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Sleep Disorders

Always Sleepy

11/30/2009

Question:

I am a 20 year old female and for the past 2 years I have not been feeling my age. I get a minimum of 8 hours of sleep a day yet will be tired all day. The first opportunity I get to sleep I take it. I would consider my diet to be healthy. I eat 3 meals a day and snack throughout the day. I also joined a gym 2 months ago hoping that might give me more energy, but there hasn`t been any change. I have gotten blood tests and nothing came of it. What should my next step be?

Answer:

It sounds as though this sleepiness is a problem for you and you are right to seek advice. Excessive daytime sleepiness (EDS) has many possible causes and additional information will be needed to determine how best to help you. Some of the causes of EDS include the following: 1. insufficient or fragmented sleep, 2. medication-induced sleepiness, 3. disruption in your sleep schedules (circadian rhythm), and 4. “central” causes of sleepiness.

1. The most common cause of EDS is that individuals have insufficient total sleep time or a lack of adequate sleep. Not sleeping enough hours (a condition called sleep restriction) is can lead to excessive sleepiness during the day and is easily fixed by increasing your sleep time. Most people need 7-9 hours of sleep per day. From your question, it appears that you are probably getting enough sleep, though keep in mind that some individuals may need more than 8 hours per night to feel adequately rested and a trial of sleep extension (sleeping longer than 8 hours) may be reasonable.

Fragmented sleep can be the result of sleep disorders, such as obstructive sleep apnea (OSA) or movement disorders of sleep, or other factors that interrupt sleep, such as medical conditions (i.e. asthma, heartburn), psychiatric conditions (i.e. anxiety), stimulants (i.e. caffeine, nicotine), or a poor sleep environment (i.e. too much noise, too warm). A full history and exam and possibly laboratory work are usually indicated to rule out these conditions. The sleep disorders are typically evaluated with an overnight sleep study.

2. Many medications can cause daytime sleepiness, including but not limited to: depression or anxiety medications, pain medications, allergy medications, some blood pressure medications or sleeping pills. Your physician can go over your list of medications with you to ensure this is not the cause.

3. Some people tend to function better with in the morning or in the evening people, meaning their internal clock is offset from the normal 24 hour schedule. When these individuals try to sleep on a schedule in line with normal society, they may have trouble sleeping and this can result in difficulty and sleepiness. These types of disorders can be diagnosed and treated by a sleep physician.

4. Finally, there are “central” causes of daytime sleepiness. Central causes of EDS generally mean that there is some dysregulation of the sleep-wake centers in the brain that results in EDS. The 2 most common conditions in this category include Idiopathic Hypersomnia (IHS) and narcolepsy. IHS with or without long (10hrs/night) sleep time often has onset in the second decade of life and is usually diagnosed once other causes of EDS have been excluded. Likewise, narcolepsy tends to present in the second decade of life. Narcolepsy is a disorder causing excessive daytime sleepiness and often associated symptoms of vivid dreams at sleep onset that appear real, sleep paralysis (temporary inability to move despite being awoken from sleep), cataplexy (weakness or paralysis of muscles associated with laughter or anger). The diagnosis of narcolepsy depends on the history and sleep testing.

To specifically answer your question, your next step should be to seek an evaluation by a qualified sleep specialist who can help you to identify the cause of your sleepiness and ultimately the best treatment.

If you would like further information about excessive daytime sleepiness, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you.

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Response by:

Aneesa M Das, MD Aneesa M Das, MD
Assistant Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University