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Sleep Disorders

Excessive Sleep

09/28/2010

Question:

I`m 18 years old female. Whenever I hold book, I just get sleep, which by any means I cannot control. I have tendency to sleep all day long. During sleep I`m totally unaware of my surroundings. I don`t wake even if someone beats me up. I`m worried about this as my academic perfomance has fallen down a lot. Please, please help.

Answer:

It is obvious that this sleepiness is a problem for you and you are right to seek advice. Excessive daytime sleepiness (EDS) has many causes and there are a number of possible causes to consider. These can be broadly categorized into primary sleep disorders and problems that can affect your sleep that are not sleep disorders per se.

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. In your age group, most individuals need 8-9 hours of sleep to be fully rested. If you are not getting this amount of sleep on a regular basis (not just on the weekends), then chronic partial sleep deprivation will result in daytime sleepiness as well as send into deep sleep when you do sleep, making it difficult for you to be awakened from sleep.

In terms of sleep disorders, there are conditions that can fragment your sleep during the night such that the sleep quality is poor and this can lead to daytime sleepiness. 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 increased effort to breath or a low oxygen level resulting of the reduced airflow. These arousals can occur recurrently throughout the night, which results in poor quality sleep and thus daytime sleepiness. Risk factors for OSA include being overweight, having a thick neck size (17 inches or greater in males and 16 inches in females), being male gender, and being older (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 or PSG).

Another sleep disorder that causes sleepiness is called narcolepsy. This is a condition where a person may sleep through the night though often has very fragmented sleep. They generally 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 (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 (PSG) 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, 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. Depression can also cause people to feel sleepy during the day and needs to be considered.

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. Keep in mind that most all conditions causing excessive sleepiness can be successfully treated. Good luck!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University