medical condition, the treatment will focus on addressing that condition. If it is caused by medication, changing or discontinuing the medication may be recommended.

There are also medications that can help improve alertness and reduce sleepiness. These include:

• Modafinil (Provigil)
• Armodafinil (Nuvigil)
• Amphetamines
• Solriamfetol (Sunosi)
• Pitolisant (Wakix)
• Methylphenidate (Ritalin, Concerta, Methylin)
• Dextroamphetamine (Dexedrine, Procentra, Zenzedi)
• Sodium oxybate (Xyrem)
• Flumazenil (Romazicon)
• Clarithromycin (Biaxin)

Lifestyle Factors

There are several lifestyle factors that can contribute to daytime sleepiness. These factors can disrupt your sleep-wake cycle and result in feeling sleepy during the day. Here are some key lifestyle considerations:

• Shift work: Working irregular hours, especially night shifts, can disrupt your body's natural circadian rhythm. This misalignment between your internal clock and the external environment can make it challenging to get quality sleep.
• Family demands and social life: Responsibilities related to family, such as caring for a new baby, or a busy social life, can interfere with your sleep schedule. Balancing these demands with your sleep needs is essential for maintaining optimal alertness during the day.
• Environmental factors: Noisy neighbours, an uncomfortable mattress, or a snoring partner can cause broken sleep. Addressing these environmental factors can help improve sleep quality.
• Diet and substance use: Consuming caffeinated drinks, alcohol, or tranquillisers close to bedtime can disrupt your sleep. It is advisable to avoid these substances a few hours before sleeping. Additionally, maintaining a well-balanced diet is crucial to ensuring you get adequate nutrition, as deficiencies in certain vitamins and minerals can contribute to excessive sleepiness.
• Mental health: Mental states such as anxiety and depression can impact your sleep. Anxiety may keep you awake at night, making you prone to sleepiness during the day. Depression can sap your energy and alter your sleep patterns, making you sleep more or less than usual.
• Physical activity: Regular physical activity can help improve your overall sleep quality. However, it is important to avoid strenuous exercise close to bedtime, as it may interfere with your ability to fall asleep.
• Relaxation routines: Establishing a relaxation routine before bedtime can help prevent night-time anxiety and promote better sleep.
• Sleep hygiene: Practising good sleep hygiene is essential. This includes maintaining a regular sleeping schedule, creating a comfortable and distraction-free sleeping environment, and avoiding activities in the bedroom that are not related to sleep.

Sleep Treatments

Medication

Wakefulness-promoting medications include modafinil (Provigil), armodafinil (Nuvigil), pitolisant (Wakix), and solriamfetol (Sunosi). These medications are usually tried first.

Psychostimulants include amphetamine, methylphenidate (Ritalin, Daytrana, Methylin, Concerta), and dextroamphetamine (Procentra, Dexedrine, Zenzedi). These drugs have more abuse potential and side effects than first-line agents.

Other drug options include sodium oxybate (Xyrem or Xywav), flumazenil (Romazicon), and clarithromycin (Biaxin).

Sleeping pills are also available over the counter, as natural supplements, or by prescription. They can help you fall asleep and stay asleep, but they can also cause side effects and carry risks of dependence and addiction.

Lifestyle Changes

• Establish a regular sleeping schedule.
• Create a peaceful and comfortable sleeping environment.
• Avoid caffeine, alcohol, and nicotine before bedtime.
• Exercise regularly, but not within a few hours of bedtime.
• Minimise stress before bed.
• Avoid working late into the night.
• Avoid night shift work.

Therapy

Cognitive behavioural therapy (CBT) is an effective tool for improving sleep and curing insomnia. It can help you make behavioural changes to improve your sleep without the need for medications.

Support Groups

Consider joining a support group to cope with the challenges of having a sleep disorder. This can help educate your loved ones about your condition and improve your relationships.

Frequently asked questions