Daytime Sleepiness: Why Am I Always Napping?

Feeling sleepy during the day can be a symptom of an underlying health issue. The most common causes of excessive sleepiness are sleep deprivation, disorders like sleep apnea and insomnia, depression and other mental health conditions, certain medications, and medical conditions affecting the brain and body. If you are experiencing excessive sleepiness, it is important to consult a healthcare professional to determine the underlying cause and explore treatment options, which may include medications, lifestyle changes, or both.

Sleep disorders

Insomnia

Insomnia is a sleep disorder that makes it difficult for people to fall asleep or stay asleep. It often leads to excessive sleepiness during the day. Insomnia can be caused by an irregular sleep schedule, the use of caffeine, nicotine, alcohol, or certain medications, physical or mental illness, and other sleep disorders such as sleep apnea or restless legs syndrome. It affects up to 35% of adults.

Sleep Apnea

Sleep apnea is a potentially serious condition where breathing repeatedly stops and starts during sleep, causing fragmented sleep and daytime drowsiness. There are two types: obstructive sleep apnea (OSA), caused by a blockage in the airway, and central sleep apnea (CSA), caused by the brain failing to send signals to the muscles that control breathing. Sleep apnea can lead to other problems such as wide swings in heart rate and decreased oxygen levels. It is a common cause of excessive sleepiness, affecting around 20% of adults.

Restless Legs Syndrome (RLS)

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 during sleep. RLS usually worsens at night, interrupting sleep and leading to daytime sleepiness. It may be related to low iron levels and is estimated to affect up to 10% of adults in the United States.

Narcolepsy

Narcolepsy is a neurological disorder where the brain cannot properly regulate the sleep-wake cycle. People with narcolepsy may fall asleep rapidly and unexpectedly during the day and experience sudden loss of muscle control (cataplexy). It is often misdiagnosed as a psychiatric disorder and may develop between the ages of 7 and 25.

Idiopathic Hypersomnia

Idiopathic hypersomnia is a chronic sleep disorder characterised by constant excessive sleepiness, even after adequate or long periods of sleep. There is no known cause for this condition, hence the term "idiopathic." It can interfere with daily functioning and increase the risk of accidents.

If you are experiencing excessive daytime sleepiness, it is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

Underlying health conditions

Excessive daytime sleepiness is often a symptom of an underlying health issue. Here are some possible health conditions that could be causing your daytime sleepiness:

• Sleep disorders: Sleep disorders such as insomnia, sleep apnea, and restless legs syndrome can all cause excessive daytime sleepiness. Sleep apnea, for example, involves repeated interruptions in breathing throughout the night, leading to fragmented sleep and daytime drowsiness. Restless legs syndrome causes an uncontrollable urge to move the legs, making it difficult to fall and stay asleep.
• Mental health disorders: Mental health conditions such as depression, bipolar disorder, post-traumatic stress disorder (PTSD), and anxiety disorders are associated with sleep problems and excessive daytime sleepiness. Depression, in particular, is strongly linked to sleep issues, with nearly 80% of people with major depression experiencing daytime drowsiness.
• Neurological and neurodegenerative diseases: Neurological conditions like narcolepsy, where the brain cannot properly regulate the sleep-wake cycle, can cause sudden sleep attacks during the day. Neurodegenerative diseases, such as dementia and Parkinson's disease, are also associated with sleeping difficulties and daytime sleepiness.
• Injury and infection: Traumatic brain injuries, concussions, brain tumours, and infections like meningitis can lead to excessive sleepiness.
• Neurodevelopmental disorders: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) have been linked to sleep issues, including daytime sleepiness.
• Other medical conditions: Various other health problems, such as metabolic issues (e.g., diabetes, hypothyroidism), anemia, abnormal blood sodium levels, and electrolyte imbalances, can contribute to excessive daytime sleepiness.
• Medications: Certain medications, including sedatives, antidepressants, pain medications, and antihistamines, can cause drowsiness as a side effect. Additionally, withdrawal from stimulant drugs can lead to excessive sleepiness.

Medication

Prescription medications that may cause drowsiness include:

• Antidepressants
• Antihistamines, found in sleep aids or allergy medicines
• Antiemetics, which control nausea and vomiting
• Antipsychotics and anticonvulsants, which can be used to treat seizures or depression
• Alpha-blockers and beta-blockers, which are used to treat high blood pressure, and in the case of alpha-blockers, prostate problems
• Benzodiazepines and other sedatives, commonly used for anxiety or insomnia
• Drugs for Parkinson's disease
• Muscle relaxants
• Opioids and other prescription pain medications

Over-the-counter drugs and supplements that may cause drowsiness include:

• Insomnia treatments, including natural ones like melatonin
• Allergy medications, including antihistamines
• Remedies for nausea, vomiting, or diarrhea
• Weight loss products, which may contain caffeine or other stimulants
• Stop-smoking aids, which may contain nicotine
• Glucosamine and chondroitin, which are taken to relieve arthritis symptoms
• St. John's wort, which is sometimes taken to treat insomnia
• Multivitamins

If you are experiencing daytime sleepiness and suspect it may be due to your medication, it is important to consult your doctor or pharmacist. They may recommend adjusting the dosage, changing the medication, or taking the medication at a different time of day. Additionally, maintaining healthy sleep habits, limiting substances that cause tiredness, and making lifestyle changes can also help reduce daytime sleepiness.

Lifestyle factors

Maintain a Consistent Sleep Schedule

Try to go to bed and wake up at the same time every day, including weekends. This helps to regulate your body's internal clock and improve your sleep quality.

Create a Peaceful Sleep Environment

Make your bedroom conducive to sleep by keeping it well-ventilated, cool, dark, quiet, and comfortable. Use your bedroom only for sleep and sex to strengthen the mental association between the room and sleep.

Avoid Substances that Interfere with Sleep

Substances like caffeine, alcohol, and nicotine are known to disrupt sleep. Avoid consuming these, especially close to bedtime. Alcohol may help you fall asleep initially but can disrupt your sleep later in the night.

Improve Your Diet and Nutrition

A well-balanced and nutrient-dense diet is essential for optimal sleep. Avoid eating heavy meals close to bedtime, and ensure you're getting enough iron, vitamin B12 or folate, and other essential nutrients.

Exercise Regularly

Engage in regular physical activity, preferably earlier in the day. Exercise can help tire your body and improve your sleep quality. However, avoid strenuous exercise close to bedtime, as it may make it harder to fall asleep.

Manage Stress

Stress and anxiety can keep you awake at night. Incorporate relaxation techniques into your daily routine, such as meditation, deep breathing, or yoga. Consider cognitive behavioural therapy (CBT) if you struggle with chronic stress or anxiety.

Limit Screen Time Before Bed

The blue light emitted by electronic devices can interfere with your sleep. Avoid screens for at least an hour before bedtime, or use blue light filters if possible.

Avoid Working Late into the Night

Try not to work or engage in stimulating activities close to bedtime. Give your mind and body time to wind down and prepare for sleep.

Practice Good Sleep Hygiene

This includes various habits and behaviours that promote better sleep. For example, avoiding caffeine and exercise close to bedtime, maintaining a comfortable sleeping environment, and establishing a relaxing bedtime routine.

Sleep deprivation

Causes of Sleep Deprivation

There are many factors that can lead to sleep deprivation, including lifestyle, work, and environmental factors. Sleep disorders, such as insomnia, and other chronic medical conditions can also cause sleep deprivation.

Lifestyle behaviours, such as voluntary choices that reduce the time available for sleep and the use of electronic devices late at night, can contribute to sleep deprivation. An uncomfortable sleeping environment, with factors like heat, cold, or noise, can also disrupt sleep.

Working outside the traditional nine-to-five work day, or shift work, can alter our natural circadian rhythms, our biological clock that regulates alertness, sleepiness, hunger, temperature, and hormone levels.

Medical conditions such as chronic pain, mental health issues like anxiety and depression, nocturia, diabetes, and substance abuse can also cause sleep deprivation.

Symptoms of Sleep Deprivation

You may experience changes in the way you sleep, such as falling asleep unintentionally during the day, falling asleep quickly at night, or sleeping long hours on the weekends.

In terms of how you feel, sleep deprivation can lead to fatigue, lethargy, and changes in mood, including depression, anxiety, stress, paranoia, or even suicidal thoughts. It may also cause a loss of interest in sex and an increased appetite, especially for calorie-dense foods.

Effects of Sleep Deprivation

Insufficient sleep can impact your brain's functioning, including your memory, emotional regulation, attention, information processing speed, and insight. Even short-term sleep deprivation can impair these functions.

Sleep plays a crucial role in memory formation and consolidation, as well as removing toxic waste products from your brain that are associated with the development of Alzheimer's disease.

Additionally, sleep deprivation can lead to a higher risk of cardiometabolic conditions, including obesity, high cholesterol, diabetes, and hypertension. It can affect your cardiovascular system by disrupting processes that maintain healthy blood pressure, sugar levels, and inflammation control.

Sleep is essential for a healthy immune system, as it is during sleep that important proteins involved in immune function and inflammation, such as cytokines, are produced. Sleep deprivation can leave you more susceptible to infections and reduce your immune response to vaccination.

Treatment and Prevention of Sleep Deprivation

To treat sleep deprivation, it is crucial to prioritise sleep and make healthy sleep recommendations a part of your daily routine.

Maintain consistent bed and wake times, even on weekends, to establish a healthy circadian rhythm. Ensure you allocate enough time to obtain the full amount of sleep you need each night.

Establish a quiet and steady bedtime routine to prepare your mind for sleep. Create a comfortable sleeping environment, keeping the bedroom quiet, dark, and at a pleasant temperature.

Get frequent sunlight exposure during the day to support a healthy circadian rhythm that promotes alertness during the day and sleepiness at night. Engage in regular physical activity, as it can improve your sleep quality and contribute to a normal sleep schedule.

It is also important to avoid things that can disrupt your sleep. Limit your alcohol consumption, as it can interfere with sleep quality. While napping can be beneficial, frequent napping or napping for longer than 30 minutes can reduce your sleep duration at night.

Reduce your caffeine intake, especially close to bedtime, as it can make it harder to fall and stay asleep. Limit the use of electronic devices at night, as the blue light they emit can interfere with melatonin levels, which are essential for regulating sleep patterns.

If you continue to experience sleep deprivation, seek help from a healthcare professional, as it may be indicative of an underlying health condition. They can provide guidance, treatments, and support to improve your sleep quality.

Frequently asked questions