Sleep All Day: Understanding Excessive Sleep And Its Causes

Sleep is essential for our physical and mental health, but what happens when we sleep too much? Oversleeping, or long sleeping, is when someone regularly sleeps for more than 9 hours in a 24-hour period. This can be a sign of hypersomnia, a condition where people fall asleep repeatedly during the day despite getting adequate nighttime sleep. Hypersomnia can affect a person's ability to function at work and socially, impacting their quality of life and increasing the risk of accidents. It's important to identify the underlying causes of hypersomnia, which can include sleep disorders, medications, mental health issues, or other medical conditions. Treatments for hypersomnia may involve lifestyle changes, medication, or non-drug options like support groups.

Sleep disorders

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

• Sleep apnea — This occurs when the upper airway collapses 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) — RLS causes unpleasant sensations in the legs and a strong urge to move them. It can interrupt sleep and lead to sleepiness during the day.
• Narcolepsy — A rare sleep disorder characterised by excessive daytime sleepiness, involuntary napping, muscle paralysis, vivid hallucinations, and muscle weakness during periods of strong emotion (cataplexy).
• Insomnia — Insomnia makes it hard to fall asleep or stay asleep, often resulting in excessive sleepiness.
• Circadian rhythm sleep-wake disorders — These occur when a person's sleep schedule is misaligned with their local day-night cycle, leading to short and fragmented sleep. Examples include jet lag and shift work.
• Periodic limb movement disorder — A rare illness where the legs and feet, and sometimes arms, jerk or twitch during sleep.
• Idiopathic hypersomnia — A sleep disorder characterised by excessive night-time sleeping and the need for naps during the day.

Treatments for Sleep Disorders

Treatments for sleep disorders can vary depending on the specific disorder and its underlying causes. Some common treatments include:

• Medications — Wakefulness-promoting agents such as modafinil (Provigil) are often used as a first-line treatment for hypersomnia. Other medications such as psychostimulants, sodium oxybate (Xyrem), and flumazenil (Romazicon) may also be prescribed.
• Lifestyle changes — Improving sleep hygiene by maintaining a consistent sleep schedule, exercising regularly, avoiding caffeine, alcohol, and nicotine before bed, and creating a comfortable sleep environment can help reduce excessive sleepiness.
• Therapy — Cognitive behavioural therapy (CBT) can be effective in treating insomnia and improving sleep habits.
• Medical devices — Continuous positive airway pressure (CPAP) therapy is commonly used to treat sleep apnea, while oral appliance therapy can help move the tongue, lower jaw, or soft palate forward to open the airway.
• Weight loss — Losing weight can reduce the risk of sleep apnea by decreasing fat deposits in the neck.
• Surgery — In some cases where other treatments are ineffective, surgery may be an option.

Medical conditions

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

• Sleep Disorders — Sleep disorders are a common cause of excessive sleepiness. Examples include sleep apnea, insomnia, restless legs syndrome, sleep walking, narcolepsy, idiopathic hypersomnia, and circadian rhythm sleep-wake disorders.
• Mental Health Disorders — Depression is strongly linked to sleep problems and sleepiness. Bipolar disorder, post-traumatic stress disorder (PTSD), and general anxiety disorder are also associated with sleeping problems that may lead to excessive sleepiness.
• Neurological Conditions — Conditions such as narcolepsy, dementia, traumatic brain injury (TBI), concussions, brain tumours, and Parkinson's disease are associated with sleeping difficulties and daytime drowsiness.
• Neurodegenerative Diseases — Neurodegenerative diseases, including dementia and Parkinson's disease, can lead to sleeping difficulties and daytime sleepiness.
• Neurodevelopmental Disorders — Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can cause sleeping problems and daytime drowsiness.
• Other Medical Conditions — Various other medical conditions can contribute to excessive sleepiness, including chronic kidney disease, chronic obstructive pulmonary disease (COPD), multiple sclerosis (MS), rheumatoid arthritis (RA), epilepsy, hypothyroidism, oesophageal reflux, nocturnal asthma, chronic pain conditions, diabetes, and hypothyroidism.

Medication

Sedating medications, including those used to treat insomnia, allergies, nausea, vomiting, or diarrhoea, can often cause drowsiness as a side effect. Additionally, certain types of prescription medications, such as antidepressants, anti-emetics, antipsychotics, anticonvulsants, alpha and beta-blockers, benzodiazepines, and other sedatives, can induce sleepiness. Drugs for Parkinson's disease, muscle relaxants, opioids, and other prescription pain medications may also have this effect.

Furthermore, cholesterol-lowering medications, such as statins, can cause muscle pain that interferes with sleep. Alzheimer's drugs, like cholinesterase inhibitors, can induce sleeplessness and nightmares. Stimulants prescribed for ADHD and narcolepsy, asthma medications like theophylline, and even some herbal remedies and supplements, can also disrupt sleep patterns.

On the other hand, medications are often used to treat sleep disorders like insomnia and hypersomnia. Sleeping pills, including over-the-counter and prescription options, can help induce sleep and improve sleep quality. Doxepin (Silenor) and Ramelteon (Rozerem) are examples of prescription sleep aids that can help with falling and staying asleep. However, these medications are typically recommended for short-term use due to risks of side effects, misuse, and dependency.

For insomnia, doctors may prescribe medications such as Temazepam (Restoril), Triazolam (Halcion), Estazolam (Prosom), Eszopiclone (Lunesta), Zaleplon (Sonata), and Zolpidem (Ambien, Intermezzo, Zolpimist). These medications belong to a group known as Z-drugs and carry a risk of dependency, withdrawal, and misuse. They may also cause side effects like dizziness, fatigue, and worsening insomnia.

For hypersomnia, the condition characterised by excessive daytime sleepiness, wakefulness-promoting agents like modafinil (Provigil®), armodafinil (Nuvigil®), pitolisant (Wakix®), and solriamfetol (Sunosi®) are often the first line of treatment. If these are ineffective, psychostimulants such as amphetamine, methylphenidate (Ritalin®, Daytrana®, Methylin®, Concerta®), or dextroamphetamine (Procentra®, Dexedrine®, Zenzedi®) may be considered, despite their higher potential for abuse and side effects.

Precautions and Recommendations

It is important to consult a doctor before starting or stopping any medication, especially if sleep problems arise. Adjusting the dosage or timing of medication intake may help minimise sleepiness. Additionally, maintaining healthy sleep habits, such as adhering to a consistent sleep schedule, creating a comfortable sleep environment, and limiting substances like alcohol and caffeine, can also improve sleep quality.

Lifestyle factors

• Maintain a consistent sleep schedule: Establish a regular sleeping routine 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 relaxing bedtime routine: Engage in relaxing activities before bed to prevent nighttime anxiety. This can include reading, listening to soothing music, or practising meditation or deep breathing exercises.
• Exercise regularly: Incorporate at least 30 minutes of daily exercise into your routine. Regular physical activity can improve sleep quality and overall energy levels.
• Avoid stimulants and sedatives: Refrain from consuming caffeine, alcohol, and nicotine close to bedtime. These substances can disrupt sleep patterns and contribute to daytime sleepiness.
• Improve your sleep environment: Ensure your bedroom is comfortable, dark, quiet, and well-ventilated. Minimise distractions by removing electronic devices and keeping the temperature cool.
• Optimise your diet: Eat a well-balanced diet to prevent nutritional deficiencies, and avoid heavy meals, caffeine, alcohol, and certain medications before bed, as they can interfere with sleep.
• Practise good sleep hygiene: Reserve your bed and bedroom only for sleep and sex. Avoid watching television or working in bed to strengthen the mental association between your bed and sleep.
• Power naps: If necessary, take brief power naps during the day to boost alertness. However, keep them short (around 20 minutes) and avoid napping too close to bedtime, as it may disrupt your nighttime sleep.
• Address environmental factors: Identify and minimise sleep disturbances caused by factors such as a snoring partner, a noisy environment, or an uncomfortable mattress. Consider using earplugs, eye masks, or investing in a high-quality mattress.
• Manage stress and anxiety: Anxiety and stress can contribute to sleepless nights and daytime sleepiness. Practising relaxation techniques, such as deep breathing or meditation, can help calm the mind and improve sleep quality.

Mental health

Sleep and mental health are closely intertwined. Poor sleep can negatively impact mental health, and mental health problems can affect sleep quality and duration.

The Impact of Sleep on Mental Health

Sleep helps the brain work properly. A good night's sleep improves learning, problem-solving, attention, memory, and emotional regulation. Sleep helps the brain process and consolidate emotional information, and a lack of sleep is particularly harmful to the consolidation of positive emotional content. This can lead to increased negative emotional responses and decreased positive emotions, impacting an individual's mood and emotional reactivity.

Sleep deprivation can cause brain fog, confusion, and trouble concentrating. It can make individuals more irritable and less able to control their emotions, leading to increased levels of anger and aggression. Poor sleep can also cause unusual behaviours, such as increased impulsivity, hyperactivity, and emotional outbursts. It can make it harder to interact with others, and individuals may feel frazzled and struggle to cope with even minor stressors.

Severe sleep deprivation has been linked to the development of temporary psychotic symptoms, including hallucinations and delusions. Lack of sleep may also trigger the onset of certain psychological conditions, including depression and anxiety. Research has found that people with insomnia have twice the risk of developing depression compared to those without sleep problems, suggesting that addressing insomnia early on could be a preventative measure.

The Impact of Mental Health on Sleep

Living with a mental health problem can affect sleep quality and duration. Mental health conditions can cause sleep problems, and sleep disturbances can, in turn, exacerbate the symptoms of these conditions, creating a negative feedback loop.

Anxiety can cause racing thoughts and worries that keep individuals awake, and they may also experience panic attacks while trying to sleep. Depression and seasonal affective disorder (SAD) can lead to excessive sleep, including longer sleep duration and more frequent napping. Depression can also cause insomnia, with around 75% of depressed people showing symptoms of insomnia.

Trauma can cause flashbacks, nightmares, or night terrors that disturb sleep. Individuals may feel unsafe or uncomfortable in bed or in the dark. Paranoia and psychosis may also disrupt sleep, with individuals experiencing frightening hallucinations or delusions.

Psychiatric medication can have side effects that impact sleep, including insomnia, disturbed sleep, nightmares, and oversleeping. Additionally, the discontinuation of psychiatric medication can also cause sleep problems.

Bidirectional Relationship

The relationship between sleep and mental health is bidirectional, meaning that sleep problems may be both a cause and a consequence of mental health issues. This complex interplay highlights the importance of addressing sleep issues and promoting healthy sleep habits as part of a comprehensive treatment plan for mental health disorders.

Frequently asked questions