Daytime Sleep: Why Am I So Tired?

Feeling sleepy during the day can be a symptom of hypersomnia, a condition that affects 5-10% of people in the United States. Hypersomnia is characterised by the inability to stay awake and alert during the day despite getting an adequate amount of nighttime sleep. This can lead to unintended lapses into drowsiness or sleep during the day, with some people sleeping soundly at night for 12 hours or more and still feeling the need to nap. There are many causes of hypersomnia, including insufficient sleep, sleep disorders, medications, and medical or psychiatric illnesses. If you are concerned about hypersomnia, it is recommended that you seek advice from a healthcare professional.

Sleep disorders

Sleep Apnea

Obstructive sleep apnea (OSA) occurs when the tissue in the back of the throat relaxes during sleep, partially blocking your airway. This can cause you to repeatedly stop and start breathing throughout the night, leading to feelings of sleepiness during the day. Other symptoms of sleep apnea include loud snoring and gasping for air, as well as morning throat soreness and headaches.

Restless Legs Syndrome (RLS)

RLS causes an uncontrollable urge to move your legs due to uncomfortable sensations. It can make it difficult to fall asleep or stay asleep, resulting in excessive daytime sleepiness. RLS may be related to low iron levels or problems with the brain's basal ganglia, which controls movement.

Narcolepsy

Narcolepsy is a rare sleep disorder characterised by involuntary napping, muscle paralysis during sleep, vivid hallucinations before falling asleep, and muscle weakness during periods of strong emotion (cataplexy). People with narcolepsy often fall asleep suddenly, even during activities like eating or talking.

Insomnia

While insomnia itself is not a cause of hypersomnia, it can contribute to sleep deprivation and daytime sleepiness. Insomnia is characterised by difficulty falling asleep or staying asleep. It is a symptom rather than a disease and can have various underlying causes.

Circadian Rhythm Sleep Disorders

These disorders occur when your internal clock, which regulates your sleep-wake cycle, is disrupted. This can lead to fragmented sleep and sleep problems. Examples include Delayed Sleep Phase Disorder, Advanced Sleep Phase Disorder, Irregular Sleep Wake Disorder, and Shift Work Sleep Disorder.

Idiopathic Hypersomnia

Idiopathic hypersomnia is a condition where people sleep for long periods but still feel confused, irritable, and sleepy upon waking. There is no known cause for this type of hypersomnia, hence the term "idiopathic."

If you are experiencing excessive daytime sleepiness, it is important to consult a healthcare professional. They can help identify any underlying sleep disorders or conditions and provide appropriate treatment or lifestyle recommendations to improve your sleep quality.

Medication and alcohol

The Effects of Mixing Medication and Alcohol:

Combining medication and alcohol can have dangerous consequences, especially when it comes to sleeping pills and central nervous system (CNS) depressants. Both sleeping pills and alcohol can slow down brain activity and have sedating effects on the body. When taken together, they can lead to over-sedation, impaired coordination, dizziness, and an increased risk of falls. Additionally, the risk of respiratory depression and even death is heightened when these substances are mixed. It is important to note that the side effects may vary depending on factors such as age, weight, tolerance, and genetics.

Specific Sleeping Pills and Alcohol:

Some common prescription sleeping pills that interact negatively with alcohol include Lunesta (eszopiclone), Restoril (temazepam), and Unisom (doxylamine). Mixing alcohol with these medications can enhance their sedative effects and increase the likelihood of adverse reactions. It is advised to avoid consuming alcohol while taking these medications to prevent potentially fatal consequences. Other prescription sleeping pills, such as Ambien (zolpidem) and Silenor (doxepin), also carry warnings about the dangers of mixing them with alcohol.

Over-the-Counter Sleep Aids and Alcohol:

Over-the-counter sleep aids, including herbal remedies, are not exempt from the risks associated with alcohol. Melatonin, diphenhydramine, doxylamine, and valerian root are examples of over-the-counter sleep aids that can have increased sedative effects and side effects when combined with alcohol. Diphenhydramine, for instance, can cause intensified drowsiness, dizziness, and slowed breathing when mixed with alcohol. It is recommended to refrain from consuming alcohol while taking these sleep aids to avoid adverse reactions.

The Impact on Sleep Quality:

Contrary to popular belief, mixing alcohol and sleeping pills does not promote better sleep. While it may initially help individuals fall asleep faster, the quality of sleep is often poor. Alcohol and sleeping pills reduce brain-wave activity and prevent deep REM sleep, which is essential for feeling rested and energised the next day. As a result, individuals may experience fatigue and insomnia the following day. Additionally, the combination of these substances can lead to sleepwalking, sleep-eating, and even sleep-driving, which can have legal and safety implications.

Addiction and Dependence:

Mixing alcohol and sleeping pills can increase the risk of addiction and dependence on one or both substances. Studies suggest that individuals with chronic insomnia are more likely to struggle with substance abuse, and insomnia is more prevalent among individuals who consume alcohol daily. Alcohol is the most commonly abused substance in America, and mixing it with certain sleep medications can further heighten the risk of developing an alcohol use disorder. It is important to be cautious and follow the instructions provided with your medication to minimise these risks.

Treatment Options:

If you or someone you know is struggling with an addiction to mixing alcohol and sleeping pills, professional help is available. Medical detox and rehabilitation programs can provide support and skills to overcome this addiction and lead a sober life. It is important to seek help as soon as possible to prevent severe consequences and improve overall well-being.

Environmental factors

There are several environmental factors that can contribute to sleeping through the day. These factors can disrupt your sleep at night, leading to daytime sleepiness. Here are some common environmental considerations:

• Noise: A snoring partner, a baby that wakes up, noisy neighbours, or even a noisy environment can cause broken sleep.
• Temperature: Sleeping in a room that is too hot or too cold can disturb your sleep.
• Mattress and bedding: Sleeping on an uncomfortable mattress or using bedding that doesn't provide the right temperature regulation or comfort can affect sleep quality.
• Light: Exposure to light, especially bright light, can impact your sleep. This includes the presence of artificial light in your bedroom from sources like televisions or other electronic devices.
• Work schedule: Working night shifts or unconventional work schedules can disrupt your body's natural sleep-wake cycle, leading to sleep problems. This is known as Shift Work Sleep Disorder.
• Time zone changes: Travelling across time zones, as with jet lag, can affect your internal biological clock, resulting in sleep disturbances.

Addressing these environmental factors can be an important step in improving your sleep quality and reducing daytime sleepiness. Creating a comfortable, peaceful, and distraction-free sleeping environment can help promote better rest. Additionally, maintaining a consistent sleep schedule and avoiding caffeine and alcohol close to bedtime can also improve sleep habits.

Shift work

The disorder is caused by a mismatch between your internal body clock and the external environment, which affects the timing and duration of sleep. Circadian rhythms are physical, mental, and behavioral changes that follow a 24-hour cycle and are primarily influenced by light and dark. Shift work schedules go against most people's internal body clocks, making it difficult to adjust to a different sleep/wake schedule. This results in difficulties with sleeping when desired and unwanted sleepiness.

There are several strategies that shift workers can use to improve their sleep:

• Maintaining a consistent sleep schedule, even on days off, to help align the body clock with the sleep pattern.
• Creating a bedroom environment that is conducive to sleep by keeping it cool, dark, quiet, and uncluttered.
• Taking naps before or during shifts to improve alertness and performance.
• Consuming moderate amounts of caffeine to stay alert, but avoiding it within three to four hours of bedtime.
• Adjusting sleep times gradually before rotating to a new shift to give the body more time to adjust.
• Talking to employers about scheduling fewer overnight shifts or having more flexibility.
• Timing exposure to bright and dim light by reducing light exposure after leaving work if sleeping during the day, and using blue light-blocking glasses or blackout shades.
• Making enough time for sleep on days off by prioritizing sleep over social activities.

In addition to these strategies, there are also medical treatments for SWSD, including light therapy, melatonin supplements, and wake-promoting medications. However, these should be used under the guidance of a healthcare provider.

Medical conditions

There are a number of medical conditions that can cause excessive daytime sleepiness. These can be physical or mental health conditions, or the result of prescription medications.

Physical Health Conditions

• Chronic pain
• Diabetes
• Fibromyalgia
• Hypothyroidism
• Heart disease
• Asthma
• Nerve conditions
• Kidney disease
• Obesity
• High blood pressure
• Respiratory infections
• Vitamin B12 deficiency

Mental Health Conditions

• Depression
• Anxiety
• Bipolar disorder
• Schizophrenia
• Generalised anxiety disorder
• Panic disorders
• Dysthymia

Sleep Disorders

• Insomnia
• Restless leg syndrome
• Narcolepsy
• Sleep apnea
• Circadian rhythm sleep-wake disorders
• Hypersomnia
• Kleine-Levin syndrome
• Idiopathic hypersomnia
• Delayed sleep phase syndrome
• REM sleep behaviour disorder
• Shift work sleep disorder
• Parasomnias
• Sleep-related movement disorders

Frequently asked questions