I am tired of being sleepy
Find out how sleepy you are by filling out the ESS (Epworth Sleepiness Scale) https://www.mdapp.co/epworth-sleepiness-scale-calculator-201/
Most of us experience DS (daytime sleepiness) at some stage. 20% of people have frequent difficulty with it. DS is higher in teenagers, college students, shift workers, new parents, people who travel for their job frequently and use the internet excessively.
DS can be caused by 1) sleep loss (not getting enough sleep), 2) disturbed or poor quality sleep, 3) medical condition or medications. Primary hypersomnia such as Narcolepsy or Idiopathic hypersomnia may also cause daytime sleepiness.
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.
Further tests include: Sleep study (Please see sleep study) to make sure that you do not have other underlying sleep disorder. MSLT (mean sleep latency test) (Please see MSLT) to measure how sleepy you are. An MSLT must be performed to diagnose Narcolepsy.
What are the treatments available?
Not sleeping enough
Increase your sleep time
Underlying medical, neurological or
psychiatric conditions or sleep
disorder
Treat the underlying condition
Medications
Methylphenidate, modafinil, armodafinil, sodium
oxybate are used to treat daytime sleepiness.
Behavioral methods
– Scheduled naps will help people with Narcolepsy feel better, for an hour or more after nap.
– Learning to recognize and handle sleepiness.
Primary hypersomnia is a lifelong condition and you need to learn to live with it. Here are some things to think about:
- It is important to have regular sleep wake times and ensure that you get enough sleep. Most people will feel sleepy if they do not sleep enough. However, patients with primary hypersomnia will experience severe sleepiness, even with appropriate treatment.
- Talk with your doctor before starting a new medication. Some medications can make your sleepiness worse or may interact with your hypersomnia medications. Make sure to tell your doctor that you have narcolepsy.
- Do not choose a profession which requires prolonged wakefulness, travel or shift work. These jobs are associated with sleep loss and you will have a difficult time functioning in these jobs.
How sleepy am I?
Do you wake up feeling tired? Are you drowsy? Do you have difficulty staying awake during the day? Is it causing difficulty with your work or at school? Is it affecting how you feel? Do you find yourself spending less time with people and activities you enjoy because of sleepiness? Are you sleepy while driving? Is this happening frequently?
Find out how sleepy you are by filling out the ESS (Epworth Sleepiness Scale) https://www.mdapp.co/epworth-sleepiness-scale-calculator-201/
Most of us experience DS (daytime sleepiness) at some stage. 20% of people have frequent difficulty with it. DS is higher in teenagers, college students, shift workers, new parents, people who travel for their job frequently and use the internet excessively.
DS can be caused by 1) sleep loss (not getting enough sleep), 2) disturbed or poor quality sleep, 3) medical condition or medications. Primary hypersomnia such as Narcolepsy or Idiopathic hypersomnia may also cause daytime sleepiness.
Do you feel that sleeping longer does not help you feel better? There are several reasons why you may be experiencing this:
- f 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) (link to 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.
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 (link to REM behavior disorder in parasomnias section), restless legs syndrome (link 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.
How is it evaluated?
If you have any of the above symptoms, make an appointment with AMARA Sleep. (link to make an appointment). AMARA Sleep is one of the few Sleep Centers in India which has the expertise to diagnose and manage these conditions.
When you visit AMARA Sleep, our doctor will perform a thorough medical and sleep evaluation to look for underlying medical causes for your daytime sleepiness. You will be asked to keep a sleep diary (link to AMARA sleep diary), so that we can understand your sleep times and sleep pattern.
Further tests include:
Sleep study (link to sleep study) to make sure that you do not have other underlying sleep disorder.
MSLT (mean sleep latency test) (link to MSLT) to measure how sleepy you are. An MSLT must be performed to diagnose Narcolepsy.
What are the treatments available?
Primary hypersomnia is a lifelong condition and you need to learn to live with it. Here are some things to think about:
- It is important to have regular sleep wake times and ensure that you get enough sleep. Most people will feel sleepy if they do not sleep enough. However, patients with primary hypersomnia will experience severe sleepiness, even with appropriate treatment.
- Talk with your doctor before starting a new medication. Some medications can make your sleepiness worse or may interact with your hypersomnia medications. Make sure to tell your doctor that you have narcolepsy.
- Do not choose a profession which requires prolonged wakefulness, travel or shift work. These jobs are associated with sleep loss and you will have a difficult time functioning in these jobs.
