Daytime Sleepiness: Why Am I Always Sleeping?

If you're sleeping all day, you may be experiencing hypersomnia, or excessive daytime sleepiness. Hypersomnia is characterised by excessive sleepiness during the day or an above-average amount of time sleeping at night (usually beyond the recommended 7-9 hours for adults). People with hypersomnia may nap during the day, fall asleep during the day, and still sleep for long hours at night. Hypersomnia can be caused by a variety of factors, including sleep disorders such as sleep apnea and insomnia, medical conditions, medications, mental health disorders, and lifestyle factors. If you think you may have hypersomnia, it is important to consult a medical professional for diagnosis and treatment.

Sleep disorders

One common sleep disorder is insomnia, which involves problems falling asleep or staying asleep. About one-third of adults experience insomnia symptoms, and 4-22% meet the criteria for insomnia disorder. Insomnia is often treated with a combination of sleep medications and behavioural techniques, such as cognitive behavioural therapy.

Another sleep disorder is sleep apnea, a breathing disorder characterised by interruptions in breathing during sleep. This can cause snoring, snorting, gasping, or even pauses in breathing. Sleep apnea is typically treated with lifestyle changes, such as weight loss or sleeping on one's side, and in some cases, a CPAP (continuous positive airway pressure) device may be prescribed.

Restless leg syndrome (RLS) is another common sleep disorder, characterised by a tingling or prickly sensation in the legs, along with a powerful urge to move them. The symptoms of RLS can cause difficulty falling asleep and can lead to frequent awakenings, resulting in daytime sleepiness.

Hypersomnia is a condition where people experience extreme daytime sleepiness, falling asleep repeatedly during the day despite getting adequate nighttime sleep. This can affect work life, social life, and overall quality of life. Treatment for hypersomnia includes medications, non-drug options, education, and support groups.

Circadian rhythm sleep-wake disorders occur when a person's sleep-wake rhythms (body clock) become misaligned with the external light-darkness cycle, resulting in significant sleep problems and daytime sleepiness. These disorders can be caused by internal factors, such as a person's body clock differing from the light-dark cycle, or external factors, such as shift work or jet lag.

If you are experiencing sleep difficulties or excessive daytime sleepiness, it is important to consult a healthcare professional for proper diagnosis and treatment. Sleep disorders can have a significant impact on your life, and they should not be ignored.

Mental health

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

Depression and Anxiety

Prolonged sleep might be due to depression and anxiety. Both conditions can contribute to sleepiness. Depression can cause insomnia, or make you sleep more, including staying in bed for longer or sleeping more often. Anxiety can cause racing or repetitive thoughts and worries that keep you awake. You may also experience panic attacks while trying to sleep.

Trauma

Traumatic experiences can cause flashbacks, nightmares, or night terrors that disturb your sleep. You might feel unsafe or uncomfortable in bed or in the dark.

Paranoia and Psychosis

Paranoia and psychosis may make it difficult to sleep. You may hear voices or see things that are frightening or disturbing. Psychotic episodes can be triggered by poor sleep, and existing symptoms can be worsened.

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.

Medications

Psychiatric medication can cause insomnia, disturbed sleep, nightmares, and oversleeping. Stopping psychiatric drugs can also lead to sleep problems. Some medications that treat mental health disorders may make you sleep longer than normal due to their sedating effects.

Other Factors

Medication

Prescription Medications

Prescription medications that can cause drowsiness include:

• Antidepressants
• Antihistamines, found in sleep aids or allergy medicines
• Anti-emetics, which are used to control nausea and vomiting
• Antipsychotics and anticonvulsants, which can be used to treat seizures, depression, or bipolar disorder
• Alpha-blockers and beta-blockers, which are used to treat high blood pressure
• 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

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

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

Treatment Options

If you are experiencing excessive daytime sleepiness due to medication, there are several options to consider:

• Consult your doctor or pharmacist: Discuss the possibility of adjusting the dosage or changing the medication. They may also advise taking the medication at a different time of day, such as at night when you are preparing for sleep.
• Explore alternative treatments: In some cases, non-drug therapies or lifestyle changes may be more effective in improving your sleep. For example, cognitive behavioural therapy (CBT) is often recommended as a first-line treatment for insomnia.
• Prioritize sleep hygiene: Establish a consistent bedtime routine, create a sleep-promoting environment, and avoid substances like caffeine and alcohol close to bedtime.
• Be cautious with activities that require alertness: Until you understand how your medication affects you, avoid driving or operating heavy machinery.

Medical conditions

Excessive daytime sleepiness is a symptom of an underlying health issue. While the most common cause of excessive sleepiness is sleep deprivation, there are several medical conditions that can cause this issue.

Mental Health Disorders

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

Neurological Conditions

Narcolepsy is a neurological condition in which the brain cannot properly regulate the sleep-wake cycle. This makes people prone to falling asleep rapidly, even at inopportune times. Other neurological conditions that can cause excessive sleepiness include dementia, epilepsy, traumatic brain injury, concussions, brain tumours or lesions, and infections such as meningitis.

Neurodegenerative Diseases

Neurodegenerative diseases such as dementia and Parkinson's disease are linked to sleeping difficulties and daytime drowsiness.

Physical Health Conditions

Chronic pain, diabetes, fibromyalgia, and hypothyroidism may make it hard for you to stay awake for longer. Additionally, metabolic problems, including diabetes and hypothyroidism, can be risk factors for drowsiness. Other medical conditions like anemia, abnormal blood sodium levels, and electrolyte imbalances can also cause excessive sleepiness.

Sleep Disorders

Several sleep disorders can lead to excessive daytime sleepiness, including insomnia, sleep apnea, restless leg syndrome, hypersomnia, and circadian rhythm sleep-wake disorders.

Lifestyle factors

• Diet: An unbalanced diet or skipping meals can lead to tiredness throughout the day. Diet-related causes of fatigue include deficiencies in specific vitamins and minerals, blood sugar fluctuations, excessive alcohol consumption, and excessive caffeine intake. A well-balanced diet can help prevent nutritional deficiencies and improve sleep quality.
• Dehydration: Dehydration occurs when fluid output exceeds intake, and it can quickly deplete hydration levels. Drinking adequate water and staying hydrated is essential for maintaining energy levels and preventing fatigue.
• Poor sleep habits: Not getting enough quality sleep, having an inconsistent sleep schedule, and factors like a noisy or uncomfortable sleeping environment can all contribute to daytime fatigue. Maintaining good sleep hygiene, such as sticking to a bedtime routine and avoiding exercise close to bedtime, can help improve sleep quality.
• Inactive lifestyle: A sedentary lifestyle can lead to restless and poor-quality sleep. Regular physical activity, on the other hand, improves sleep quality and mental health. Engaging in moderate to vigorous exercise for at least 150 minutes per week has been linked to reduced insomnia, depression, and anxiety.
• Overexertion: Pushing yourself too hard through excessive exercise or other strenuous activities can deplete your body's energy reserves, leading to fatigue, poor sleep, and low motivation. Finding a balance between activity and rest is crucial.
• Stress: Psychological stress can disrupt sleep, and poor sleep can, in turn, increase stress levels and fatigue. Managing stress through relaxation techniques or stress management strategies can help improve sleep and overall well-being.
• Substance use: Excessive alcohol consumption and the use of certain substances or medications can disrupt sleep patterns and contribute to daytime sleepiness. It is important to speak with a healthcare professional if you suspect that substance use is affecting your sleep.

Frequently asked questions