Battling Excessive Sleep: Always Tired, What's The Cause?

Sleeping for 18 hours a day and still feeling tired could be a sign of an underlying health condition. Oversleeping, or long sleeping, is defined as sleeping for more than nine hours in a 24-hour period. It can be caused by various factors, such as illness, medication, mental health disorders, or other health issues. If you are experiencing chronic fatigue, it is important to consult a healthcare professional to rule out any underlying conditions and receive proper treatment.

Sleep disorders

• Insomnia is the most prevalent sleep disorder. It involves difficulty falling asleep or staying asleep. Insomnia can be episodic, persistent, or recurrent, and it can be caused by a variety of factors, including environmental, genetic, psychological, and behavioural issues.
• Sleep apnea is a breathing disorder characterised by interruptions in breathing during sleep. Obstructive sleep apnea is the most common type, often caused by obesity or certain genetic or endocrine disorders. Central sleep apnea is rarer and usually occurs in older adults or people with heart disorders or stroke.
• Restless leg syndrome (RLS) is an urge to move one's legs, accompanied by uncomfortable sensations such as creeping, crawling, or tingling. It typically begins in the teens or twenties and affects up to 3% of the population.
• Hypersomnia is the inability to stay awake during the day. This includes narcolepsy, which causes extreme daytime sleepiness. People with narcolepsy also experience cataplexy, a brief sudden loss of muscle tone triggered by laughter or joking.
• Circadian rhythm sleep-wake disorders occur when a person's sleep-wake rhythms (body clock) are misaligned with the external light-darkness cycle. This can be caused by internal factors, such as a person's body clock differing from the light-dark cycle, or external factors like shift work or jet lag.
• Parasomnia involves acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating. It can be caused by environmental, genetic, and gene-environment interactions.

If you suspect you may have a sleep disorder, it is important to consult a healthcare professional for a proper diagnosis and treatment plan.

Underlying health conditions

If you are sleeping 18 hours a day and still feel tired, it is important to consult a healthcare professional to rule out any underlying health conditions. Here are some possible conditions that could be contributing to your excessive sleepiness:

Sleep Disorders

• Sleep apnea: A disorder characterised by pauses in breathing during sleep, leading to snoring, choking, and daytime sleepiness.
• Insomnia: Difficulty falling or staying asleep, which can be caused by menopause, medical conditions, stress, poor sleep environment, or excessive mental stimulation.
• Restless legs syndrome (RLS): A disorder causing an urge to move the legs due to unpleasant sensations, which can lead to insomnia and daytime fatigue.
• Narcolepsy: A rare disorder causing excessive daytime sleepiness, sleep attacks, muscle paralysis, hallucinations, and muscle weakness during strong emotions.
• Idiopathic hypersomnia: A disorder with no known cause, characterised by excessive sleepiness, difficulty waking, and a need for long sleep durations (up to 14-18 hours a day).
• Circadian rhythm sleep-wake disorders: Disorders where sleep-wake cycles are misaligned with light-darkness cycles.
• Bruxism: Involuntary teeth grinding or clenching during sleep.

Mental Health Disorders

• Depression and anxiety: These conditions are often associated with sleep disturbances and can contribute to feelings of sleepiness and fatigue.
• Bipolar disorder: A mood disorder that can cause feelings of sluggishness during the day.
• Premenstrual dysphoric disorder: A type of mood disorder that can lead to daytime fatigue.

Physical Health Conditions

• Chronic pain: Conditions such as fibromyalgia can interfere with sleep and cause daytime sleepiness.
• Diabetes: This condition has been linked to increased daytime sleepiness and a higher risk of sleep apnea.
• Hypothyroidism: An underactive thyroid can slow down metabolism and lead to constant fatigue.
• Obesity: Being overweight increases the risk of sleep apnea and daytime sleepiness, regardless of sleep apnea.
• Cardiovascular disease: Heart-related conditions can disrupt sleep and impact overall sleep quality.
• Chronic illnesses: Conditions like chronic kidney disease, multiple sclerosis, rheumatoid arthritis, or chronic obstructive pulmonary disease (COPD) can contribute to fatigue and sleep disturbances.

It is important to note that this list is not exhaustive, and a healthcare professional should be consulted for a proper diagnosis and treatment plan.

Medication side effects

Some of the most common drugs that can cause fatigue include:

• Allergy medications (antihistamines)
• Antidepressants
• Anxiety medications (benzodiazepines)
• Blood pressure medications (beta-blockers)
• Gut medications
• Muscle relaxants
• Opioid pain medications
• Seizure or epilepsy medications (anticonvulsants)

Sleeping pills can also cause drowsiness and are intended for short-term use. They can lead to dependence and abuse, and their side effects can be dangerous. Common side effects of sleeping pills include:

• Burning or tingling sensations in the hands, arms, feet, or legs
• Constipation or diarrhea
• Dizziness, lightheadedness, or impaired balance
• Drowsiness during the day
• Gas, heartburn, stomach pain, nausea, or change in appetite
• Mental impairment the following day
• Difficulty paying attention or remembering things
• Uncontrollable shaking
• Weird dreams or nightmares

If you are experiencing excessive sleepiness, it is important to consult your doctor. They may recommend adjusting the dose or changing the medication. It is not advisable to stop taking medication without consulting a medical professional.

Lifestyle factors

• Shift work: Working shifts that go against the typical sleep-wake body cycle, or circadian rhythm, can disrupt your sleep patterns and lead to oversleeping.
• Limited time for sleep: Certain jobs, such as caregiving, may not allow adequate time for sleep, resulting in sleep deprivation and a tendency to oversleep when the opportunity arises.
• Inadequate sleep schedule: Not leaving enough time in your schedule for sleep can lead to sleep debt, causing you to oversleep when you finally have the chance.
• Sedentary lifestyle: A lack of physical activity during the day can contribute to tiredness and fatigue. Engaging in daily exercise and exposing yourself to sunlight can help improve your sleep quality and reduce the need for oversleeping.
• Caffeine and stimulant intake: While caffeine and stimulants may provide a temporary energy boost, over-reliance on them can disrupt your sleep cycle and contribute to fatigue. Reducing caffeine intake and cutting back on stimulants may help improve your sleep and energy levels.
• Alcohol consumption: Alcohol has sedating effects and is a common cause of excessive daytime sleepiness (EDS). Reducing alcohol intake may help improve sleep patterns and reduce the need for oversleeping.
• Stress: Chronic stress can lead to structural and functional changes in the brain, contributing to chronic inflammation and symptoms like fatigue. Managing stress through therapy or other techniques can help improve sleep quality.
• Diet: A diet high in ultra-processed foods and added sugar can impair sleep quality and lead to chronically high blood sugar and insulin levels, resulting in fatigue. Switching to a diet rich in nutrient-dense foods like fruits, vegetables, legumes, and healthy protein sources can help reduce fatigue and support healthy sleep.

Vitamin deficiencies

Vitamin B12

A deficiency in this vitamin can cause anaemia, which is when there aren't enough red blood cells to meet the body's need for oxygen, or when these cells don't carry enough of an important protein called haemoglobin. This can make you feel tired and weak. Meat and dairy products are the main sources of B12, so many vegetarians and vegans become deficient.

Vitamin B1 (Thiamine)

Deficiency in this vitamin can cause a disease called beriberi, which affects several organs, including the muscular and peripheral nervous systems. General symptoms include fatigue, muscle weakness, muscle pain, and shortness of breath.

Vitamin B6 (Pyridoxine)

Deficiency in this vitamin can cause microcytic anaemia, which is when red blood cells are smaller than normal, due to defective haemoglobin biosynthesis. This can make you feel weak, tired, and fatigued.

Vitamin B9 (Folate)

Deficiency in this vitamin can cause megaloblastic anaemia, which is when red blood cells are larger than normal. This can make you feel weak, fatigued, and breathless.

Vitamin C

Before the characteristic features of scurvy (the disease caused by severe vitamin C deficiency) are present, symptoms of moderate deficiency include fatigue, irritability, and muscle pain.

Iron

Iron deficiency can cause anaemia, which can make you feel tired and weak. Iron is found in haemoglobin, a protein in red blood cells that carries oxygen around the body.

Magnesium

Deficiency in magnesium can cause muscle weakness, fatigue, and loss of appetite.

Frequently asked questions