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Sleep Disorders

Couldn`t Maintain the Sleep Pattern

01/19/2010

Question:

I am sleeping more than 9 hrs almost 10 hrs !If I want to goto some courses in the morning 8`o clock,then I stopped sleeping more and try to get tup at least 7:15,eventhough my body is not much feel happy to do!But other days like ,if I am free I am sleeping like 10 or 11 hrs continuously! Generally i goto bed by 11 or 11 30 and keep the alarm by (6-7) atleast planning to sleep for 7 hrs..But couldnt do that!!Even after sleeping more than 9 or 10 hrs I feel depressed to!I have a lot of things to do at home,I have to practise for study and concentrate on my part time job which Im doing at home ..But feeling depressed!! I feel this oversleep will be because of lack of exercise..or??But my BMI is correct..Im in the correct BMI now,,..So not intersted to do more exercises too..Im a female of age 29.Can any doctor can help me??

Answer:

It is obvious that your sleep is a problem for you and you are right to seek advice. It’s not clear from your question if your problems primarily concern too much sleep, excessive daytime sleepiness (EDS) despite long sleep or depression. Further history will be needed in order to determine the exact nature of your problem and how best to treat you. This will require a visit to a physician, probably starting with your primary care doctor.

Sleep needs vary considerably between individuals. While most individuals need 7-8 hours to feel rested, some can get by with 6 hours of sleep per night or less while others may require 9 or more hours. It’s possible that you fit into this later category and that your symptoms of depression are not related to sleep. It’s also possible that you could have a primary sleep disorder that is resulting in unrefreshing sleep and EDS, no matter how long you sleep.

In terms of sleep disorders, there are conditions that fragment your sleep during the night such that the sleep quality is poor and this can lead to EDS. The most common of these sleep disorders is obstructive sleep apnea (OSA). This is a condition where the upper airway behind the tongue and soft palate is narrowed so that when the person falls asleep, the airway may partially or completely close off. An arousal from sleep can result from either the effort to breath or if the oxygen level drops as a result of the reduced airflow. These arousals can occur recurrently throughout the night which results in poor quality sleep and thus daytime sleepiness. Those at risk for OSA tend to be overweight, have a thick neck size (17 inches or greater in males and 16 inches in females), male gender, and those over the age of 60. However, individuals not meeting these criteria can have OSA as well. There is often a history of loud snoring during sleep, choking or gasping at night, witnessed apneas (bed partners see the lack of breathing), and unrefreshing sleep. OSA is diagnosed with an overnight sleep study (polysomnography).

Another sleep disorder that causes sleepiness despite long sleep episodes is called narcolepsy. This is a condition where a person may sleep through the night although commonly, people with narcolepsy say they will initially fall asleep fast but keep waking up during the night. They may or may not feel refreshed when they wake up but become sleepy again a few hours later. Naps may help the person feel refreshed. There are other symptoms that may go with this condition such as sleep paralysis (the person wakes up with a sensation that they can't move), hypnagogic hallucinations (seeing images from dreams as one is falling asleep) and cataplexy (muscle weakness or loss of muscle tone with extreme emotions - particularly laughter). Narcolepsy is diagnosed with a sleep study where you sleep overnight (polysomnography) and then stay for a series of naps the next day (multiple sleep latency test or MSLT).

A third sleep condition is called idiopathic hypersomnia. This is a condition where one sleeps all night but does not feel refreshed on awakening and dozes off during the day. Naps are typically not refreshing. This too needs to be diagnosed with a PSG and MSLT.

Aside from these conditions, other causes of daytime sleepiness may include side effects due to medications you may be taking, certain medical conditions (such as an underactive thyroid), and depression.

As you can see, there are a number of possible explanations for your symptoms and it would best to undergo a thorough evaluation to determine how best to proceed. You should probably discuss this problem with your primary care physician first and then seek the opinion of a Sleep Specialist if needed.

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

Meena S Khan, MD 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