It has been estimated that 18% of the population experiences excessive daytime sleepiness.
What Is Excessive Daytime Sleepiness?
Excessive daytime sleepiness means that you have the urge to sleep throughout the day, regardless of how much sleep you had the night before. While most people assume that waking tired means their sleep is abnormal, it can also be a sign that your body is trying to heal and is asking for extra sleep.
How is excessive daytime sleepiness different from fatigue?
When you think sleepiness, think falling asleep, versus fatigue. Fatigue and sleepiness do not always come together. Fatigue is tiredness that may not be accompanied by the desire to sleep or the ability to fall asleep.
Have you ever felt fatigued but unable to sleep? That was the case for a client of mine, who struggled to fall asleep. No matter how tired she was she struggled to sleep at night and could not nap during the day.
Why might this happen? Her brain lacked the raw materials it needed to support sleep, whether at night or during the day.
As we restored her body’s ability to sleep, through the use of certain amounts of D and B vitamins, according to the RightSleep program, her ability to sleep came “back online.” In this case, the return of daytime naps were a sign of healing.
Roughly a year later, this same client found that most days she no longer needed to nap. Why? Because her sleep at night was now effectively doing its job, she experienced more energy and less fatigue during the day.
This story is meant to illustrate not only that daytime sleepiness and fatigue are different, but also that daytime sleepiness can be a good sign IF your body is finally getting what it needs to sleep better, as is common with participants of the RightSleep program.
Causes of Excessive Daytime Sleepiness
As we discussed, excessive daytime sleepiness can be a sign of healing. However, it can also be a sign of an untreated sleep disorder.
Keep in mind that you can still have a sleep disorder even if you sleep for eight or more hours a night.
How is this possible? Sleep duration is not necessarily an indicator of sleep quality. I discovered this first hand when I first started doing sleep studies in my neurological practice.
I found there were people who slept for 8 hours, but they had only a fraction of the normal REM (rapid eye movement) or deep (slow wave) sleep necessary to wake up feeling rested.
Whether or not you’ve had a formal sleep disorder diagnosis, the following are several conditions that are thought to be related to excessive daytime sleepiness.
Sleep-wake disorders, or “circadian rhythm sleep disorders,” have to do with your body falling away from the natural rhythm of the sun.
Ideally, when in optimal health, you will wake with the sun, energized and ready to seize the day, and you’ll start to feel sleepy as the sun goes down. You’ll fall asleep easily at a consistent time, generally around 9-11pm.
When your body’s inner “clock” gets thrown off, this connection to nature goes away and you may find yourself not wanting to get up in the morning, or not feeling sleepy until much later at night.
The remedy? In addition to giving your body the chemicals it needs by following the RightSleep program, healthy exposure to sunlight often helps restore your circadian rhythm.
Shift-Work Sleep Disorder
Shift work sleep disorder refers to your body’s struggle to regulate sleep when you work nights. This kind of work goes against your body’s natural inclination to sleep during nighttime hours and be awake during the day.
It also means that you are sleeping during a time when you would have naturally been exposed to sunlight. For these reasons, it can be extremely detrimental to your health.
As long as you are working nights, you will not be able to fully restore your sleep. This is why it is listed as a barrier to healing through the RightSleep Program.
If you want to heal your body every day through restorative sleep, please consider changing jobs so you can sleep and wake at the most optimal times and get healthy sun exposure during the day.
Idiopathic hypersomnia essentially means that you sleep all the time and we don’t know why. But, excessive daytime sleepiness can be a sign that your body is lacking the chemicals it needs to achieve proper, restorative sleep at night.
Conditions That Can Cause Excessive Daytime Sleepiness
Restless Legs Syndrome
Restless Legs Syndrome is one of the most prevalent sleep movement disorders, impacting 5-10 percent of adults and 2-4 percent of children.
This occurs most often in drowsiness leading into sleep. The legs move or kick involuntarily to the frustration of the sleeper.
If restless legs syndrome is disrupting your ability to fall asleep or sleep soundly, it can quickly lead to excessive daytime sleepiness. When left untreated, this disorder can cause your legs to involuntarily move even during the day whenever you feel sleepy, such as sitting on an airplane or long rides in the car.
Medications can be a short-term solution to cope with the problem. Medications used to treat restless legs syndrome include: Benzodiazepines, gabapentin and pregabalin, narcotics, and dopamine mimickers like ropinirole and mirtazapine.
For long-term relief, it is important to understand that restless legs syndrome has been linked to deficiency states, such as iron deficiency and vitamin B12 deficiency. The root cause must be addressed for long-term relief.
Narcolepsy can be thought of as an “attack of sleepiness” that you cannot fend off. So you fall asleep despite knowing it’s inappropriate or dangerous, like when you’re in the middle of a conversation, or even when you’re driving.
What is going on here? It has to do with how your body is producing orexin, the ‘’awake” chemical, analogous to the “drowsy” chemical, melatonin.
Medicine currently describes what is going on as an autoimmune attack on orexin-secreting cells in the brain. When you have less of the “awake” chemical during the day, you will fall asleep inappropriately.
One can also have suspected narcolepsy that is not the autoimmune disorder described above. If your lab tests don’t show antibodies to the orexin-secreting cells, then you have “idiopathic narcolepsy,” which means narcolepsy or daytime hypersomnia occurring for a different reason.
One form of “idiopathic narcolepsy” is preceded by REM behavioral disorder, which is acting out dreams during REM sleep. Sometimes a person who has physically acted out their dreams during the night for many years then begins to experience daytime hypersomnia. In this case both disorders, the REM behavioral and daytime sleepiness are related to brain acetylcholine deficiency.
Until recently, most medical professionals were taught that depression caused sleep disorders, including excessive daytime sleepiness.
It is now becoming more and more clear that the sleep disorder is likely what is causing the depression. Most sleep disorders develop due to a domino effect of vitamin and mineral deficiencies that undermine the chemistry that sustains a normal mood and normal sleep.
As the sleep disorder worsens, there can be more exaggerated effects on mood, energy and focus.
Most sleep challenges are slowly progressive neurochemical changes. They start off as an occasional event, then slowly become more and more common until they become impossible to ignore, as in the case of insomnia.
Insomnia can take different forms. Maybe you struggle to fall asleep sometimes. Or at times you wake up and cannot get back to sleep. As referenced in the case study earlier in the article, excessive daytime sleepiness can even turn into the inability to sleep at night or during the day.
Seeing this as a progression that may only get worse can motivate you to seek solutions. A short-term remedy could be a prescription sleep medication. But ultimately, you want to resolve the root-cause deficiencies that may be preventing your body from easily transitioning into restorative sleep every night.
Sleep Apnea that is caused by collapse of the airway at night can be treated with CPAP devices. For some people a CPAP device can help resolve obstructive sleep apnea by keeping their breathing tube open during sleep.
But if, despite wearing the device, you still experience excessive daytime sleepiness, you may still not be achieving the deeper, restorative phases of sleep. The reason has to do with the brain’s role in paralysis during deep sleep.
During deep sleep the brain controls the level of paralysis of the body, including the air tube. If the airway is a little too paralyzed it may collapse and produce obstructive sleep apnea.
This is different from central sleep apnea which means that the diaphragm itself has become too paralyzed and you do not breathe at all.
The root cause of this abnormal paralysis often comes back to unaddressed deficiencies that prevent the brain from doing its job properly to support a healthy sleep cycle.
How Important is it to Resolve Your Excessive Daytime Sleepiness?
Ask yourself these questions to help assess the severity of impact your excessive daytime sleepiness might be having in your life:
Excessive Sleepiness Self-Assessment
- Do you “sleep normally,” yet feel tired when you wake in the morning?
- Does your bed partner say that you move a lot in sleep?
- Do you ever wake up unable to move?
- Do you have dreams that seem to be while you’re ‘’in between‘’ awake and asleep?
- Are you tired during the day but unable to sleep at night?
- Are you tired during the day but unable to nap during the day?
- Do you fall asleep while driving or while sitting at your desk or watching TV?
- Do you have ‘’attacks’’ of sleepiness during the day that you are unable to fight off?
- Do you act out your dreams at night?
- Are you aware of having any sleep difficulty?
- Do you sleep (a) Four hours or less per night? (b) Or, eleven or more hours per night?
- Four hours or less per night?
- Or, eleven or more hours per night?
- Most nights, are you unable to fall asleep until 2am or later?
- Do you wake more than once per night?
- Do you snore?
- Do you wake up to go to the bathroom at night?
- Do you wake with pain in the morning?
- Do you feel that you suffer from anxiety or depression?
While many people who experience excessive daytime sleepiness answer “yes” to many of the above, even one “yes” could mean you have a sleep issue that needs urgent resolution.
The good news is, if you have been struggling, there is something you can do about it.
Will Sleep Medications Help To Combat Excessive Sleepiness?
Sleep medicines, if they help you consolidate or deepen your sleep at night should, over time, help you have less daytime sleepiness. Keep in mind that medications are ideally a short term solution to help you as you seek to address the root cause.
Should I Take Supplements To Combat Excessive Sleepiness?
Just as in the case of sleep medicines, if supplements improve your sleep at night, they could be an ideal short-term solution. However, tackling the root cause of your issue, may help you remove or reduce the supplements needed for sleep.
How to Treat Excessive Daytime Sleepiness
Improving your sleep at night, ensuring your sleep is of optimal duration and quality, can resolve long-term daytime sleepiness.
Listen to your body — it is okay to nap during the day, no matter what you may have heard. However, if your daytime sleepiness is long term and extreme, it may be a sign of an underlying sleep disorder. When you achieve consistently restorative sleep, you will not regularly struggle with excessive daytime sleepiness. Your body only asks for what it needs.
Always discuss sleep issues with your doctor. Recommendations here are designed to support someone who has already discussed sleep issues with a private physician.