Sleep: A Day-Long Need Or A Mystery?

Sleeping for an entire day could be a result of a number of factors, including environmental factors, physical and mental health conditions, and sleep disorders. Environmental factors such as shift work, family demands, or a busy social life can contribute to not getting enough sleep. Physical and mental health conditions like chronic pain, diabetes, depression, and anxiety can also cause excessive sleepiness. Additionally, sleep disorders such as hypersomnia, narcolepsy, sleep apnea, and restless leg syndrome can lead to sleeping for extended periods. If you find yourself sleeping for an entire day, it is recommended to consult a healthcare professional to rule out any underlying medical conditions and improve your sleep habits.

Sleep disorders

One common sleep disorder is insomnia, which involves difficulty falling asleep or staying asleep. About one-third of adults experience symptoms of insomnia, 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, mouthpieces, or a CPAP machine.

Restless leg syndrome (RLS) is another common sleep disorder, characterised by an urge to move one's legs, often accompanied by uncomfortable sensations. This can make it difficult to fall asleep or stay asleep.

Circadian rhythm sleep-wake disorders involve a misalignment between a person's sleep-wake rhythms and the external light-darkness cycle, leading to significant sleep problems and daytime sleepiness.

Hypersomnia is a condition where people experience excessive sleepiness and repeatedly fall asleep during the day, in addition to sleeping for long hours at night. This can be caused by various factors, including insufficient sleep, sleep disorders, medications, or medical or psychiatric illnesses.

If you are experiencing sleep difficulties or excessive sleepiness, it is important to consult a healthcare professional for proper diagnosis and treatment. They may recommend lifestyle changes, medications, or refer you to a specialist in sleep disorders.

Mental health disorders

There are many reasons why you may have felt the need to sleep for an entire day. It could be that you have been experiencing sleep deprivation, or it could be indicative of an underlying health condition.

Mental health and sleep are closely intertwined. Sleep issues can worsen mental health conditions, and mental health problems can lead to poor sleep. Research has shown that a lack of sleep is especially detrimental to the consolidation of positive emotional content, which can, in turn, influence mood and emotional reactivity. Poor sleep has been linked to an increased risk of mental health disorders and their severity, including the risk of suicidal ideation or behaviours.

Anxiety and Depression

Anxiety disorders affect an estimated 20% of adults and 25% of teenagers. These disorders are characterised by excess fear or worry that can affect everyday life and create risks for health problems, including heart disease and diabetes. Types of anxiety disorders include generalised 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. Worry and fear contribute to a state of hyperarousal, which is considered a central contributor to insomnia. Sleep problems may become an additional source of worry, creating anticipatory anxiety at bedtime that makes it even harder to fall asleep.

Depression is a type of mood disorder marked by feelings of sadness or hopelessness, and it is estimated that over 300 million people worldwide suffer from it. Around 75% of depressed people show symptoms of insomnia, and many also suffer from excessive daytime sleepiness and hypersomnia (sleeping too much).

Historically, sleeping problems were seen as a consequence of depression, but growing evidence suggests that poor sleep may induce or exacerbate depression. This creates a negative feedback loop where poor sleep worsens depression, which then further interrupts sleep. However, this also opens up a potential avenue for new types of treatment for depression, such as a focus on improving sleep quality.

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 the person experiencing them. During manic periods, there is usually a decreased need for sleep, while during depressed periods, there may be excessive sleep.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder is a subtype of depression that most often affects people during times of the year with reduced daylight hours. It is closely tied to the disruption of a person's internal biological clock, or circadian rhythm, which helps control multiple bodily processes, including sleep. As a result, people with SAD tend to sleep too much or too little or experience changes to their sleep cycles.

Post-Traumatic Stress Disorder (PTSD)

PTSD frequently causes people to replay negative events in their minds, suffer from nightmares, and experience a constant state of being on alert, all of which can interfere with sleep. At least 90% of US veterans with combat-related PTSD from recent wars have insomnia symptoms.

Schizophrenia

Schizophrenia is a mental health disorder characterised by a difficulty differentiating between what is and is not real. People with schizophrenia are more likely to experience insomnia and circadian rhythm disorders. Poor sleep and symptoms of schizophrenia may be mutually reinforcing, so there are potential benefits to stabilising and normalising sleep patterns.

Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD is usually diagnosed in children but can last into adulthood. It involves a reduced attention span and increased impulsiveness. Sleeping problems are common in people with ADHD, and they may have difficulty falling asleep, experience frequent awakenings, and feel excessive daytime sleepiness.

Autism Spectrum Disorder (ASD)

ASD is a term that encompasses several neurodevelopmental conditions affecting communication and social interaction, usually diagnosed in early childhood and persisting into adulthood. Children and adolescents with ASD have a higher prevalence of sleep problems, including insomnia and sleep-disordered breathing, which can contribute to a worsening of symptoms and quality of life. Addressing insomnia and other sleep disturbances is an important component of care as it may decrease excessive daytime sleepiness and other health and behaviour problems.

Treatment Options

Cognitive Behavioural Therapy (CBT) has been shown to be effective in improving both sleep and mental state. Different types of CBT have been developed for specific problems such as depression, anxiety, and bipolar disorder. Additionally, CBT for insomnia (CBT-I) has a proven track record in reducing sleeping problems and improving emotional well-being.

Improving sleep habits and cultivating a bedroom setting that is conducive to sleep can also go a long way in reducing sleep disruptions. This includes having a set bedtime and maintaining a steady sleep schedule, finding ways to wind down with relaxation techniques, avoiding alcohol, tobacco, and caffeine in the evening, dimming lights and putting away electronic devices at least an hour before bed, and getting regular exercise and natural light exposure during the day.

Physical health conditions

In addition, prolonged sleep might be due to depression and anxiety. Both mental health conditions can contribute to sleepiness. However, it's not always easy to tell whether depression causes sleep problems or sleep problems contribute to depression. In some cases, both may be true.

Other physical health conditions that can cause excessive sleepiness include:

• Obesity
• Cardiovascular disease
• Chronic painful conditions
• Hypothyroidism (underactive thyroid gland)
• Oesophageal reflux
• Nocturnal asthma

Additionally, sleep disorders can also be a cause of excessive sleepiness. These include:

• Circadian rhythm sleep-wake disorders: Disorders related to misalignments between sleep-wake cycles and light-darkness cycles.
• Hypersomnolence disorder or hypersomnia: With hypersomnia, individuals are excessively sleepy but also tend to sleep for longer periods.
• Narcolepsy: A sleep disorder where a person feels the need to sleep or falls asleep throughout the day.
• Obstructive sleep apnea (OSA): A sleep-related condition where people experience interruptions in their breathing while they're asleep, causing issues like snoring or breathing pauses.
• Restless leg syndrome (RLS): A disorder that causes an individual to feel like they need to move their legs as they experience tingling, creeping, burning, or other sensations in the legs.

Medication

There are several medications that can help you fall asleep, stay asleep, or both. However, many of these medications carry risks of side effects, misuse, and dependency. It is important to consult a doctor before starting any new sleep medication, as they can interact with other substances, including other medications, alcohol, and vitamin supplements.

Doxepin (Silenor) is a sleep aid that may help people with insomnia fall and stay asleep. It is typically prescribed for up to 3 months and is available in 3 and 6 mg doses. However, it is not recommended for those taking monoamine oxidase inhibitors, a type of antidepressant, or for those with glaucoma or urinary retention. Silenor may cause side effects such as central nervous system (CNS) depression, worsening depression or suicidal thoughts, and unusual thinking patterns and behavior changes.

Temazepam (Restoril) is a benzodiazepine prescribed for the short-term treatment of insomnia, typically for 7 to 10 days. It has a risk of dependency and addiction if misused. Restoril is not recommended for pregnant people and can cause side effects such as CNS depression, unusual thinking, and anxiety.

Triazolam (Halcion) is another benzodiazepine prescribed for the short-term treatment of insomnia, typically for 7 to 10 days. Like Temazepam, it has the potential for dependency and misuse. Common side effects may include ataxia (lack of muscle coordination) and complex sleep behaviors. It may also cause withdrawal symptoms, CNS issues, worsening depression, and issues with performing activities such as driving.

Ramelteon (Rozerem) is a melatonin antagonist that may help a person fall asleep by affecting melatonin receptors and positively impacting circadian rhythms. Due to its low likelihood of misuse or dependency, it may be prescribed for longer-term use. However, it can still cause side effects such as dizziness, unpleasant taste, viral infections, and headaches.

Suvorexant (Belsomra) may help a person fall asleep and maintain sleep, but it has a risk of misuse and dependency, and can cause CNS impairments that impact activities like driving. It may also cause worsening suicidal thoughts or depression and complex sleep behaviors.

Trazodone (Desyrel) is typically used to treat major depressive disorder, but it may be prescribed off-label to help with sleep since one of its effects is drowsiness. The typical starting dose is 150 mg daily, divided into two doses, but lower doses may be prescribed for sleep disturbances to reduce the risk of side effects. However, it can still cause mental health side effects, such as suicidal ideation, and may increase the effects of alcohol when taken together.

Estazolam (Prosom) is a benzodiazepine prescribed for the short-term treatment of insomnia. It has a risk of misuse and dependency and can cause side effects such as loss of coordination and hypokinesia (reduced range of movements).

Eszopiclone (Lunesta) is part of the Z-drug family and may help a person fall and stay asleep. However, it carries a risk of misuse and dependency, and its effects may diminish over time. Side effects include an unpleasant taste in the mouth, dizziness, viral infections, and headaches. Lunesta may also cause complex sleep behaviors, such as sleepwalking or driving while asleep.

Zaleplon (Sonata) is another Z-drug used for the short-term treatment of insomnia. It may help a person fall asleep but does not help maintain sleep. It has a risk of dependency and a high likelihood of misuse. Side effects include difficulty concentrating, hallucinations, mood changes, and memory loss.

Zolpidem (Ambien, Intermezzo, Zolpimist) is a Z-drug that may help with falling asleep and sleep maintenance. It is typically prescribed for short-term insomnia relief and has a risk of dependency. Zolpidem can cause complex sleep behaviors and side effects such as dizziness, headache, and next-day sleepiness.

In addition to prescription medications, over-the-counter (OTC) sleep aids are also available. These often contain antihistamines, which can make you drowsy, but they can also interfere with other medications or worsen health conditions. Natural sleep aids, such as melatonin and valerian supplements, are also options, but it is important to check with a healthcare provider before taking them.

Environmental factors

• Shift Work: Working outside the typical 9-to-5 schedule, especially night shifts, can disrupt your body's natural sleep-wake cycle. This misalignment with your internal clock can lead to broken sleep and excessive daytime sleepiness.
• Time Constraints: Certain jobs or caregiving responsibilities may leave limited time for sleep. For example, caregivers, including those with a new baby, may experience interrupted sleep due to the demands of their role.
• Inadequate Sleep Schedules: Not allocating enough time for sleep in your daily routine can contribute to oversleeping. It's important to prioritize sleep and ensure you're getting the rest you need.
• Uncomfortable Environment: Factors in your sleep environment, such as noise from a snoring partner, a baby that wakes up frequently, noisy neighbours, temperature fluctuations, or an uncomfortable mattress, can all lead to broken sleep.
• Jet Lag: Travelling across time zones can affect your internal biological clock, which is sensitive to light. This disruption can impact your sleep-wake cycles and result in excessive sleepiness during the day.
• Light Exposure: Exposure to light, especially from electronic devices before bedtime, can delay sleep onset and disrupt your sleep. It's recommended to avoid screens and create a peaceful sleeping environment to promote better sleep.

Frequently asked questions