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Thursday, May 23, 2013
Sleepy all the time
I feel tired all day long. When I wake up in the morning, I always feel terrible, like I did not sleep at all. (I also feel ill, too-like with the flu-but it goes away in about 30 minutes.) Sometimes I get so tired during the day that I am want to lie down. (I can`t do this at work, and feel like I am in a fog.) I can lie down on weekends, though. When I lie down, I will pass out for about an hour. One weekend I passed out for six hours (from 3:00pm to 9:00pm, and when I woke up I felt like I did not sleep at all). A lot of nights I only get 6-7 hours of sleep. Could this be causing my constant exhaustion, or is something else going on? I have been tired for over 30 years, and had trouble waking up as a child also. But the constant daily exhaustion has been severe these last two years!
Your main complaints are that of unrefreshing (or nonrestorative) sleep and excessive daytime sleepiness. These are quite common conditions in modern society and have a number of potential underlying causes, all of which can be treated with some degree of success. It is likely that the 2 problems are linked and may have the same cause, but I’ll address them separately.
Not feeling rested after a night of adequate sleep can be frustrating. Feeling "terrible, like I did not sleep at all” should be considered abnormal and usually signals there is a problem with your sleep.
There are a number of potential reasons that a decent night of sleep may not be refreshing, many of which have to do with factors or conditions that may interrupt or fragment sleep. Some possible causes of nonrestorative sleep include:
- a poor sleep environment (too loud, too brightly lit)
- anxiety or stress
- sleep apnea (a condition where individuals struggle to breath in their sleep)
- periodic limb movement disorder (frequent leg twitches in sleep)
- painful conditions
- certain medical conditions such as heartburn
- asthma or heart disease, certain medications
- excessive use of stimulants such as caffeine and nicotine
How best to treat your problem really depends on obtaining more information so that appropriate treatments can be recommended.
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. From your question, it appears that you could probably benefit from getting some additional sleep and you should try to extend your sleep hours by an hour or so per night. However, having said that, you may have other issues going on. There are a number of sleep disorders commonly associated with daytime sleepiness and these include obstructive sleep apnea (OSA), narcolepsy, restless legs syndrome with or without periodic limb movements in sleep and a delayed sleep phase (usually resulting in inadequate sleep time). Please see our website for additional details on each of these conditions.
In addition, there are other non-sleep related causes for fatigue and sleepiness. These may include medication side effects, substance abuse, depression, fatigue syndromes (such as chronic fatigue syndrome), and hypothyroidism, to name a few. In some cases, no clear cause for sleepiness can be found and the condition is labeled as idiopathic hypersomnia.
To determine if there is sleep-related cause for your problems, a thorough history and physical examination are needed. A referral to a Sleep Specialist by your primary care physician may be necessary to help sort out whether further testing is needed. Once a history and physical examination have been performed, the Sleep Specialist will decide if further evaluation by a sleep study is necessary. If a primary sleep disorder is discovered, you should maintain hope as all of these problems are treatable with a fairly high degree of success. I also recommend that you should consider avoiding driving until sleep issues are addressed. Failing asleep behind the wheel can have grave consequences.
To learn more about sleep or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The website sleepeducation.com also provides plenty of good consumer friendly information. Good luck and here's to better sleep!
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University