Battling The Urge To Sleep All Day

Feeling sleepy all day can be a symptom of a variety of conditions, including sleep disorders, mental health disorders, and medical conditions. Sleep disorders such as insomnia, sleep apnea, and narcolepsy can cause excessive daytime sleepiness. Mental health disorders like depression, anxiety, and bipolar disorder are also associated with sleeping problems and daytime drowsiness. Medical conditions such as hypothyroidism, chronic pain, and diabetes can disrupt sleep and lead to daytime sleepiness. Identifying the underlying cause of excessive sleepiness is crucial for determining the appropriate treatment.

Sleep disorders: insomnia, sleep apnea, narcolepsy, restless leg syndrome, hypersomnia, etc

Sleep disorders are characterised by problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Here is a list of some common sleep disorders:

• Insomnia is the most common sleep disorder, affecting about one-third of adults. It involves difficulty falling or staying asleep. Insomnia can lead to sleep deprivation, causing impaired concentration and memory, diminished reaction time, increased irritability and depression, and poor work performance. It is often associated with psychological, medical, environmental, or lifestyle factors.
• Sleep apnea is a potentially life-threatening disorder where breathing is interrupted during sleep, causing irregular heartbeat, high blood pressure, heart attacks, and strokes. Obstructive sleep apnea occurs when air cannot flow into or out of the nose or mouth, while central sleep apnea is rarer and occurs when the brain fails to send signals to the breathing muscles.
• Narcolepsy is a neurological disorder caused by a lack of hypocretin in the brain, which helps keep the brain awake and active. It results in excessive daytime sleepiness and sudden uncontrollable episodes of falling asleep. Narcolepsy is also associated with cataplexy, hallucinations, and sleep paralysis.
• Restless Leg Syndrome (RLS) is characterised by unpleasant sensations and an irresistible urge to move the limbs, often the legs. It can cause involuntary jerking movements during sleep, leading to sleep deprivation and impaired concentration and memory. RLS may be connected to iron deficiency or other conditions such as kidney failure, Parkinson's disease, diabetes, and rheumatoid arthritis.
• Hypersomnia, including narcolepsy and idiopathic hypersomnia, is characterised by extreme daytime sleepiness despite getting adequate or excessive amounts of nighttime sleep. Those with hypersomnia may experience "sleep drunkenness," slow thinking, anxiety, and difficulty remaining awake during the day. The cause of hypersomnia is often unknown, but it may be linked to neurotransmitters, genetics, or circadian rhythm disruptions.

If you are experiencing persistent sleep difficulties, it is important to consult a healthcare professional for a proper diagnosis and treatment plan. They can help identify any underlying conditions and provide guidance on improving your sleep habits and overall quality of life.

Mental health: depression, anxiety, bipolar disorder, etc

Sleep and mental health are closely intertwined. Poor sleep can negatively impact your mental health and vice versa. Research suggests that the relationship between sleep and mental health is complex and bidirectional. This means that sleep problems can both result from and contribute to the development and maintenance of various mental health issues.

Depression

Living with depression can affect your sleep patterns. You may experience insomnia, find it difficult to wake up or get out of bed, or sleep excessively. Depression can also cause hypersomnia, resulting in excessive daytime sleepiness. It is believed that addressing insomnia early on may help reduce the risk of developing depression.

Anxiety

Anxiety disorders are strongly associated with sleep problems. Worry and fear can induce a state of hyperarousal, making it challenging to fall asleep. Sleep problems may further contribute to feelings of anxiety, creating a cycle that perpetuates both sleep and anxiety issues. Addressing sleep problems is crucial for alleviating the severity of anxiety disorders.

Bipolar Disorder

Bipolar disorder is characterised by episodes of extreme moods, including mania (high) and depression (low). Sleep patterns fluctuate significantly depending on the emotional state of individuals with bipolar disorder. During manic periods, they may feel a reduced need for sleep, while during depressive periods, they may sleep excessively. Addressing insomnia can help reduce the impact of bipolar disorder.

Other Mental Health Disorders

Sleep disturbances are also linked to other mental health conditions, such as post-traumatic stress disorder (PTSD), schizophrenia, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). In the case of PTSD, individuals often replay negative events in their minds, suffer from nightmares, and experience a constant state of alertness, all of which interfere with sleep. Medications used to treat schizophrenia may exacerbate sleep problems. Sleep difficulties associated with ADHD include difficulty falling asleep, frequent awakenings, and excessive daytime sleepiness. Children and adolescents with ASD often experience insomnia and sleep-disordered breathing, which can contribute to a worsening of symptoms and a reduced quality of life.

Medication side effects: antidepressants, antihistamines, painkillers, etc

Feeling sleepy during the day can be a side effect of certain medications, including antidepressants, antihistamines, painkillers, and other prescription and over-the-counter drugs.

Antidepressants

Antidepressants are one of the most common culprits of daytime sleepiness. Specifically, tricyclic antidepressants tend to be the most sedating, with examples including amitriptyline (Elavil, Vanatrip), doxepin (Silenor, Sinequan), imipramine (Tofranil, Tofranil PM), and trimipramine (Surmontil). However, other types of antidepressants, such as MAOIs and SSRIs, can also cause sleepiness. For instance, paroxetine (Brisdelle, Paxil) tends to be the most sedating SSRI, while Fluoxetine (Prozac, Sarafem) tends to cause insomnia.

Antihistamines

Antihistamines are commonly used to treat allergies, hay fever, hives, conjunctivitis, and reactions to insect bites or stings. They can also be used to prevent motion sickness, treat nausea and vomiting, and as a short-term treatment for insomnia. Antihistamines are typically divided into two groups: those that cause drowsiness and those that are non-drowsy. Sedating antihistamines include brompheniramine (Bromax), clemastine (Tavist Allergy), diphenhydramine (Benadryl), and hydroxyzine (Atarax, Vistaril). While non-sedating antihistamines are less likely to cause sleepiness, they may still do so in some individuals. Examples include loratadine (Claritin) and cetirizine (Zyrtec).

Painkillers

Opioid pain medications, which act on the central nervous system, can commonly cause sedation. Examples include morphine, fentanyl, oxycodone, hydrocodone, and codeine. Additionally, muscle relaxants, which work on the nerves in the brain and spine, can also lead to drowsiness. Common muscle relaxants include carisoprodol (Soma) and cyclobenzaprine (Flexeril).

Other Medications

Other types of medications that can cause fatigue and sleepiness include:

• Anxiety medications, such as benzodiazepines (e.g., alprazolam, clonazepam)
• Blood pressure medications, particularly beta-blockers (e.g., atenolol, metoprolol)
• Cancer treatments, which can change protein and hormone levels in the body
• Gut medications for nausea, vomiting, or diarrhea
• Seizure or epilepsy medications (anticonvulsants)
• High cholesterol medications, such as statins and fibrates
• Proton pump inhibitors (PPIs), when used long-term

Lifestyle factors: diet, exercise, shift work, etc

Lifestyle factors such as diet, exercise, and shift work can significantly impact sleep quality and duration.

Diet

A healthy, balanced diet is essential for maintaining optimal sleep patterns. Consuming a diet rich in fruits, vegetables, and fatty fish can promote better sleep. In contrast, diets high in saturated fat and sugar are associated with poorer sleep quality. Caffeine and alcohol consumption, especially close to bedtime, can disrupt sleep. Therefore, it is advisable to limit caffeine and alcohol intake and maintain a balanced diet to improve sleep.

Exercise

Regular exercise is another critical component of a healthy lifestyle that can improve sleep. Engaging in physical activity, such as aerobic exercise or resistance training, can enhance sleep quality and reduce the risk of sleep disorders like insomnia and obstructive sleep apnea. However, it is important to avoid exercising too close to bedtime, as it may make it challenging to fall asleep.

Shift Work

Shift work, or working non-traditional hours, can disrupt the body's natural circadian rhythms, leading to shift work sleep disorder (SWSD). This disorder causes difficulties with falling and staying asleep and excessive sleepiness during unwanted times. SWSD is common, affecting 10-40% of people working non-traditional shifts. Treatment options include lifestyle changes, light therapy, and medication. Creating a consistent sleep schedule, even on days off, is crucial for shift workers to improve their sleep.

Other Lifestyle Factors

In addition to diet, exercise, and shift work, other lifestyle factors can influence sleep. These include daily social media and internet usage, which have been linked to poorer sleep quality and shorter sleep duration. Reading from electronic devices, such as e-readers or tablets, before bed can also disrupt sleep due to the emission of blue light. Maintaining a consistent daily routine and limiting exposure to screens and blue light before bed can help improve sleep.

Medical conditions: hypothyroidism, chronic pain, diabetes, etc

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

• Hypothyroidism: This is a thyroid condition where the thyroid doesn't produce enough thyroid hormones. It can cause fatigue and affect metabolism and circadian rhythms, leading to extreme tiredness.
• Chronic pain: Conditions such as arthritis or fibromyalgia can induce pain and complicate sleep, making individuals prone to daytime drowsiness.
• Diabetes: This metabolic problem can be a risk factor for drowsiness. People with diabetes often experience sleep problems, such as frequent urination at night, restless leg syndrome, and neuropathy, which can disrupt sleep.
• Mental health disorders: Approximately 80% of people with major depression experience excessive daytime sleepiness. Bipolar disorder, post-traumatic stress disorder (PTSD), and general anxiety disorder are also associated with sleep problems and excessive sleepiness.
• Neurological conditions: For example, narcolepsy, dementia, and Parkinson's disease.
• Neurodevelopmental disorders: Such as ADHD and autism spectrum disorder (ASD).
• Other medical conditions: Anemia, abnormal blood sodium levels, and electrolyte imbalances can also cause excessive sleepiness.

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

Frequently asked questions