Battling Excessive Daytime Sleepiness: Why Can't I Stay Awake?

Feeling sleepy all day can be a symptom of hypersomnia, a condition where people fall asleep repeatedly throughout the day. Hypersomnia can be caused by a variety of factors, including insufficient sleep, sleep disorders, medications, and medical or psychiatric illnesses. It can affect your ability to function at work and socially, impact your quality of life, and increase your risk of accidents. If you are experiencing hypersomnia, it is important to consult a healthcare professional for proper diagnosis and treatment.

Sleep disorders

There are several sleep disorders that can cause excessive sleepiness. These include:

• Obstructive sleep apnea (OSA): This occurs when the tissue in the back of the throat relaxes during sleep, partially covering the airway. This can cause you to repeatedly stop and start breathing throughout the night, leading to fragmented sleep and excessive sleepiness during the day.
• Central sleep apnea (CSA): This occurs when the brain fails to send the correct signals to the muscles that control breathing while you sleep.
• Restless legs syndrome (RLS): RLS causes an uncomfortable urge to move the legs, often accompanied by throbbing or itching sensations. These symptoms usually worsen at night, interrupting sleep and leading to daytime sleepiness.
• Narcolepsy: A neurological disorder characterised by excessive daytime sleepiness and sudden loss of muscle control (cataplexy). People with narcolepsy may fall asleep suddenly and experience vivid dreams or hallucinations.
• Insomnia: While not always a sleep disorder, insomnia can be a symptom of another disorder and can lead to excessive sleepiness. It is characterised by trouble falling or staying asleep.
• Circadian rhythm sleep disorders: These are caused by problems with the body's internal clock, leading to difficulty falling asleep or staying awake at the appropriate times.
• Periodic limb movement disorder: A rare disorder where the legs and feet, and sometimes arms, jerk or twitch during sleep.
• Hypersomnia: This is a condition where people fall asleep repeatedly during the day, even after getting a full night's sleep. It can be caused by various factors, including medical conditions, medications, alcohol use, or insufficient sleep.

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

Underlying health conditions

Excessive daytime sleepiness can be a symptom of underlying health conditions. These can be mental or physical and include:

• Depression
• Anxiety
• Schizophrenia
• Lupus
• Parkinson's disease
• Multiple sclerosis
• Cancer
• Chronic pain
• Obesity
• Hypothyroidism
• Sleep apnea
• Restless legs syndrome
• Narcolepsy
• Idiopathic hypersomnia
• Kleine-Levin syndrome
• Insomnia
• Circadian rhythm sleep disorders
• Periodic limb movement disorder
• Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS)
• Epilepsy
• Encephalitis
• Delayed sleep phase syndrome
• Multiple systems atrophy
• Myotonic dystrophy
• Genetic disorders
• Mood disorders
• Head trauma
• Tumours
• Central nervous system diseases

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

Lifestyle factors

Maintain a Consistent Sleep Schedule

It is important to establish a regular sleeping schedule by going to bed and waking up at the same time each day. This helps regulate your body's internal clock and improves sleep quality.

Create a Peaceful Sleep Environment

Your bedroom should be a tranquil space dedicated to sleep. Keep the room well-ventilated, cool, dark, quiet, and comfortable. Eliminate noise, light, and distractions to create an ideal environment for rest.

Avoid Caffeine, Alcohol, and Nicotine

Caffeine, alcohol, and nicotine are known to interfere with sleep. Avoid consuming caffeinated products, including coffee, tea, cola, chocolate, and certain over-the-counter medications, within several hours of bedtime. While alcohol may seem like a sleep aid, it often leads to disrupted sleep and can cause nightmares and night sweats.

Regular Exercise and Healthy Diet

Engaging in regular physical activity and maintaining a well-balanced diet are crucial for improving sleep quality. Exercise helps regulate your body's internal clock and tires your body, making it easier to fall asleep. A healthy diet ensures your body gets the necessary nutrients for optimal rest and recovery.

Relaxation and Stress Management

Incorporating relaxation techniques into your bedtime routine can help prevent nighttime anxiety and improve sleep quality. This can include activities such as meditation, deep breathing exercises, or listening to soothing music. Additionally, managing stress through techniques like cognitive behavioural therapy (CBT) can help address underlying mental health issues that may contribute to excessive sleepiness.

Avoid Working Late

Working late into the night can disrupt your sleep schedule and interfere with your body's natural sleep-wake cycle. Try to establish boundaries and maintain a healthy work-life balance to prioritize your sleep.

Limit Screen Time

Blue light emitted by electronic devices can interfere with your sleep. Avoid screens, including televisions, phones, and computers, for a few hours before bedtime to give your mind a break and prepare your body for sleep.

Medication

Many common medications can make it difficult to fall or stay asleep. 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, a hormone that regulates the sleep-wake cycle.
• Decongestants: Phenylephrine and pseudoephedrine can be stimulating, raising blood pressure and heart rate, and may cause insomnia.
• Diuretics: While they don't directly affect sleep, diuretics like furosemide (Lasix) and hydrochlorothiazide can interrupt sleep by increasing urination.
• Smoking-cessation drugs: Nicotine replacement products and prescription medications like varenicline (Chantix) can cause unusual dreams or nightmares, disrupting sleep.
• Steroids: Oral steroids like prednisone stimulate the production of cortisol, the stress hormone, which can disrupt the sleep cycle.
• Antihistamines: Found in sleep aids and allergy medications, antihistamines can cause drowsiness as a side effect.
• Antiemetics: Drugs used to control nausea and vomiting can cause sleepiness.
• Antipsychotics and anticonvulsants: Used to treat seizures or depression, these medications can lead to 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 medications can cause drowsiness.
• Parkinson's disease drugs, muscle relaxants, opioids, and other prescription pain medications: These can all cause sleepiness.

On the other hand, certain medications can be beneficial for improving sleep, especially for those with insomnia. These include:

• Sleeping pills: These are available over the counter, as natural supplements, or by prescription. Over-the-counter options often contain antihistamines, while natural supplements may include melatonin or valerian, an herb that promotes relaxation and sleep. Prescription sleeping pills, such as benzodiazepines and Z-drugs (e.g., zolpidem and eszopiclone), are stronger and more effective but carry a risk of dependence and addiction, so they are typically recommended for short-term use.
• Wakefulness-promoting agents: Medications like modafinil (Provigil®), armodafinil (Nuvigil®), pitolisant (Wakix®), and solriamfetol (Sunosi®) can help promote wakefulness during the day.
• Psychostimulants: Drugs like amphetamine and methylphenidate (Ritalin®, Daytrana®, Methylin®, Concerta®) can be stimulating and improve alertness.
• Alternative treatments: For those who don't respond well to sleeping pills, alternative therapies like electroacupuncture are being researched as potential treatments for insomnia.

Sleep inertia

The symptoms of sleep inertia are most noticeable after waking from a long sleep or a nap longer than 30 minutes. It usually lasts for 15 to 60 minutes but can continue for a few hours, especially if you are sleep-deprived. Sleep inertia can be dangerous for people who work long or irregular hours, such as medical professionals, emergency responders, or military personnel, as it can increase the risk of work-related injuries.

There are several ways to reduce the effects of sleep inertia:

• Consistent wake-up times: Maintaining a regular sleep schedule helps to regulate your body's sleep-wake cycles and reduce the severity of sleep inertia.
• Natural light exposure: Exposing yourself to natural light, especially during sunrise, can help to reduce the symptoms of sleep inertia.
• Gentle alarms: Opt for gentle alarm methods, such as a smart alarm clock that registers your sleep state or a sunrise alarm that gradually increases light and sound intensity.
• Caffeine intake: Consuming caffeine in moderation can help improve alertness and reduce the effects of sleep inertia. However, excessive caffeine intake may negatively impact your sleep.
• Napping: Taking short naps of 30 minutes or less during the day can help reduce sleep inertia, but longer naps may increase its severity.
• Temperature adjustments: Sleeping in a cool, comfortable environment can improve sleep quality and reduce sleep inertia.

If you are experiencing persistent or severe sleep inertia, it is recommended to consult a healthcare professional or a sleep specialist. They can help identify any underlying sleep disorders or conditions that may be contributing to your sleep inertia.

Frequently asked questions