Daytime Sleepiness – What is it?

Daytime sleepiness is something many people encounter from time to time for a wide variety of reasons. Some of these reasons are as harmless as short-term sleep deprivation caused by staying out too late celebrating at a wedding to as serious as a life-threatening medical condition. It’s important to differentiate between sleepiness and fatigue when we’re talking about daytime sleepiness. Sleepiness is an inability to stay awake at appropriate times while fatigue is having very low energy associated with wakefulness but does not involve sleepiness. In general, sleepy people get short-term relief from napping, whereas fatigued people report they cannot fall asleep.

Depending on the cause of your daytime sleepiness, you may also experience:

• Difficulty concentrating
• Difficulty regulating your body temperature
• Dizziness
• Emotional distress or irritability
• A headache
• Lack of interest in your usual activities
• Pain
• Palpitations
• Shortness of breath
• Unintentional weight gain
• Weakness

Now, let’s look at some of the more common conditions that can cause daytime sleepiness symptoms.

What causes it?

The causes of excessive daytime sleepiness include things like sleep deprivation, medication effects, illicit substance use, obstructive sleep apnea (OSA), and other medical and psychiatric conditions. They range in risk from low to high and may or may not require medical care. Let’s explore what might be causing your daytime sleepiness from the highest risk issues to the lowest.

High-risk causes of daytime sleepiness require that you see a physician to get the appropriate treatment as they can have serious outcomes when left untreated.

Obstructive Sleep Apnea

If you have sleep apnea, your daytime sleepiness may be accompanied by other symptoms such as snoring, nightmares, depression, dry mouth, dry throat, fatigue, headache, irritability, mood swings, or weight gain. When you sleep all of your muscles relax, including your tongue and some of the soft tissue in your throat, causing your airway to become blocked when you have obstructive sleep apnea. This causes you to stop breathing, if only for a couple of seconds. During these seconds, you wake up, even though you may not remember waking, interrupting your normal sleep cycle and causing you to wake up feeling like you have not slept at all.

The prevalence of obstructive sleep apnea (OSA) is estimated to be 9 percent for women and 24 percent for men ages 30 to 60. Research shows that in patients with OSA, approximately 23 percent of women and 16 percent of men experience excessive daytime sleepiness.

It is important to see your physician or dentist if you have sleep apnea because apnea increases your risk of developing heart disease, high blood pressure, and a variety of other problems. Treatments for sleep apnea include CPAP – continuous positive airway pressure, dental devices, position therapy, and surgery.

Severe Anemia

If you have severe anemia, your fatigue may be accompanied by other symptoms such as shortness of breath, chest pain, headache, dizziness, and even fainting. You may also experience arrhythmia, potentially life-threatening disruptions to normal heart rhythms because your heart is working extra hard. Anemia occurs when your red blood cells have a very low level of hemoglobin; the protein responsible for carrying oxygen to all your body’s tissues. People who have severe anemia have typically had a serious accident or injury recently or are experiencing internal bleeding from an ulcer. Treatment often includes iron supplements, vitamin B12 injections, or you may even need a blood transfusion to correct this condition.

Post-traumatic Brain Injury Syndrome

If you’ve recently had a traumatic brain injury, your sleep cycle may have been impacted. The good news is that as the injury heals, sleep cycles typically start to normalize again, and your daytime sleepiness will begin to occur less and less frequently. If you’ve recently experienced a car accident, fall, or sport-related injury, be sure to talk to your physician about the sleep problems you’re experiencing.

Depression – Severe

If you have severe depression, it’s common to experience a feeling of a loss of energy and even exhaustion although you have had an adequate quantity of sleep. Severe depression extends beyond one depressive episode, it is chronic and continues even though everything in your life may otherwise be good.

If you are having thoughts of hurting yourself or someone else, please get help immediately. You can call the National Suicide Prevention Lifeline 24/7 for support at 1-800-273-8255. Talk to someone right away. They can also provide confidential support, advice, and resources if you are concerned that a friend or family member might be depressed.

Medium to high-risk causes of daytime sleepiness require that you see a physician to get the appropriate treatment. However, they are unlikely to have severe health consequences if left untreated.

Restless Legs Syndrome (RLS)

If you have restless leg syndrome, your sleep is disrupted by a leg twitching sensation that may be hard to describe. People with RLS often describe it as feeling like their legs have a sensation of ongoing, achy activity even while still that just won’t get better until they get up and move around. Restless leg syndrome is quite common throughout pregnancy and may be aggravated by smoking, using alcohol, consuming caffeine, and medications (including allergy medications and SSRIs used to treat depression and other conditions). Making lifestyle changes and adopting good sleep hygiene habits is the first step in treating restless leg syndrome. If these steps do not help, see your physician for as there are medications available to treat RLS.

Restless leg syndrome is different from periodic limb movement disorder (PLMD) in that with RLS your legs are still, but the sensation you feel in your legs keeps you awake while with PLMD you experience an involuntary movement of your legs.

Periodic Limb Movement Disorder (PLMD)

If you have periodic limb movement disorder (PLMD), you may be unaware of it unless your sleep partner has told you about it. PLMD is an involuntary movement of your legs (or less often, your arms) during the night as you sleep. Typically, the movements are not enough to wake you, though they may. Either way, they cause interruptions in your sleep that leaves you feeling unrested and results in daytime sleepiness.

The cause of PLMD is currently unknown, but scientists believe it may be related to anemia, central nervous system problems, or genetics. The first step in treating PLMD is to practice good sleep hygiene habits. If you do not experience relief despite having good sleep hygiene, a consultation with your physician is your next step.

Narcolepsy

If your daytime sleepiness involves abruptly falling asleep at unpredictable (and often inconvenient) times, you may have narcolepsy. This goes way beyond dosing off while watching a movie and may include additional symptoms including falling asleep under unusual circumstances (such as when driving or mid-conversation), sleep paralysis, dreams so vivid that they feel real, and cataplexy (a loss of muscle tone). While there is currently no cure for narcolepsy, having good sleep hygiene and physical activity helps, plus there are medications that your physician can prescribe.

Medium risk causes of daytime sleepiness require prescription medication or other therapies for treatment and require that you see a physician, however, they are unlikely to have severe health consequences if left untreated.

Fibromyalgia

If you’re experiencing problems such as difficulty falling asleep, trouble staying asleep, or waking up too early in addition to generalized pain, malaise and fatigue, and emotional distress, fibromyalgia may be the cause. While there is currently no cure for fibromyalgia, there are medications that can provide relief for fibromyalgia pain and sleep disruptions. Discuss your sleep problems with your physician to see how your problems can be treated most effectively.

Chronic Fatigue Syndrome

Does your daytime sleepiness extend to persistent fatigue that interferes with your ability to pursue your day-to-day responsibilities and activities actively? If so, you may have chronic fatigue syndrome. There is inconsistent evidence about the cause of CFS, but it is often (though not always) preceded by a virus, such as Lyme disease, or a traumatic physical or psychological experience. We do know that full recovery is uncommon and that some people are affected by both chronic fatigue syndrome and fibromyalgia. It’s important to talk to your physician about your symptoms to find an effective treatment.

Hypothyroidism

If you have hypothyroidism, you may also experience symptoms like feeling cold even when the people around you feel warm enough, difficulty concentrating, experiencing frequent constipation, and weight gain in addition to feeling sluggish and sleepy all the time. Hypothyroidism may also be caused by an iodine deficiency, or it may be the result of an autoimmune disorder. While there is no scientific evidence supporting the use of natural remedies for hypothyroidism or a specific diet to treat hypothyroidism, it is easy to treat with medication. The first step to take to resolve this issue is to schedule an appointment with your physician to get tested.

Premenstrual Dysphoric Disorder

If you’re a woman that feels “normal” for about half of the month and “out-of-control” for the rest of the month, you may have premenstrual dysphoric disorder (PMDD), an extreme form of premenstrual syndrome. During the 10-14 days before a period, in addition to experiencing daytime sleepiness you may also have bloating, exhaustion, irritability, and joint pain – all of which seem to disappear once your period starts magically.

If PMDD is causing so much daytime sleepiness that you are unable to function in your day-to-day life, you should see your physician. There are medications available that can help minimize the severity of your symptoms, relieve the exhaustion you’re feeling, and help you feel less sleepy during the day.

Mild Anemia

If you have anemia, your tissues are not getting enough oxygen, either because you have a low red blood cell count or because you have a condition that is making your hemoglobin low. Hemoglobin is the protein in red blood cells that carries oxygen from your lungs to the rest of your body. Anemia causes your heart to work harder to get adequate oxygen to your tissues which make you tired more easily, regardless of whether you are getting enough quality sleep.

Having low hemoglobin can be caused by a variety of things including not getting enough iron in your diet, problems with your body absorbing iron normally, and significant blood loss. Of these, iron deficiency anemia is the most common cause. You can eat iron-rich food sources like animal proteins, such as meat, chicken, fish, eggs, and produce like prunes and legumes to help alleviate anemia. See your physician to have tests run to check if you have anemia and to get help figuring out the cause of it if you do have it.

Depression – Mild to Moderate

Many people with depression experience daytime sleepiness in addition to other symptoms including a lack of interest in usual activities, low energy, difficulty concentrating, feelings of hopelessness, and sleep problems such as insomnia, excessive waking during the night, nightmares, and other sleep disturbances. Depression can cause both the mental and physical fatigue that is responsible for feelings of daytime sleepiness. It’s important to note that sleeping difficulties are common in depression.
Treatment for mild to moderate depression, whether acute (short-term) or chronic (long-term), includes things that you can do yourself such as exercising, spending time out-of-doors every day, or talking with a trusted friend or family member, and medications that can be prescribed by your physician.

Infections

Although you would be expected to have other signs or symptoms of an infection, daytime sleepiness may be the primary sign you recognize as the infection may currently be smoldering just under the surface. Examples of these types of infections include Urinary tract infections (UTIs), yeast infections, and even pneumonia. If you simply aren’t feeling well and are experiencing daytime sleepiness, consider getting checked out by your physician.

Low to medium risk causes of daytime sleepiness are typically limited in duration. You may find it necessary, or at least helpful, to see a physician for treatment. However, these causes are unlikely to have severe health consequences outcomes if left untreated.

Insomnia Disorder

There are a variety of distinct types and classes of insomnia, covering problems from being tired, yet unable to sleep to being able to fall asleep easily, yet being unable to stay asleep. Regardless of how you categorize your difficulty sleeping, you have insomnia, and it can leave you feeling drowsy during the day.

It is not unusual to experience insomnia during particularly stressful life events, or when traveling across time zones. This type of insomnia typically resolves on its own and does not require a visit with a physician. Insomnia can also be caused by things as simple as:

• drinking water before bed, such that you often wake to use the bathroom
• lifestyle habits
• medical problems, such as chronic pain or reflux
• psychiatric problems, such as anxiety and depression
• shift work requiring working irregular or non-customary hours
• sleeping after eating or eating too close to bedtime
• smoking, or using alcohol or caffeine close to bedtime

If you have sleeping problems at least three nights per week for at least three months, you have chronic insomnia which does need further evaluation by a physician. Treatments for insomnia include lifestyle modifications and medications.

Idiopathic Hypersomnia(sometimes called“long-sleeping disorder”)

If you find yourself regularly sleeping for extended periods of time, often – more than ten hours at a time, yet still feeling sleepy all the time, you may have idiopathic (no identifiable cause) hypersomnia (excessive sleepiness). The excessive sleepiness of idiopathic hypersomnia is thought to be caused by a disorder of the nervous system, though the definitive cause has yet to be determined. Since idiopathic hypersomnia is not fully understood, there is no cure for it.

It’s important not to confuse idiopathic hypersomnia with African trypanosomiasis (also called “sleeping sickness”). While trypanosomiasis induces continuous sleep, it does have a known cause – a parasite found in rural Africa.

Premenstrual Syndrome

If you’re a woman, you may experience insomnia either right before or during your monthly period. During the premenstrual phase, levels of Melatonin, a hormone made by the pineal gland that helps regulate sleep, decrease which can cause insomnia. The period of deep sleep (slow wave sleep, or SWS) is also increased which can cause fatigue that lasts throughout the day.

Medication and Drug Effects

If you’re talking a medication that acts on the central nervous system, sleepiness is a common side effect. The regulation of sleep and wakefulness periods is a complex process that involved multiple factors and systems. However, most drugs with clinically sedative or hypnotic actions affect one or more of the central neurotransmitters implicated in the regulation of sleep and wakefulness. These drugs include dopamine, epinephrine, norepinephrine, acetylcholine, serotonin, histamine, glutamate, γ-aminobutyric acid, and adenosine.

These medications include prescription and nonprescription sleeping pills and other medications containing sedating H1 antihistamines, such as diphenhydramine (Benadryl), longer-acting benzodiazepines, sedating antidepressants, beta blockers, anticonvulsants, and antipsychotic medications. Among drugs of abuse, marijuana has significant sedating effects as do amphetamines and cocaine after their long episodes of drug-induced wakefulness.

Low-risk causes of daytime sleepiness are typically limited in duration and are unlikely to need intense medical care.

Poor Sleep Hygiene

Sleep hygiene is a variety of factors, practices, and habits that are necessary to getting quality sleep every night and achieving full daytime alertness. The term “hygiene” is often misunderstood as strictly being synonymous with “cleanliness,” but it actually means the practices aimed at preserving your health.
Your daily routines can significantly impact your quality of sleep. Quality sleep is essential to avoiding daytime sleepiness. Even a few slight adjustments can, in some cases, mean the difference between sound sleep and a restless night.

Improvements in sleep hygiene offer an easy way to find the path to great sleep and should be the first thing you try when daytime sleepiness becomes an issue. Here are some common poor sleep hygiene habits that may be causing your problem:

• Sleeping on an irregular schedule
• Drinking coffee or other caffeinated drinks late at night or in the afternoon
• Have an alcoholic drink close to bedtime
• Using sleeping pills
• Using devices that emit blue light, such as computers, mobile phones, eReaders, etc., within a few hours of going to bed
• Taking long naps, especially in the afternoon and evening
• Working out right before going to bed
• Reading, watching TV, or working in bed
• Eating within two hours before going to bed

If you’re guilty of practicing any of these poor sleep hygiene habits, it’s time to make a change today.

Diet

They say you are what you eat. This applies to sleep too. It is possible for what you eat to be causing your daytime sleepiness. Whether it’s a food allergy or a condition like celiac disease, taking a close look at your diet can help you identify certain foods that leave you feeling sleepy after eating them. Eating more fruits and vegetables, whole foods, and less processed foods and may help you to feel better during the day. Plus, there are certain foods like turkey and cherries that contain elements like tryptophan or melatonin that are associated with daytime sleepiness; these are unlikely to be significant contributors to feeling tired although.

Be sure to consider the role of caffeine in how you are feeling. Even though caffeine is a stimulant that initially wakes you up, you may experience a “caffeine crash” that leaves you feeling sleepy as it wears off (typically over 4-6 hours).

Finally, ensure that you are drinking enough water as dehydration is a leading cause of daytime fatigue. You may find it helpful to keep a water bottle on hand to make staying hydrated easy during the day.

Sleep Deprivation

Sleep deprivation is probably the most common cause of excessive daytime sleepiness. Sleep deprivation occurs when you simply do not get enough sleep for you and symptoms can occur in healthy persons even after only one night of sleep loss. Sleep deprivation can be caused by anything from partying late into the night at a wedding to getting too little sleep on a routine basis. The debate on how much sleep you need is endless, but it is agreed upon that most adults need from seven to nine hours of sleep on average each night.

Not getting as much sleep as you need, especially several times a week, is when you will most likely begin to suffer from excessive daytime sleepiness. The obvious solution is to get more sleep.

There are other factors that can contribute to your feelings of tiredness or fatigue during the day. These include:

• After lunch, most people experience a natural dip in their circadian rhythm between 1 PM and 3 PM causing them to feel a little sleepy. This feeling will be more intense if you get poor quality or inadequate sleep at night.
• Spending too much time laying around in bed, or on the couch, can also make you feel more tired. You should aim to spend no more than 8 to 9 hours in bed or resting elsewhere each day.
• For those with physical ailments or restrictions, even sitting up in a chair and getting morning sunlight upon awakening can be helpful.
• Boredom itself can make fatigue worse, so combat it by taking a walk, doing household chores, or getting out of the house to run errands and socialize.
• Finally, some people mistake their eye fatigue for physical fatigue. If you spend your day staring at a computer screen or TV, your eyes start feeling fatigued. To relieve the associated blurring of the vision or twitching of the eyelids, try to take a break from your screen time to get some relief.

Take time to identify each of the reasons that may be contributing to your condition and then set about making some changes to see if they make an impact on your sleepiness. If you continue to struggle with daytime sleepiness, make an appointment with your physician or a sleep specialist.

Possible solutions

The best way to treat daytime sleepiness is to address its underlying cause as discussed with each of the potential causes above. Often this means addressing sleep hygiene and lifestyle issues and consulting with your physician. If you are diagnosed with a sleep disorder such as sleep apnea, the recommended treatment for your specific condition is often the most effective solution to your daytime sleepiness. There are cases, however, in which specific medication to treat your daytime sleepiness may be needed. For example, if you have sleep apnea and use a CPAP machine, but continue to feel drowsy during the day, your physician may suggest medication to make you more alert. Medication can also be prescribed for people with narcolepsy to help them remain awake and productive during the day. Shift workers who persistently feel sleepy during work hours may also benefit from medication if adjusting their sleep habits does not help, or if rotating schedules make it difficult to sleep sufficiently.

It’s very important to work closely with your physician to determine which treatment is right for you. This will depend on your unique situation, schedule, sleep habits, and medical history, as well as any further tests your physician needs to understand the root of your daytime sleepiness.

Why get treatment?

Moving through your day struggling with sleepiness is not a wonderful way to live, especially when there might be a serious underlying condition. The benefits of quality sleep reach well beyond simply getting enough rest to feel more awake during the day, but poor-quality sleep can have long-term detrimental effects on your health and well-being.

Seek medical care immediately if you have daytime sleepiness symptoms and:

• A recent head injury
• Sudden onset or severe headache
• Chest pain
• The sleepiness is not improved by improving your sleep hygiene

Talk to your physician or ask for a referral to a sleep specialist to discuss your daytime sleepiness and work on a treatment plan.