Sleep: Days Of Unconsciousness And What Causes It

Sleeping for long periods can be a symptom of hypersomnia, a condition characterised by excessive sleepiness during the day. People with hypersomnia may nap during the day, fall asleep during the day, and sleep for long hours at night. Hypersomnia can be caused by a variety of factors, including sleep disorders, medications, and medical or psychiatric illnesses. If you are concerned about your sleeping habits, it is recommended that you speak to a healthcare professional.

Sleep disorders

Insomnia

Insomnia is a common sleep disorder characterised by difficulty falling asleep or staying asleep. It affects about one-third of adults, with 4-22% meeting the criteria for insomnia disorder. It can be episodic, persistent, or recurrent, and is often caused by specific life events or situations. Insomnia is typically treated with a combination of sleep medications and behavioural techniques, such as cognitive-behavioural therapy.

Sleep apnea

Sleep apnea is a breathing disorder characterised by interruptions in breathing during sleep. These interruptions can cause snoring, snorting, gasping, or breathing pauses. Sleep apnea is typically diagnosed through a clinical sleep study and can be treated with lifestyle changes, such as weight loss or sleeping on one's side. In more severe cases, a CPAP (continuous positive airway pressure) device may be prescribed to keep the airways open during sleep.

Restless leg syndrome (RLS)

RLS is a condition that involves tingling or prickly sensations in the legs, along with a powerful urge to move them. It can cause difficulty falling asleep and frequent awakenings, leading to daytime sleepiness. RLS typically begins in the teens or twenties and affects up to 3% of the population.

Hypersomnia

Hypersomnia is a condition characterised by extreme daytime sleepiness, even after getting adequate or more than adequate nighttime sleep. People with hypersomnia may nap during the day, fall asleep during the day, and still sleep for long hours at night. They may experience "sleep drunkenness", where they have difficulty waking up in the morning or after daytime naps and may appear confused or combative. Hypersomnia can affect work life, social life, and overall quality of life. Treatment options include medications, non-drug options, education, and support groups.

Circadian rhythm disorders

Circadian rhythm disorders occur when an individual's sleep-wake rhythms (body clock) become misaligned with the external light-darkness cycle. This misalignment results in significant sleep problems and extreme daytime sleepiness, leading to distress and functional impairment. These disorders can be caused by internal factors, such as a person's body clock being different from the light-dark cycle, or external factors, such as shift work or jet lag.

Parasomnia

Parasomnia involves acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating.

Mental health disorders

Excessive sleepiness, or hypersomnia, can be a symptom of several mental health disorders. These include:

• Depression: This can make people sleep more, including staying in bed for longer or sleeping more often. About 75% of depressed people show symptoms of insomnia, and many people with depression also suffer from excessive daytime sleepiness and hypersomnia.
• Seasonal Affective Disorder (SAD): A subtype of depression that tends to affect people during times of the year when there is less daylight. People with SAD may sleep too much or too little or experience changes to their sleep cycles.
• Anxiety Disorders: These create excess fear or worry that can affect everyday life and create risks for health problems. Types include general anxiety disorder, social anxiety disorder, panic disorder, specific phobias, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Anxiety disorders have a strong association with sleeping problems, with worry and fear contributing to a state of hyperarousal that is considered a central contributor to insomnia.
• Bipolar Disorder: Bipolar disorder involves episodes of extreme moods that can be both high (mania) and low (depression). Sleep patterns change considerably depending on the emotional state of a person with bipolar disorder. During manic periods, they usually feel less need to sleep, but during depressed periods, they may sleep excessively.
• Schizophrenia: People with schizophrenia are more likely to experience insomnia and circadian rhythm disorders.
• Attention-deficit/hyperactivity disorder (ADHD): ADHD is usually diagnosed in children but can last into adulthood. People with ADHD may have difficulty falling asleep, frequent awakenings, and excessive daytime sleepiness.
• Autism Spectrum Disorder (ASD): Children and adolescents with ASD have a higher prevalence of sleep problems, including insomnia and sleep-disordered breathing. These issues tend to be more persistent than sleeping problems in children without ASD, and they can contribute to a worsening of symptoms and quality of life for people with the condition.

Health issues

Sleeping for long periods can be a symptom of hypersomnia, a condition characterised by excessive sleepiness during the day. People with hypersomnia may sleep for up to 18 hours a day and still not feel rested. This condition can be caused by other medical conditions, medications, or insufficient sleep.

Hypersomnia can be caused by a wide range of factors, including:

• Sleep disorders such as sleep apnoea, insomnia, and narcolepsy
• Mental health disorders such as depression and anxiety
• Obesity
• Cardiovascular disease
• Chronic pain
• Medical conditions such as hypothyroidism, epilepsy, encephalitis, multiple sclerosis, Parkinson's disease, and more
• Medication and substance use, including alcohol, sedatives, anti-hypertensives, anti-epileptics, anti-Parkinsonian agents, skeletal muscle relaxants, antipsychotics, opiates, and cannabis
• Genetic factors, as family history is present in up to 39% of people with idiopathic hypersomnia
• Age, as older adults may need less sleep than younger people
• Lifestyle factors, such as working night shifts or long hours, and family demands
• Environmental factors, such as a snoring partner, a baby that wakes up at night, noisy neighbours, or an uncomfortable mattress
• Changes in time zone, which can affect the body's internal clock

If you are experiencing hypersomnia, it is important to seek medical advice, as it can negatively impact your quality of life and increase your risk of accidents. Treatment options include medication and lifestyle changes. Maintaining good sleep habits, such as establishing a regular sleeping schedule and creating a peaceful sleeping environment, can also help improve sleep quality.

Lifestyle factors

• Maintain a consistent sleep schedule: Go to bed and wake up at the same time each day, including weekends. This helps regulate your body's internal clock and can improve the quality of your sleep.
• Establish a relaxing bedtime routine: Engage in relaxing activities before bed to help you wind down and prepare for sleep. This could include reading, listening to soothing music, practising meditation or deep breathing exercises, or taking a warm bath. Avoid stimulating activities and try to maintain a quiet and peaceful environment.
• Create a sleep-friendly environment: Ensure your bedroom is cool, dark, quiet, and comfortable. Minimise the use of electronic devices before bed, as the light emitted can interfere with your sleep. If possible, avoid working or engaging in stimulating activities late into the night, as it may disrupt your sleep schedule.
• Regular exercise and healthy diet: Engage in regular physical activity, preferably during the day. Maintaining a healthy weight and eating a well-balanced diet can also contribute to better sleep quality. Avoid excessive exercise close to bedtime, as it may make it harder to fall asleep.
• Limit stimulants and alcohol: Avoid consuming caffeinated products, nicotine, and alcohol close to bedtime. These substances can interfere with your sleep and make it harder to fall asleep. Alcohol may make you feel drowsy initially but can disrupt your sleep later in the night.
• Power naps during the day: If necessary, take short "power naps" during the day to boost alertness. Keep these naps brief (20-30 minutes) and avoid napping too close to bedtime, as it may interfere with your nighttime sleep.
• Address environmental disturbances: Minimise external disturbances such as noise, light, or an uncomfortable mattress. Consider using earplugs, eye masks, or adjusting the temperature to create a more conducive sleep environment.
• Seek professional help: If lifestyle adjustments do not help improve your sleep, consider seeking advice from a healthcare professional or a sleep disorder clinic. They can provide personalised guidance and recommendations based on your specific circumstances.

Sleep inertia

The symptoms of sleep inertia are most noticeable after waking up from a long sleep or a nap exceeding 30 minutes. During sleep inertia, individuals may experience slower reaction times, impaired short-term memory, and decreased cognitive alertness. These symptoms can be particularly concerning for those who work long or irregular hours, such as medical professionals, emergency responders, or military personnel, as they can impact decision-making abilities and the ability to perform safety-critical tasks.

The exact cause of sleep inertia is unknown, but several theories have been proposed. One theory suggests that it is related to an increase in delta waves in the posterior part of the brain, which are more likely to occur after periods of sleep deprivation or loss. Another theory implicates adenosine, a compound found in the brain that plays a role in sleep and wakefulness. Upon waking, adenosine levels should be low, but research suggests that sleep inertia could be caused by high levels of adenosine, which slow down neural activity.

To mitigate the effects of sleep inertia, it is recommended to maintain consistent wake-up times, expose yourself to natural light, and use gentle alarms. Avoiding alcohol and smoking, napping for short periods, and adjusting the lighting and temperature of your bedroom may also help reduce sleep inertia.

Frequently asked questions