Sleep All Day: Why Am I Always Tired?

Feeling sleepy all day can be a symptom of an underlying health issue. The most common causes of excessive sleepiness are sleep deprivation, disorders like sleep apnea and insomnia, depression and other mental health conditions, certain medications, and medical conditions affecting the brain and body. If you are experiencing excessive sleepiness, it is important to consult a healthcare professional to determine the underlying cause and explore treatment options.

Sleep disorders, such as sleep apnea, insomnia, and narcolepsy

Sleep disorders such as sleep apnea, insomnia, and narcolepsy can cause excessive daytime sleepiness. People with these conditions often feel sleepy during the day, even if they have gotten a full night's sleep.

Sleep apnea is a serious condition in which a person's breathing is disrupted and sometimes stops for a few seconds during sleep. This disorder can lead to fatal illnesses if left untreated. People with sleep apnea may experience loud snoring, gasping for air while sleeping, and sore throat and headaches upon waking up. Obstructive sleep apnea occurs when the tissue at the back of the throat relaxes and partially covers the airway. Central sleep apnea happens when the brain fails to send the correct nerve signals to the muscles that control breathing during sleep.

Insomnia is a common sleep disorder that makes it difficult for people to fall asleep or stay asleep. People with insomnia may experience a "restless mind," making it challenging to fall asleep. Insomnia can be acute, lasting a few days or weeks, or chronic, occurring at least three nights a week for more than three months. It can be caused by stress, major life changes, travel, or frequent napping.

Narcolepsy is a chronic brain disorder characterised by uncontrollable urges to fall asleep at any time. People with narcolepsy experience excessive daytime sleepiness and may fall asleep during conversations or while performing other activities. They may also experience cataplexy, which is a sudden loss of muscle control while awake. Narcolepsy is often misdiagnosed as a psychiatric disorder, and its exact causes are still unknown. However, it is believed to be related to low levels of the chemical hypocretin, which helps regulate sleep cycles.

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

Mental health disorders, including depression, bipolar disorder, and anxiety

Sleep disturbances are often linked to mental health disorders, including depression, bipolar disorder, and anxiety. Changes in sleep patterns can be a symptom of an underlying mental health condition. For example, a noticeable change in sleep routine is a common symptom of depression. Individuals with depression may sleep significantly more or less than usual, and experience low motivation, irritability, changes in appetite, feelings of hopelessness, and a loss of interest in previously enjoyable activities. Bipolar disorder can also affect sleep in various ways, including insomnia, hypersomnia (oversleeping), and decreased need for sleep. During manic episodes, individuals with bipolar disorder may go for days without sleep without feeling tired. In addition, anxiety is the most common mental health disorder in the US, and research suggests that most people with anxiety experience some form of sleep disruption. Sleep anxiety, a fear or worry about falling or staying asleep, is a common characteristic of insomnia.

Mental health disorders can lead to sleep disturbances through various mechanisms. For instance, individuals with anxiety disorders may experience chronic anxiety, feeling stressed or worried all the time, even in everyday situations such as falling asleep. Chronically high levels of stress hormones, especially before sleep, can make it challenging for the body to relax and fall asleep. Additionally, anxiety can impact rapid eye movement (REM) sleep, the phase of sleep associated with vivid dreams. If an individual with anxiety has disturbing dreams or nightmares, they may be woken up during this REM phase.

The relationship between sleep and mental health is bidirectional, meaning that sleep can also influence mental health. Sleep deprivation or jet lag, for example, can trigger manic or hypomanic episodes in individuals with bipolar disorder. Sleep disturbances can aggravate mood disorders, creating a cycle where disrupted sleep worsens mental health symptoms, which in turn further affects sleep.

To address sleep issues related to mental health disorders, it is important to seek professional help. Treatment options may include therapy, such as cognitive-behavioral therapy for insomnia (CBT-I), medication, or a combination of both. Lifestyle changes can also be beneficial, such as improving sleep hygiene, engaging in physical activity, limiting alcohol and caffeine intake, and managing stress.

Medication side effects, such as those from antihistamines and antidepressants

Feeling sleepy during the day can be a side effect of certain medications, including antihistamines and antidepressants. Antihistamines are commonly found in over-the-counter sleep aids and allergy medications. They work by blocking histamine activity in the body, which causes drowsiness. Some examples of antihistamines that can cause drowsiness include brompheniramine, diphenhydramine, hydroxyzine, and meclizine. It is important to note that while antihistamines can help with sleep in the short term, they are not recommended for long-term use.

Antidepressants are another type of medication that can cause drowsiness. Specifically, tricyclic antidepressants are known to make people feel tired and sleepy. Examples of tricyclic antidepressants that can cause drowsiness include amitriptyline, doxepin, imipramine, and trimipramine. It is worth noting that not all antidepressants will cause drowsiness, and the effects can vary from person to person. Additionally, the sleep-related side effects of antidepressants often aren't permanent and may subside after a couple of weeks.

If you are experiencing excessive drowsiness or fatigue due to medication, there are a few things you can do. Firstly, consult your doctor or pharmacist to see if there are non-drowsy versions of the medication or alternative treatments available. Secondly, you may be able to adjust the timing of your medication by taking it at night or before bed to minimize the impact on your daytime activities. It is important not to stop taking your medication without consulting your doctor first.

Lifestyle factors, like shift work, family demands, and social life

Shift work, family demands, and social life can all impact your sleep.

Shift Work

Working shifts that are misaligned with your body's natural sleep-wake cycle can disrupt your sleep and have a detrimental effect on your health. Shift work disorder mainly affects those who work overnight or early morning shifts, or who rotate shifts, and can cause significant problems with falling and staying asleep. This is because shift work disrupts the body's normal 24-hour sleep-wake cycle, known as the circadian rhythm. Working against this natural cycle can lead to negative health consequences, including an increased risk of heart attack, diabetes, metabolic syndrome, accidents, and certain types of cancer. To protect your sleep and health while working shifts, it is important to minimize the number of consecutive days spent on challenging shifts, maintain a consistent shift schedule, and prioritize sleep on days off.

Family Demands

The quality of family relationships can also influence your sleep. Strained and demanding family relationships are associated with more troubled sleep, while supportive family relationships are linked to better sleep quality. Family strain and conflict can contribute to stress, anxiety, and worry, making it difficult to fall and stay asleep. On the other hand, supportive family relationships can promote healthy habits and provide emotional care, reducing the negative impact of stressful events on sleep quality. Additionally, frequent contact with family members can be beneficial for sleep when relationships are not strained, as it provides companionship and reduces feelings of loneliness.

Social Life

A busy social life can often compete with sleep, and it is easy to sacrifice sleep to accommodate an overbooked schedule. However, sleep is essential for powering you through busy days and optimizing your energy levels. Sleep deprivation can negatively impact your immune system, alter appetite hormones, affect your mood, interfere with memory and productivity, and increase the risk of medical problems such as Type 2 diabetes and heart disease. Therefore, it is crucial to prioritize sleep by establishing a consistent bedtime routine and aiming for 7 to 9 hours of sleep each night.

Medical conditions, such as hypothyroidism, chronic pain, and diabetes

Medical Conditions

There are several medical conditions that can cause excessive sleepiness and fatigue. Here are some of the most common ones:

• Hypothyroidism: Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones. This can affect sleep quality and is associated with insomnia. It may also contribute to other sleep disorders such as obstructive sleep apnea and restless leg syndrome. Treatment for hypothyroidism often involves thyroid hormone replacement therapy, which can help improve sleep in some patients.
• Chronic Pain: Chronic pain can disturb sleep for one in five Americans at least a few nights a week, according to the National Sleep Foundation. It creates a vicious cycle where pain disrupts sleep, leading to fatigue, which in turn increases sensitivity to pain. Good sleeping habits and "relaxing distraction" techniques, such as meditation and guided imagery, can help manage chronic pain and improve sleep.
• Diabetes: Diabetes is a condition that can cause extreme tiredness and exhaustion that doesn't go away with rest or sleep. This fatigue is caused by high blood sugar levels, insulin resistance, and in some cases, the side effects of strong diabetes medication. Blood glucose testing can help determine if high or low blood sugar is the cause of fatigue. Regular exercise, a healthy diet, and adequate sleep can also help boost energy levels.

Other medical conditions that can cause excessive sleepiness include:

• Sleep apnea
• Restless legs syndrome
• Narcolepsy
• Depression
• Chronic fatigue syndrome
• Anaemia
• Cancer
• Coeliac disease
• Alzheimer's disease
• Chronic kidney disease
• Chronic obstructive pulmonary disease (COPD)
• Multiple sclerosis (MS)
• Rheumatoid arthritis (RA)

Frequently asked questions