Ask an Expert: What`s Wrong With Me

Sleep Disorders

What`s Wrong With Me
03/24/2009

Question:

I have had 3 breakdowns and since the last one in 2001 I feel like I can sleep 24 hours straight. Even when I stay awake through the day I can`t fall asleep that night till the wee hours and then have to get up early to take son to school. I`ve tried naps but my naps aren`t naps, and I end up sleeping for hours. I am constantly tired. How can I get help with this kind of problem?

Answer:

This sounds like it is very frustrating for you and you are smart to seek help. Both hypersomnia (sleeping at times when you want to be wake) and insomnia have multiple underlying causes that may or may not be related.
Probably the most common cause of excessive sleepiness is simply a lack of adequate hours of sleep. Individual sleep needs vary, but most people require at least 7 1/2 to 8 hours of sleep daily to feel rested. Furthermore, the sleep needs to take place on a regular schedule as an erratic sleep schedule, as you may have, can lead to irregularities in the body's internal clock and create problems with sleepiness. Some of the sleep disorders commonly associated with daytime sleepiness include obstructive sleep apnea (OSA), narcolepsy, idiopathic hypersomnolence, periodic limb movements in sleep and a delayed sleep phase (usually resulting in inadequate sleep time).
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 addition, certain medications and medical conditions can make individuals feel tired and sleepy during the daytime, independent of their effects on sleep. In some cases, no clear cause for sleepiness can be found and the condition is labeled as idiopathic hypersomnia.
It sounds as though you may have problems with insomnia as well. Identifying the underlying factors that are contributing to insomnia is extremely important to ensure appropriate treatment. Insomnia has multiple underlying causes. Factors affecting one's ability to fall asleep at the start of the night are quite varied and may include one or more of the following:

Excessive sleep during the daytime

A poor sleep environment (i.e. the bedroom is too noisy, too bright or too warm)

Learned poor sleep habits (i.e. watching TV to fall asleep)

Excessive use of stimulants (both medications and common substances such as caffeine and nicotine)

Certain medications

Stress or anxiety

Pain

Medical conditions that may make it uncomfortable or difficult to breath well when lying down

Heartburn

Restless legs syndrome (an irresistible need to move the legs when awake at night)

Circadian rhythm disturbances (when the body's biologic rhythms are out of synchrony or delayed)

Occasionally some individuals will not have any of these underlying causes contributing to their insomnia and their condition is labeled as primary insomnia.

As you can see, your issues may be quite complex and require a thorough evaluation to determine how best to manage you problems. A referral to a sleep specialist would probably be a good idea and should start with a discussion with your primary doctor. In the meantime, it's always a good idea to practice good sleep hygiene, as sticking with these simple rules of thumb can significantly improve your sleep. These include:

Try to go bed only when you are drowsy.

Maintain a regular wake time, even on days off work and on weekends.

Keep a regular schedule. Regular times for meals, medications, chores and other activities help keep the inner clock running smoothly.

Avoid napping during the daytime. If you do nap, try to do so at the same time every day and for no more than one hour. Mid-afternoon (no later than 3 PM) is best for most people.

Do not spend excessive amounts of time in bed. Use your bed only for sleep, intimacy, and times of illness.

A relaxing pre-sleep ritual such as a warm bath, light bedtime snack, or 10 minutes of reading may help. Avoid heavy meals before bedtime.

Try to exercise regularly. Vigorous exercise should be limited to earlier in the day, at least six hours before bedtime. Mild exercise should be done no more than 4 hours before bedtime.

Avoid ingestion of caffeine within 6 hours of bedtime. "Reasonable" caffeine consumption is considered to be the equivalent of about 1-2 cups of coffee per day.

Do not drink alcohol when sleepy. Even a small dose of alcohol can have a significant effect when combined with tiredness and alcohol tends to cause sleep disruption after the first few hours of sleep. Do not drink alcohol while taking sleeping pills or other medications.

Avoid the use of nicotine close to bedtime or during the night.

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Response by:

Meena S Khan, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
Clinical Assistant Professor of Neurology
College of Medicine
The Ohio State University