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Sleep Disorders

Always sleepy

11/19/2008

Question:

I am a student in an university, my classes usually start at 9am and end some where around 3.30pm. After that I have sports training at 5pm that I have to attend to until 7pm. My problem is that this semester, I have been falling asleep in class so much that I was cautioned several times by my lecturers. Now that the semester is over, I still feel sleepy all the time, even when I could sleep in late until 10 am. I dont get to sleep earlier than 1 or 2 am. What puzzles me is that I do get 8 hours of sleep and I don`t do any excessive work that may lead to tiredness during this holiday, but still im always sleepy all the time. I`m very concerned because I`ve never been this way before. Is it because I have gained around 15 kilos in my weight in the last two years?

Answer:

It is obvious that this sleepiness is very distressing to you as it has had a significant impact on your daily activities. Excessive daytime sleepiness (EDS) has many causes and there are a number of possible causes to consider.

The most common cause of EDS is that patients have insufficient total sleep time. It’s unclear from your question if you are getting 8 hours of sleep on a nightly basis and are still sleepy or if you are only getting 8 hours per night when on holiday. This is important to distinguish between the two. If you get 8 hours a sleep regularly and are still sleepy during the daytime, then you may have a primary sleep disorder. On the hand, if you are getting significantly less than this regularly but sleep for 8 hours on holidays, you may be suffering from chronic partial sleep deprivation. In this later case, the “catch up sleep” during holidays may not be enough to resolve your sleepiness unless you sleep for 8 hours per night for several days in a row. If you are suffering from chronic partial sleep deprivation (lack of regular adequate sleep), then getting more sleep is the answer.

Of the sleep disorders than can result in EDS, obstructive sleep apnea (OSA) and narcolepsy are prime conditions to consider. I'm not aware of your weight, body mass index (BMI), and clinical history, so I can't comment on whether you have a higher risk of having OSA or not. The main risk factors for the development of sleep apnea include being overweight and/or having specific anatomic abnormalities (such as large tonsils) that may narrow the airway. Aside from unrefreshing sleep and daytime sleepiness, individuals with sleep apnea often complain of loud snoring, headaches upon awakening, a poor sense of well-being, decreased ability to concentrate and reduced alertness. It is important to diagnose and treat this condition as treatment can improve symptoms and reduce the risks of long term complications associated with OSA. The diagnosis typically requires a sleep study and, if you are diagnosed with OSA, there may be a range of treatment options available. .

I also think that in all young adults it is imperative to consider narcolepsy. Narcolepsy is a condition that is caused by the inability of the brain to regulate the sleep-wake cycle normally. This disorder is characterized by EDS, abnormal vivid dreams especially at sleep onset, sleep paralysis (sensation of feeling paralyzed and being partially awake) and cataplexy (muscular weakness precipitated by an emotional stir). The evaluation for narcolepsy typically also requires a sleep study as well as a daytime nap test.

Aside from these conditions, numerous other factors may influence the quality of your sleep. These can range from the environment you sleep in (i.e. too warm, too loud) to your other medical problems (i.e. heartburn or breathing problems) to medications you may taking. Fragmented sleep from any of these conditions can lead to daytime fatigue and sleepiness. In some cases, no clear cause for sleepiness can be found and the condition is labeled as idiopathic hypersomnia.

Thank you for visiting NetWellness. On this site, we try to answer general questions about sleep disorders but cannot diagnose or recommend treatment. You appear to have some very specific questions about your sleepiness, which can only be answered properly by a physician who is familiar with your medical history, physical exam, and test results. You should probably discuss this problem with your primary care physician and seek the opinion of a Sleep Specialist. Take care.

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Response by:

Steven  Kadiev, MBBCh Steven Kadiev, MBBCh
Formerly:
Assistant Professor
College of Medicine
The Ohio State University