Daytime Sleepiness: Why Can't I Stay Awake?

Feeling sleepy all day can be a symptom of hypersomnia, a condition where people fall asleep repeatedly throughout the day, even if they've had a full night's rest. Hypersomnia can be caused by a variety of factors, including sleep deprivation, sleep disorders, medications, mental health disorders, and other medical conditions. It can significantly impact a person's daily life, including their work, social life, and overall quality of life. If you're experiencing hypersomnia, it's important to consult a healthcare professional for proper diagnosis and treatment.

Sleep disorders

There are two main types of hypersomnia: secondary hypersomnia and primary hypersomnia. Secondary hypersomnia is caused by another condition, such as a physical or mental health issue, drug use, injury, or genetic disorder. Primary hypersomnia means that hypersomnia is its own condition and is not caused by another medical condition.

Some common causes of secondary hypersomnia include:

• Sleep apnea
• Restless leg syndrome
• Vitamin deficiencies
• Mood disorders such as depression
• Substance use, including alcohol and drugs such as sedatives, blood pressure medications, and anti-epileptic drugs
• Withdrawal from stimulant drugs
• Insufficient sleep syndrome, or not getting enough sleep at night

Primary hypersomnia can be further classified into four conditions:

• Narcolepsy type 1: caused by low levels of the brain chemical hypocretin (orexin) and can cause sudden muscle weakness when you feel emotion
• Narcolepsy type 2: milder symptoms and normal levels of hypocretin, without muscle weakness
• Kleine-Levin syndrome: rare condition mostly in male teenagers, causing extreme bouts of hypersomnia that may last from a few days to a few weeks
• Idiopathic hypersomnia: hypersomnia without a known cause

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 and lifestyle changes.

Sleep deprivation

Failure to Prioritize Sleep

Sacrificing sleep for other activities can cause drowsiness the next day, and this can accumulate over time. When this happens over an extended period, it is known as insufficient sleep syndrome.

Poor Sleep Quality

Sleep insufficiency is not just about the quantity of sleep but also the quality. People who do not smoothly progress through sleep cycles may fail to get enough deep sleep or REM sleep. As a result, they may not wake up feeling refreshed, even if they have slept for the recommended number of hours.

Pain

Any condition that induces pain, such as arthritis or fibromyalgia, can disrupt sleep and cause daytime drowsiness.

Frequent Nighttime Urination

Nocturia, or the need to get up during the night to use the bathroom, can make it difficult to fall back asleep.

If you are experiencing excessive sleepiness, it is important to consult a healthcare professional to determine the underlying cause and explore treatment options.

Medical conditions

There are several medical conditions that can cause excessive sleepiness. These include:

• Sleep disorders: These include insomnia, sleep apnea, restless leg syndrome, narcolepsy, and hypersomnia.
• Mental health disorders: Depression, bipolar disorder, post-traumatic stress disorder (PTSD), and general anxiety disorder are all associated with sleeping problems that may lead to excessive sleepiness.
• Neurological conditions: Conditions such as narcolepsy, where the brain cannot properly regulate the sleep-wake cycle, can cause excessive daytime sleepiness.
• Neurodegenerative diseases: Dementia and Parkinson's disease are associated with sleeping difficulties and daytime drowsiness.
• Injury and infection: Traumatic brain injuries, concussions, brain tumours, and infections such as meningitis can lead to excessive sleepiness.
• Neurodevelopmental disorders: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) have been linked to sleeping problems, which may result in daytime sleepiness.
• Other medical conditions: Metabolic problems such as diabetes and hypothyroidism, as well as anemia, abnormal blood sodium levels, and electrolyte imbalances, can also cause excessive sleepiness.
• Vitamin and mineral deficiencies: Low levels of iron and vitamin B complex may contribute to feelings of sleepiness. Additionally, vitamin D and vitamin B12 deficiencies may also play a role.

Medication

Some common medications that can cause sleepiness or fatigue include:

• Allergy medications (antihistamines) such as brompheniramine, diphenhydramine, hydroxyzine, and meclizine.
• Antidepressants, particularly tricyclics like amitriptyline, doxepin, imipramine, and trimipramine.
• Anxiety medications, including benzodiazepines like alprazolam, clonazepam, diazepam, and lorazepam.
• Blood pressure medications, especially beta-blockers like atenolol, metoprolol, and propranolol, which work by slowing down your heart rate.
• Cancer treatments, due to their impact on protein and hormone levels in the body.
• Gut medications that control nausea, vomiting, or diarrhoea.
• Muscle relaxants such as carisoprodol and cyclobenzaprine, which work on the nerves in the brain and spine.
• Opioid pain medications, including fentanyl, oxycodone, morphine, and hydrocodone.
• Seizure or epilepsy medications (anticonvulsants), such as benzodiazepines, carbamazepine, phenobarbital, and valproic acid.

Additionally, certain sleeping pills and natural sleep aids can cause daytime drowsiness. Sleeping pills, whether over-the-counter or prescription, are designed to make you feel drowsy and relaxed. While they can be effective in treating insomnia, they may also lead to side effects such as confusion, memory issues, and balance problems. Natural sleep aids like melatonin supplements can also cause similar side effects.

Managing Medication-Related Sleepiness

If you experience sleepiness due to your medication, there are several strategies you can consider:

• Consult your doctor or pharmacist: Discuss alternative medications that may have fewer side effects or explore the option of adjusting your dosage.
• Timing: Consider taking your medication at a different time of day, preferably in the evening or before bed, to minimise daytime sleepiness.
• Alertness aid: Ask your doctor about prescribing a medication to help you feel more alert and awake during the day.
• Lifestyle changes: Adopt good sleep habits, such as maintaining a regular sleep schedule, limiting caffeine and exercise before bedtime, and creating a comfortable sleep environment.
• Non-drug therapies: Explore alternative treatments like cognitive behavioural therapy (CBT) to improve your sleep without medication.

It is important to remember that you should not stop taking any prescribed medication without consulting your doctor first. They can provide guidance and help find solutions to manage your medication's impact on your sleep.

Lifestyle factors

• Maintain a consistent sleep schedule: Establish a regular sleeping routine by going to bed and waking up at the same time each day. This helps regulate your body's sleep-wake cycle.
• Create a peaceful sleep environment: Ensure your bedroom is well-ventilated, maintained at a comfortable temperature, dark, quiet, and equipped with a comfortable mattress, pillows, and bedding.
• Avoid stimulants and depressants: Refrain from consuming caffeinated products (coffee, tea, cola, chocolate), alcohol, and nicotine-containing products, especially close to bedtime. While alcohol may help you fall asleep initially, it can disrupt your sleep later in the night and cause fragmented sleep. Caffeine and nicotine are stimulants that can interfere with your ability to fall asleep.
• Improve your diet: Adopt a healthy and balanced diet, such as the Mediterranean diet, which is rich in plants, whole grains, and healthy fats. Increase your protein intake for longer night sleep and reduce your consumption of sugar and saturated fats, as these can contribute to daytime sleepiness.
• Exercise regularly: Incorporate regular physical activity into your routine, but avoid exercising too close to bedtime as it may increase alertness and make it challenging to fall asleep.
• Manage stress and anxiety: Practice relaxation techniques or engage in activities that promote relaxation to prevent night-time anxiety and improve sleep quality.
• Maintain a healthy weight: Obesity has been linked to hypersomnia, so maintaining a healthy weight through diet and exercise may help reduce excessive sleepiness.
• Avoid working late into the night: Establish boundaries between work and personal time to ensure you get sufficient sleep. Working late can disrupt your sleep schedule and contribute to sleep deprivation.
• Limit screen time before bed: Reduce your exposure to screens, such as televisions, computers, and phones, before bedtime. The blue light emitted by these devices can interfere with your sleep.
• Join a support group: Consider seeking support from a psychologist or counsellor, and find a support group specifically for hypersomnia. This can help you cope with the challenges of living with this condition and improve your overall well-being.

Frequently asked questions