Daytime Sleepiness: Why Do I Feel So Sleepy?

Feeling sleepy during the day is a common issue that can be caused by a variety of factors, including lifestyle choices, medical conditions, sleep disorders, and mental health issues. This condition, known as excessive daytime sleepiness or hypersomnia, affects 5% to 10% of people in the United States and can have a significant impact on daily functioning and quality of life. It is important to recognize and address the signs of excessive daytime sleepiness to improve overall health and well-being.

Sleep disorders

Sleep Apnea

Obstructive sleep apnea (OSA) occurs when the airway becomes blocked and breathing stops momentarily during sleep. Central sleep apnea (CSA) happens when the brain fails to send the correct signals to the muscles that control breathing. Both conditions cause fragmented sleep, leading to daytime drowsiness. People with sleep apnea are more likely to have accidents and are at an increased risk of other medical conditions, such as elevated hemoglobin levels and heart disease.

Restless Legs Syndrome (RLS)

RLS causes an overwhelming urge to move the legs, often accompanied by uncomfortable sensations. It can disrupt sleep and lead to excessive daytime sleepiness. RLS may be linked to low iron levels, a genetic component, or problems with the basal ganglia region of the brain.

Narcolepsy

Narcolepsy is a neurological disorder characterised by the brain's inability to regulate the sleep-wake cycle properly. People with narcolepsy experience excessive daytime sleepiness and may fall asleep suddenly and involuntarily, even during conversations or meals. It can also cause cataplexy (sudden muscle weakness triggered by emotions), vivid hallucinations, and sleep paralysis.

Insomnia

Insomnia is a common sleep disorder that makes it difficult to fall asleep or stay asleep. It is often associated with other sleep problems that contribute to excessive daytime sleepiness. Insomnia may be related to an irregular sleep schedule, caffeine consumption, alcohol intake, physical or mental illness, or other sleep disorders.

Idiopathic Hypersomnia

Idiopathic hypersomnia is a chronic sleep disorder characterised by constant excessive sleepiness, even after adequate or long periods of sleep. People with this condition may have difficulty being awakened and often experience unrefreshing sleep. The cause of idiopathic hypersomnia is unknown, but it can significantly impact an individual's quality of life and daily functioning.

If you are experiencing excessive daytime sleepiness, it is important to consult a healthcare professional for proper diagnosis and treatment. They can help identify any underlying sleep disorders or health conditions that may be contributing to your symptoms.

Sleep deprivation

People with sleep deprivation may experience the following:

• Constant, recurrent episodes of extreme sleepiness during the day
• Sleeping longer than average yet still feeling sleepy during the day
• Difficulty waking up in the morning or after daytime naps
• Daytime naps that do not improve alertness
• Slow thinking, slow speech, inability to focus or concentrate, and memory problems
• Change or loss of appetite
• Irritability or anxiety

If you are experiencing sleep deprivation, there are several things you can try to improve your sleep quality:

• Go to bed at the same time each night
• Avoid drinking alcohol and caffeine, especially close to bedtime
• Create a peaceful sleeping environment
• Avoid working late into the night
• Exercise regularly and maintain a healthy diet
• Try relaxation techniques such as hot baths and massages

Medication

Many common drugs can make it challenging to fall or stay awake during the day. These include:

• Antidepressants: Fluoxetine (Prozac) can be stimulating and make it hard to fall asleep, while paroxetine (Paxil) can be sedating and cause sleepiness.
• Beta-blockers: These medications, such as metoprolol (Lopressor, Toprol XL) and atenolol (Tenormin), are used to treat high blood pressure or an irregular heartbeat. They can decrease the body's natural levels of melatonin, disrupting your sleep-wake cycle.
• Decongestants: Phenylephrine and pseudoephedrine can be stimulating, raising your blood pressure and heart rate, and may cause insomnia.
• Diuretics: Drugs like furosemide (Lasix), torsemide (Demadex), and hydrochlorothiazide can interrupt sleep by increasing the urge to urinate during the night.
• Smoking-cessation drugs: Nicotine replacement products and prescription medications like varenicline (Chantix) and bupropion (Wellbutrin) can cause unusual dreams or nightmares, disrupting sleep.
• Steroids: Oral steroids like prednisone can stimulate the production of cortisol, mimicking the body's stress response and disrupting the sleep cycle.
• Antihistamines: Found in sleep aids and allergy medications, antihistamines can block histamines that cause alertness, leading to drowsiness.
• Antiemetics: Drugs used to control nausea and vomiting can cause sleepiness.
• Antipsychotics and anticonvulsants: These medications, used to treat seizures or depression, can induce drowsiness.
• Alpha and beta-blockers: Drugs used to treat high blood pressure can cause sleepiness.
• Benzodiazepines and other sedatives: Commonly used for anxiety or insomnia, these can make you feel sleepy during the day.
• Drugs for Parkinson's disease, muscle relaxants, opioids, and prescription pain medications: These can all contribute to daytime drowsiness.
• Over-the-counter medications: Remedies for insomnia, allergies, nausea, vomiting, or diarrhea may have drowsiness as a side effect.

If you experience excessive daytime sleepiness, certain medications can help promote alertness and improve your ability to stay awake during the day. These include:

• Armodafinil (Nuvigil) or modafinil (Alertec, Provigil): These medications work by altering the amounts of certain natural substances in the area of the brain that controls sleep and wakefulness.
• Psychostimulants: Drugs typically used for ADHD, such as amphetamines, dextroamphetamine (Dexedrine Spansule, ProCentra, Zenzedi), or methylphenidate (Concerta, Daytrana, Methylin, Ritalin), can enhance alertness but come with a higher risk of side effects and dependence.
• Antidepressants: For hypersomnia tied to a mood disorder, such as depression, doctors may prescribe antidepressants like Prozac or Wellbutrin. However, these may not be effective for certain types of hypersomnia, such as Kleine-Levin syndrome.
• Pitolisant (Wakix): This antihistamine drug is prescribed for excessive daytime sleepiness and can also treat cataplexy associated with narcolepsy type 1.
• CPAP: For those diagnosed with sleep apnea, continuous positive airway pressure (CPAP) therapy involves wearing a mask that delivers a continuous flow of air into the nostrils to keep the airways open during sleep.

Medical conditions

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

• Sleep apnea: A potentially serious condition in which breathing repeatedly stops and starts during sleep, causing fragmented sleep and daytime drowsiness. Obstructive sleep apnea is caused by a blockage in the airway, while central sleep apnea occurs when the brain fails to send signals to the muscles that control breathing.
• Restless legs syndrome (RLS): A disorder characterised by unpleasant sensations in the legs and a strong urge to move them, which can interrupt sleep and lead to daytime sleepiness.
• Narcolepsy: A neurological disorder in which the brain cannot properly regulate the sleep-wake cycle, causing sudden sleep attacks and extreme daytime sleepiness.
• Depression: Changes in sleep patterns, including sleeping more or less than usual, can be a symptom of depression. Depression is strongly associated with sleep problems, and it can be difficult to determine whether depression causes sleep issues or vice versa.
• Insomnia: Difficulty falling or staying asleep, which can be related to other sleep problems that cause excessive daytime sleepiness.
• Circadian rhythm sleep-wake disorders: When a person's sleep schedule is misaligned with their body's internal clock, leading to short and fragmented sleep. Examples include jet lag and shift work.
• Neurological conditions: In addition to narcolepsy, other neurological conditions such as dementia and Parkinson's disease are associated with sleeping difficulties and daytime drowsiness.
• Neurodegenerative diseases: Conditions such as dementia and Parkinson's disease can also lead to excessive daytime sleepiness.
• Injury and infection: Traumatic brain injuries, concussions, brain tumours, and infections such as meningitis can cause sleeping problems and excessive sleepiness.
• Neurodevelopmental disorders: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) have been linked to sleeping problems and daytime sleepiness.
• Metabolic problems: Conditions such as diabetes and hypothyroidism can be risk factors for drowsiness.
• Other medical conditions: Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) can also cause excessive daytime sleepiness.

Lifestyle factors

• Maintain a consistent sleep schedule by going to bed and waking up at the same time every day. This helps regulate your body's internal clock and improves sleep quality.
• Create a peaceful and comfortable sleeping environment that is well-ventilated, cool, dark, quiet, and has a comfortable mattress, pillows, and bedding.
• Limit caffeine and exercise before bedtime to avoid stimulating your body and mind when you want to wind down.
• Avoid caffeinated products such as coffee, tea, cola, chocolate, and certain over-the-counter medications several hours before bedtime. Caffeine is a stimulant that can interfere with your sleep.
• Refrain from consuming alcohol and nicotine before bedtime. Alcohol may help you fall asleep initially, but it can disrupt your sleep later in the night and cause sleep fragmentation. Nicotine, on the other hand, is a stimulant that can keep you awake.
• Avoid working late into the night as it can disrupt your sleep schedule and impact your sleep quality. Try to establish boundaries and set aside dedicated time for rest.
• Engage in regular physical activity and maintain a healthy weight. Exercise can improve your overall health and sleep quality, making it easier to stay awake during the day.
• Follow a well-balanced and nutrient-dense diet to prevent nutritional deficiencies. Certain deficiencies, such as low iron and vitamin B complex levels, have been linked to excessive sleepiness.
• Maintain good sleep hygiene by creating a relaxing bedtime routine. This can include activities such as reading, listening to soothing music, or practising meditation or deep breathing exercises.
• Limit screen time, especially before bed, as the blue light emitted by electronic devices can interfere with your sleep. Opt for more relaxing activities to prepare your mind and body for sleep.
• Consider joining a support group or seeking counselling to cope with the challenges of hypersomnia. Educating your loved ones about your condition can also help them understand your situation and provide better support.

Frequently asked questions