What are the causes of DS (daytime sleepiness)?
Sleep loss
Reduced sleep times will create a ‘sleep debt’
Poor quality sleep
Sleep can be disturbed due to:
1. noise, uncomfortable temperature and light or a poor bed
2. snoring, restless legs
Medical conditions
Hypothyroidism can cause daytime fatigue and conditions like pain, breathing difficulty, gastric upset may disrupt sleep.
Medication
Pain pills such as opiates and anti-anxiety pills like alprazolam, can cause daytime sleepiness, while corticosteroids, diuretics can disturb sleep at night, causing you to feel sleepy during the day. Substances such as alcohol may also contribute to DS.
Primary hypersomnia
Narcolepsy, Idiopathic hypersomnia
Do you feel that sleeping longer does not help you feel better? There are several reasons why you may be experiencing this:
- If the quality of your sleep is light and disturbed, sleeping longer will not help you feel better.
- Are you sleeping less on weekdays due to your work and lifestyle? If so, you are accumulating a sleep debt (hours of sleep required minus actual hours slept) during the work days. Are you planning to sleep longer on weekends 'to catch up on sleep'? This recovery sleep can help you feel better if the sleep debt is low, but may not be enough to overcome the huge sleep debts. For instance, if you require 7.5 hours of sleep, but sleep 4-6 hours on the weekdays, you may accumulate a sleep debt of approximately 11- 12 hours, and sleeping a few hours longer on your days off may not be enough to 'recover your debt'.
- If you are sleepy even after sleeping soundly for 7-8 hours (depending on your sleep requirement) (Please see how much sleep do I need?), you may have a primary hypersomnia such as Narcolepsy or Idiopathic Hypersomnia.
Narcolepsy is characterized by daytime sleepiness and 1 or more of the symptoms listed below, which are caused by intrusion of muscle paralysis and dreams (usually seen in REM sleep) into wakefulness.
People with narcolepsy find it hard to stay awake for extended periods of time. They describe overwhelming drowsiness and sudden attacks of sleep, which will affect their work, performance, social activities and mood. They are prone to accidents and depression.
Symptoms of Narcolepsy. This includes sleep hallucinations etc.
Sleep hallucinations (SH)
Sleep paralysis (SP)
Cataplexy
Do your muscles suddenly become limp or weak, causing your legs and body to drop or fall? Does this occur in response to strong emotions like laughter, surprise, fright or anger? You may be having Cataplexy.
Cataplexy is characterized by a sudden loss of muscle tone which is triggered by strong emotions like laughter. This may involve weakness of the face, arms or legs. Sometimes droopy eyelids, mouth falling open, tongue protrusion and head bobbing may be seen. Some people may fall to the ground during an attack, or may experience difficulty smiling or speaking.
It usually lasts < 1 minute, but may last longer. This is seen in both adults and children and is caused by the intrusion of the muscle paralysis of REM sleep into wakefulness.
Narcolepsy is a neurological disorder caused by destruction of cells of the lateral hypothalamus which produce a neuropeptide called orexin. Orexin (also known as hypocretin) regulates wakefulness and hunger. There are 2 subtypes of Narcolepsy (type 1 and 2), depending on the presence of cataplexy. Type 1 patients have cataplexy, while SH and SP may be seen in both types. People with Narcolepsy also have increased incidence of REM behavior disorder (Please see REM behavior disorder in parasomnias section), restless legs syndrome (Please see to restless legs syndrome) and disturbed sleep at night.People who live with sleepiness most of their life, may feel that it is normal. In addition, people with SH, SP and cataplexy may be misdiagnosed as having a psychiatric disease such as psychosis or hysteria.
IH (idiopathic hypersomnia) is characterized by severe daytime sleepiness, which starts during adolescence and young adulthood, similar to narcolepsy. Patients with IH sleep very deeply at night and have a difficult time waking up in the morning and after naps. This is known as sleep inertia or ‘sleep drunkenness’. They also do not have SH, SP or cataplexy.While we understand what causes narcolepsy well, we do not understand IH very well.
If you have any of the above symptoms, make an appointment with AMARA Sleep.
