Daytime Sleepiness: Why Am I Always Sleeping?

Feeling sleepy all day can be a symptom of hypersomnia, a condition where people fall asleep repeatedly during the day despite getting enough sleep at night. It can be caused by a variety of factors, including sleep deprivation, sleep disorders, medications, and medical or psychiatric illnesses. If you're experiencing hypersomnia, it's important to consult a healthcare professional to determine the underlying cause and explore treatment options, which may include lifestyle changes, medication, or therapy.

Sleep disorders like insomnia, sleep apnea, and restless legs syndrome

Sleep is essential for physical and mental health, but millions of people worldwide struggle with sleep disorders. Sleep disorders are medical conditions that disrupt normal sleep patterns, affecting sleep duration and quality. While insomnia, sleep apnea, and restless legs syndrome (RLS) are distinct conditions, they often co-occur and can have overlapping symptoms and treatments. Here's an overview of these three sleep disorders:

Insomnia:

Insomnia is characterised by persistent difficulty falling asleep or staying asleep. It can be acute (short-term, often stress-related) or chronic (lasting three months or more). Insomnia can lead to frequent waking during the night and a feeling of unrefreshment after sleep. It is often treated with Cognitive Behavioural Therapy for Insomnia (CBT-I), recommended as a first-line treatment by the American Academy of Sleep Medicine (AASM). Medications are prescribed only when necessary, and lifestyle changes, such as improving sleep hygiene, avoiding stimulants, and maintaining a consistent sleep schedule, are also crucial.

Sleep Apnea:

Sleep apnea is a breathing disorder that causes interruptions in breathing during sleep. Obstructive sleep apnea (OSA) is the more common form, characterised by airway blockages. Central sleep apnea (CSA) is less common and involves the brain failing to send proper signals to breathing muscles. Sleep apnea leads to fragmented sleep and daytime drowsiness. Treatment options include Continuous Positive Airway Pressure (CPAP) therapy and lifestyle changes such as weight management and limiting alcohol intake.

Restless Legs Syndrome (RLS):

RLS is a neurological condition causing an irresistible urge to move the legs, typically during rest. It is often accompanied by tingling or crawling sensations in the legs, which worsen at night or when lying down. Genetic predisposition and chronic conditions like diabetes are associated with RLS. Treatment options include medications such as dopamine agonists and iron supplements, as well as lifestyle adjustments like regular exercise and caffeine avoidance.

While these sleep disorders can have distinct features, they often co-occur and interact with one another. For example, patients with sleep apnea may also experience restless legs syndrome, and treating one condition may help improve the symptoms of the other. Additionally, insomnia can be a symptom of or be comorbid with sleep apnea and restless legs syndrome, further complicating the clinical picture. Therefore, comprehensive assessment and tailored treatment plans are essential for managing these sleep disorders effectively.

Underlying health conditions, e.g. hypothyroidism, epilepsy, depression, and cancer

If you've been sleeping all day, it could be the result of underlying health conditions. Here are some possible medical reasons why you might be experiencing excessive daytime sleepiness:

Hypothyroidism

Hypothyroidism, or an underactive thyroid gland, is a common condition that can disrupt sleep and cause daytime drowsiness. It is a metabolic problem that can be a risk factor for drowsiness and is classified as a secondary hypersomnia, where excessive sleepiness is due to a known cause.

Epilepsy

Illnesses such as epilepsy can result in hypersomnia, or excessive sleepiness. Epilepsy is categorised as a secondary hypersomnia, indicating that it is a known cause of excessive daytime sleepiness.

Depression

Depression is strongly linked to sleep problems and sleepiness. It is estimated that nearly 80% of people with major depression experience excessive daytime sleepiness. This mental health condition can contribute to sleepiness and is often associated with sleeping problems.

Cancer

Cancer and its treatment can affect sleep in various ways. The impact of cancer on sleep may depend on the type of cancer, the stage of the disease, and the treatments involved. Cancer-related fatigue is a common symptom that can lead to excessive daytime sleepiness. Additionally, cancer treatments such as chemotherapy and radiation therapy can cause fatigue and disrupt sleep patterns.

It's important to note that these are just a few examples of possible underlying health conditions that could contribute to excessive daytime sleepiness. If you are concerned about your sleep patterns, it is always best to consult with a healthcare professional for personalised advice and guidance.

Lifestyle factors, e.g. shift work, family demands, and medication

Shift work, family demands, and medication are all factors that can impact your sleep.

Shift work, especially night shifts, can be very disruptive to your sleep. This is because it is difficult to get good sleep while working night shifts, and your body's internal clock (the circadian rhythm) is affected. As a result, you may experience insomnia when trying to sleep and excessive sleepiness during the time when your body expects to be asleep.

Family demands, such as a new baby, can also cause you to sleep all day. A new baby can disrupt your sleep schedule, leading to sleep deprivation and daytime sleepiness.

Additionally, medication can also play a role in making you sleepy during the day. Certain medications, such as sedatives, sleeping pills, antihistamines, beta-blockers, antidepressants, and antipsychotics, can cause drowsiness and disrupt your sleep patterns. It is important to be aware of the side effects of any medications you are taking and consult your doctor if you have concerns.

Other lifestyle factors that can contribute to excessive sleepiness include long working hours, social life, and environmental factors such as noise or an uncomfortable sleeping environment. Addressing these lifestyle factors and making adjustments to improve your sleep hygiene can help you get better quality sleep.

Sleep quality and quantity

Sleep Quality

Sleep quality refers to the depth and restorativeness of sleep. Various factors can influence sleep quality, including sleep environment, sleep disorders, and underlying health conditions. Here are some aspects to consider:

• Sleep environment: A quiet, dark, and comfortable bedroom can promote better sleep quality. Reducing noise, light, and distractions can improve sleep.
• Sleep disorders: Conditions such as sleep apnea, restless legs syndrome, and insomnia can disrupt sleep quality. It's important to address these issues with a sleep specialist or through lifestyle changes.
• Underlying health conditions: Certain health issues like depression, anxiety, thyroid disorders, and cancer can impact sleep quality. Treating these conditions effectively can improve sleep.
• Medications: Certain medications, including sedatives, antidepressants, and antihistamines, can cause drowsiness and affect sleep quality. Discussing potential side effects with a doctor can help find alternatives or adjust dosages.

Sleep Quantity

Sleep quantity refers to the duration of sleep, and most adults require 7-9 hours of sleep per night. Here are some factors that influence sleep quantity:

• Sleep deprivation: Lack of sleep is a common issue, often caused by sacrificing sleep for other activities or poor sleep habits. This can lead to insufficient sleep syndrome, resulting in chronic sleep deprivation.
• Sleep needs: Individual sleep needs vary. While most adults require 7-9 hours, some may need more or less. Listening to your body and prioritizing sleep is essential.
• Sleep disorders: Conditions like insomnia and sleep apnea can reduce sleep quantity. Effective treatment of these disorders can improve sleep duration.
• Lifestyle factors: Shift work, family demands, and social life can impact sleep quantity. Adjusting schedules or seeking support can help improve sleep quantity.

In summary, achieving optimal sleep quality and quantity involves addressing sleep disorders, creating a conducive sleep environment, managing health conditions, and prioritizing sleep within your daily routine. Consult with a healthcare professional if you have concerns about your sleep patterns, as they can provide personalized advice and treatment options.

Age-related sleep problems

Older adults may also experience more fragmented sleep due to changes in their sleep architecture, spending more time in the lighter stages of sleep and less time in the deeper stages. This can lead to frequent awakenings during the night. Additionally, older people tend to have shorter periods of slow-wave sleep, which is the restorative type of sleep that is crucial for feeling refreshed in the morning.

Various health conditions common in older adults can also contribute to sleep disturbances. For example, conditions such as arthritis, congestive heart failure, depression, and gastroesophageal reflux disorder often co-occur with insomnia and disrupted sleep. Respiratory disorders, such as sleep apnea, also become more prevalent with age and can cause multiple arousals throughout the night.

It is important to note that sleep problems are not an inevitable part of aging. By addressing any underlying medical conditions and adopting healthy sleep habits, older adults can improve their sleep quality and overall well-being.

Frequently asked questions