Daytime Sleepiness: Why Am I Always Tired?

Feeling sleepy during the day can be a symptom of a variety of conditions and lifestyle factors. Hypersomnia, a condition characterised by excessive sleepiness, can be caused by insufficient sleep, sleep disorders, medications, and medical or psychiatric illnesses. Other factors that can cause sleepiness include nutrient deficiencies, stress, underlying health conditions, drug side effects, and lifestyle factors such as diet, exercise, and shift work. If you are experiencing chronic fatigue, it is important to consult a doctor for a diagnosis and treatment.

Sleep Disorders

There are over 80 known sleep disorders, and they can significantly impact your quality of life. Sleep disorders can affect your ability to function at work and socially, and they can also increase your risk of accidents, especially motor vehicle accidents. Here are some of the most common sleep disorders:

• Insomnia is the most common sleep disorder. It involves difficulty falling or staying asleep. Insomnia can be caused by various factors, such as menopause, medical conditions, psychological stress, poor sleeping environments, and excessive mental stimulation.
• Sleep apnea is a potentially serious condition where your breathing stops and starts repeatedly throughout the night. This results in fragmented sleep and can lead to excessive sleepiness during the day. Obstructive sleep apnea (OSA) occurs when throat tissue relaxes and partially covers the airway, while central sleep apnea (CSA) is caused by the brain failing to send the correct nerve signals to the muscles controlling breathing during sleep.
• Restless legs syndrome (RLS) causes an uncontrollable urge to move your legs, making it difficult to fall and stay asleep. It may be related to genetic factors, low iron levels, or problems with the brain's basal ganglia.
• Hypersomnia, as discussed earlier, includes conditions like narcolepsy and idiopathic hypersomnia, where people experience excessive daytime sleepiness despite getting adequate or excessive nighttime sleep.
• Circadian rhythm disorders disrupt the patterns that help you sleep and wake up at appropriate times.
• Parasomnia involves unusual behaviour during sleep, such as sleepwalking or sleep paralysis.

If you suspect you may have a sleep disorder, it is important to consult a healthcare professional for diagnosis and treatment. They may recommend lifestyle changes, medications, or refer you to a sleep specialist.

Medication and Alcohol

Alcohol and certain medications can cause hypersomnia, a condition characterised by excessive sleepiness during the day. This can occur even if you've had a full night's rest. People with hypersomnia may feel the need to nap during the day and may experience "sleep drunkenness", or confusion and combativeness, upon waking up. Other symptoms include anxiety, irritability, slow thinking and speech, and memory problems.

Alcohol is a central nervous system depressant and has a sedative effect that helps you relax and makes you drowsy, so you fall asleep faster. However, researchers have found that this effect only lasts for the first part of the night. Once the body has metabolised the alcohol, you are likely to experience a rise in N1 sleep, the lightest stage of sleep, leading to frequent wakings and fragmented, low-quality sleep.

Long-term alcohol use can result in chronic sleep problems and disorders like sleep apnea. Alcohol can also increase the need to urinate during the night, further disrupting sleep.

It is never advised to mix alcohol with sleeping pills or certain sedating medications, such as prescription sleep aids, as this can result in serious symptoms such as over-sedation, confusion, dizziness, fainting, a slowed heart rate, and slowed or difficulty breathing. The combination of alcohol and sleeping pills can also increase the risk of overdose.

Other medications that can cause hypersomnia include:

• Benzodiazepines
• Barbiturates
• Melatonin
• Sleeping aids
• Antihypertensive drugs
• Antiepileptic drugs
• Antipsychotics
• Opiates
• Skeletal muscle relaxants
• Antidepressants
• Antihistamines
• Cannabis

Lifestyle Factors

Feeling sleepy during the day can be influenced by a variety of lifestyle factors. Here are some potential reasons related to your daily habits and routines:

Sleep Habits

Inadequate or insufficient sleep is one of the most common causes of daytime sleepiness. This could be due to long working hours, family demands, or social activities that result in not getting enough sleep at night. Maintaining a regular sleep schedule and ensuring you get the recommended amount of sleep (typically 7-9 hours for adults) is crucial for optimal health and energy levels.

Shift Work

Working shifts, especially night shifts, can significantly disrupt your sleep patterns. It is challenging to get quality sleep while working nights, and your body's internal clock, or circadian rhythm, can become out of sync. This disruption to your natural sleep-wake cycle can lead to excessive daytime sleepiness.

Environmental Factors

External factors such as a snoring partner, a noisy baby, loud neighbours, temperature fluctuations, or an uncomfortable mattress can all contribute to broken sleep. These disturbances can accumulate over time, leading to daytime sleepiness.

Diet and Nutrition

What you eat and drink can have a significant impact on your energy levels. Consuming a diet high in ultra-processed foods, added sugars, and caffeinated beverages can impair your energy and sleep quality. On the other hand, a well-balanced diet rich in nutrient-dense foods like fruits, vegetables, legumes, and healthy protein sources can help reduce fatigue and promote healthy sleep.

Additionally, certain nutrient deficiencies, such as low levels of riboflavin (vitamin B2), pantothenic acid (vitamin B5), or pyridoxine (vitamin B6), have been linked to fatigue. Ensuring you get enough of these essential nutrients may help alleviate daytime sleepiness.

Stress and Mental Health

Chronic stress can lead to structural and functional changes in the brain, contributing to fatigue. It can also cause physical symptoms, such as muscle tension and shortness of breath, which can further deplete your energy levels. Additionally, mental health conditions like depression and anxiety can disrupt your sleep patterns, making you more prone to sleepiness during the day.

Sedentary Lifestyle

Leading a sedentary lifestyle without regular physical activity can contribute to daytime tiredness. Incorporating exercise into your daily routine can help reduce overall fatigue and improve your sleep quality.

If you are experiencing persistent or excessive daytime sleepiness, it is important to consult with a healthcare professional. They can help identify any underlying causes and provide guidance on lifestyle changes, treatments, or further steps to improve your sleep and energy levels.

Nutritional Deficiencies

• Vitamin D Deficiency: Insufficient vitamin D, whether from diet or lack of sunlight exposure, can lead to feelings of exhaustion throughout the day and sleep disturbances at night. Vitamin D deficiency has been linked to insomnia and an increased risk of sleeping less than four hours a night.
• Omega-3 Fatty Acid Deficiency: Omega-3 fatty acids, found in flax seeds, walnuts, fortified eggs, and fish, play a crucial role in regulating hormones associated with stress and lowering blood pressure. Omega-3 supplements have been reported to increase sleep duration by an average of one hour per night.
• Selenium Deficiency: Selenium is a mineral commonly lacking in vegan and vegetarian diets. It has been found to reduce abnormal sleep patterns and improve sleep continuity. Selenium can be obtained from seafood like oysters, shrimp, and tuna, while vegetarians can find sufficient amounts in Brazil nuts and cremini mushrooms.
• Vitamin C Deficiency: While vitamin C is known for its immune-boosting properties, it also plays a role in sleep. Extreme vitamin C deficiency causes scurvy, but even milder deficiencies can cause uncomfortable symptoms like swollen joints, anemia, and mood disorders. Regular vitamin C supplementation or consuming citrus fruits, tomatoes, and broccoli can help mitigate sleep disorders.
• Vitamin B6 Deficiency: Vitamin B6 is essential for the production of melatonin and serotonin, hormones that influence sleep and mood. A deficiency in vitamin B6 can lead to depression and insomnia. Increasing your intake of bananas, potatoes, spinach, carrots, fish, and dairy products can help boost your B6 levels.
• Other Nutrient Deficiencies: In addition to specific vitamin and mineral deficiencies, a general lack of essential nutrients can also contribute to sleep problems and fatigue. This includes macronutrients like carbohydrates, proteins, and fats, as well as micronutrients like vitamins, minerals, and trace elements. A balanced diet ensures your body receives the building blocks for healthy cells, tissues, and organs, as well as the proper functioning of various physiological processes, including sleep.

Underlying Health Conditions

There are several underlying health conditions that could be causing your daytime sleepiness. Here are some potential reasons:

Chronic Fatigue Syndrome (CFS)

CFS affects about 1 million people in the United States, with women being more likely to receive a diagnosis. Symptoms include extreme fatigue, weakness, trouble sleeping, and a lack of refreshed feeling after sleep. Other symptoms include trouble concentrating, paying attention, or remembering things, and headaches. People with CFS may also experience post-exertional malaise, a temporary period of extreme fatigue after minor physical or mental activity.

Thyroid Conditions

Thyroid conditions such as hypothyroidism (when the thyroid doesn't produce enough thyroid hormones), Hashimoto's thyroiditis, and Graves' disease can cause fatigue. Even hyperthyroidism (when the thyroid produces excessive thyroid hormones) can disrupt sleep, contributing to fatigue. Thyroid hormones play a crucial role in metabolism and circadian rhythms, so when they're out of balance, you may experience increased fatigue.

Anemia

Anemia is a condition where there is a lack of healthy red blood cells, often due to iron deficiency. Research suggests that sleep quality is worse in people with iron deficiency anemia. Anemia can cause symptoms such as an irregular heart rate and fatigue.

Fibromyalgia

Fibromyalgia is a condition that causes widespread pain, sleep disturbances, and fatigue. Other symptoms include pain and stiffness throughout the body, trouble with memory and concentration, and headaches or migraines. People with fibromyalgia have been found to experience decreased sleep quality and duration, as well as greater sleep disturbances.

Seasonal Allergies

Seasonal allergies, also known as hay fever or allergic rhinitis, can be associated with fatigue, sleep problems, and difficulty thinking. A 2018 study found that during pollen season, individuals with allergies experienced more fatigue and sleepiness and longer periods of deep sleep. Additionally, battling seasonal allergies with antihistamines can cause drowsiness.

Sleep Disorders

Various sleep disorders can contribute to excessive daytime sleepiness. These include insomnia, sleep apnea, restless legs syndrome, circadian rhythm disorders, and parasomnia. Sleep apnea, for example, involves repeated cessation of breathing during sleep, leading to daytime sleepiness. Restless legs syndrome causes an uncontrollable urge to move the legs, disrupting sleep and causing daytime sleepiness.

Autoimmune Disorders

Autoimmune disorders cause the immune system to attack healthy parts of the body, leading to inflammation and extreme fatigue. Examples include multiple sclerosis, lupus, celiac disease, and rheumatoid arthritis.

Mental Health Conditions

Mental health conditions such as depression, anxiety, bipolar disorder, and attention-deficit hyperactivity disorder (ADHD) can impact sleep and energy levels. For instance, changes in sleep patterns can be an early sign of depression, while insomnia can lead to or result from anxiety and depression.

Frequently asked questions