why am i so sleepy?
If you’re experiencing excessive sleepiness the differential diagnosis unfortunately is pretty broad. Many times, poor sleep habits can be the usual suspects. It’s important to review your routines, schedules, and the environment you’re sleeping in so you can spot potential problems and make adjustments.
However, when sleepiness is not due to behavioral inadequacies you have to ask one question, are you a snorer?
In the sleep world sleepiness is loosely separeted into two broad categories: the snorers and the non-snorers. Before we start blaming sleep apnea for everything, one of the main causes of sleepiness is merely insufficient sleep. Most adults need 7-9 hours of sleep per night, and even 30 minutes less can make you drowsy, underproductive, or moody. We tend to build us a “sleep debt” that accumulates over time. Research also does tell us that women need on average 30 more minutes of sleep. In our modern era its not unrealistic to see people who commonly only sleep 5 hours a night. Before 1960, the average sleep length was 8.3 hours. Avoiding caffeine in the afternoons, winding down in the evening, turning off computers and cell phones (the blue light from these devices may be alerting to the brain), and going to bed at an early and regular time are all important ways to carve out sufficient time and peace of mind for sleep.
Ok well what if none of the above applies to you. Lets say you diligently stick to your bedtime rituals and are getting 7.5 hours of actual sleep, but still feel sleepy? In this case, the culprit might be something that is resulting in poor sleep quality. Poor sleep quality can be due to many things. In brief, poor sleep quality can be caused by breathing disorders (snoring and apneas), movement disorders (REM behavior disorder, restless legs syndrome, or periodic limb movement disorder), or abnormal arousals (insomnia), or simply a higher tendency to be sleepy (hypersomnia or narcolepsy).
First and most common is sleep apnea. Sleep apnea is a sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleep. Even though there are 3 types of sleep apnea (pbstructive, central, and mixed) we will only really talk about the obstructive variant. Each pause in brearthing in a person with sleep apnea by definiton is at least 10 seconds long. Risk factors for OSA include being overweight, a family history of the condition, allergies, and enlarged tonsils.
Movement disorders can be split into Periodic limb movement disorder (PLMD) or Restless Legs Syndrome. These two terms are often incorrectly confused with one another. Although both deal with limb movement, RLS happen during wakefulness and PLMD happens during sleep. Both can lead to poor sleep quality and low sleep efficiency. PLMD might be evident to a bed partner by excessive kicking during sleep. RLS will be self reported by the patient. To assist in the 4 core criteria of diagnosing restless leg syndrome, the acronym URGE has been used: U = Urge to move, R = Rest worsens the urge, G = Getting up and moving relieves the urge, E = Evening or night worsening of the urge. Under most circumstances the diagnosis of RLS does not require sleep laboratory testing at a sleep study center. RLS can typically be diagnosed by interviewing the patient.
REM BEHAVIOR DISORDER
RBD is characterized by the patient acting out his/her dreams. These dreams often involve kicking, screaming, punching, grabbing, and even jumping out of bed. When awakened, people can usually recall the dream they were having, which will match the actions they were performing, but they will not be aware that they were moving. The actions in an episode can result in injuries to oneself or one’s bed partner. This behavior overall can result in sleep deprivation.
Narcolepsy is a long term neurological disorder that involves a decreased ability to regulate REM sleep. The cardinal symptom is excessive sleepiness. Symptoms include periods of excessive daytime sleepiness that usually lasts from seconds to minutes and may occur at any time. A majority have a sudden loss of muscle strength, known as cataplexy. These spells can be brought on by strong emotions. Less commonly there may be vivid dream like images or the inability to move for a period of time during falling asleep or upon waking-up. People with narcolepsy sleep about the same amount of hours per day as people without but the quality of sleep tends to be worse.