Fatigue and Excessive Sleepiness

Do you find it difficult to get out of bed in the morning? Do you sometimes feel sleepy while watching television or driving? If so, you may be one of the millions of Americans who suffer from excessive sleepiness, a condition that can significantly reduce quality of life, decrease productivity and interfere with relationships. Most people feel tired occasionally, but excessive sleepiness that persists is neither normal nor healthy.

CAUSES:

One of the primary causes of excessive sleepiness among Americans is self-imposed sleep deprivation. In the U.S. and many other parts of the world, sleep loss may occur as a result of economic or societal pressures. People may skimp on sleep in hopes of getting more done, and widespread access to technology makes it possible to stay busy (at the computer, for example) around the clock. By some estimates, people now sleep about 20 percent less than they did a century ago.

Working at night and sleeping during the day can also cause excessive sleepiness. Some people are able to adjust to such a schedule. However, others may never overcome the body’s natural tendency to be awake during the day and asleep at night. A similar phenomenon occurs with jet lag, in which the body is “out of sync” with the natural environment. In general, symptoms of jet lag increase with the number of time zones crossed. That is, someone flying from Beijing to San Francisco is more likely to suffer worse jet lag than someone flying from San Francisco to New York.

Excessive sleepiness is also linked with a number of primary sleep disorders. For example, sleep disordered breathing (SDB), which includes snoring and obstructive sleep apnea (OSA), is often associated with excessive sleepiness. Because SDB may result in frequent interruptions during sleep, it can lead to abnormal sleepiness during waking hours no matter how many hours a person actually spent in bed.

Insomnia is another main cause of perceived daytime sleepiness or fatigue. Insomnia symptoms may include difficulty falling asleep, difficulty staying asleep, and/or waking up still tired as well as daytime impairments such as excessive sleepiness, cognitive deficits (e.g., concentration and memory problems), fatigue, and irritability.

Narcolepsy is a neurological disorder characterized by disabling sleepiness. Most patients begin to experience symptoms in their teens or 20s, but symptoms may appear in younger children or older adults. Narcolepsy is also recognized by insomnia at bedtime, sudden sleep attacks, cataplexy (sudden muscular weakness), hallucinations, and sleep paralysis.

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and a strong urge to move them.  People who suffer from RLS may mistake the problem for insomnia since RLS symptoms are usually worse at night, leading to insomnia at night and excessive sleepiness during the day.

The good news is that these sleep disorders can be easily diagnosed and effectively treated. If you have excessive daytime sleepiness and/or feel you may suffer from a sleep disorder, talk to a healthcare professional about the problem as soon as possible.

Excessive sleepiness may also be caused by a variety of physical and mental illnesses as well as some medications.  If you suffer from a medical condition and you are experiencing excessive sleepiness, talk to your healthcare professional about the problem.  In many cases, properly treating the medical condition may alleviate sleepiness. In other cases, sleepiness must be treated independently.

POLL DATA:

Excessive sleepiness is not just a matter of feeling lousy – it can also affect mood, relationships, work, and quality of life.  According to the results of NSF's 2008 Sleep in America poll:

• 36 percent of American drive drowsy or fall asleep while driving
• 29 percent of Americans fall asleep or become very sleepy at work
• 20 percent have lost interest in sex because they are too sleepy
• 14 percent report having to miss family events, work functions, and leisure activities in the past month due to sleepiness

Each of these consequences can have an enormous impact on an individual’s health and happiness.  

One of the most serious risks associated with excessive sleepiness is drowsy driving.  NSF's 2008 poll revealed that a whopping 36 percent of American adults have nodded off or fallen asleep while driving.  Sleepiness and driving do not mix.  If you feel sleepy, you should not drive. Visit drowsydriving.org to learn how to prevent a drowsy driving-related crash.

There are several tools used to evaluate a person for excessive sleepiness.  An individual’s personal report of how they feel is also important in characterizing a sleepiness problem.  Interviewing a person’s bed partner or those sleeping nearby is also helpful in identifying things that occur during sleep (e.g., snoring and breathing pauses during sleep).

Special questionnaires developed specifically to provide insight regarding daytime sleepiness (these include the Epworth Sleepiness Scale and Stanford Sleepiness Scale). Sleep diaries may also be helpful in assessing and evaluating sleepiness as well as any underlying factors.  Additionally, there are several tests that may be employed when a sleep disorder such as SDB or narcolepsy is suspected.  Such tests may include an overnight sleep study or “polysomnogram,” and the Multiple Sleep Latency Test (MSLT).

TREATMENT:

Once a cause for excessive sleepiness is determined, there are generally a range of treatment options available to patients, including behavioral and pharmacological (drug) therapies.  For example, if the primary cause of sleepiness is OSA, continuous positive airway pressure (CPAP) or an oral appliance may be prescribed. If excessive sleepiness persists in OSA patients using CPAP or is the result of narcolepsy, approved medications may be appropriate. For sleepiness caused by voluntary sleep deprivation or poor sleep habits, treatment will center on adopting behavioral measures to make getting adequate sleep a top priority.

COPING:

Although everyone should employ all the elements of good sleep hygiene, this is particularly important for anyone with excessive sleepiness.  These are behaviors and habits that can promote healthy sleep, which helps improve alertness during the day.  They include:

• Maintaining a consistent sleep schedule, even on the weekends
• Developing a regular, relaxing bedtime routine
• Using your bedroom only for sleep and sex; if you do this, you will strengthen the association between bed and sleep
• Create a sleep environment that is dark, quiet, comfortable and slightly cool
• Removing all work materials, televisions, phones, and other distractions from the bedroom
• Avoiding caffeine in the second half of the day
• Limiting alcohol – it can disturb sleep

For some people with excessive sleepiness, adopting healthy sleep habits is enough to resolve the problem.

People vary in their need for sleep, but experts agree that for most adults the amount needed to feel one’s best is somewhere between seven and nine hours per night.  Teens and young adults usually need nine hours of sleep or more per night.  If you suffer from excessive sleepiness that persists for more than three weeks despite allowing adequate time for sleep, discuss the problem with your healthcare professional.