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Wednesday, April 16, 2014
Excessive sleeping - inability to awaken
Though there is an enormous amount of information on insomnia I have been unable to find help with the problem of over sleeping (12 to 15 hours a day) and not being able to get up out of bed. I sometimes awaken but can not get up then suddendly around 3 p.m. I will be able to get up without trying. Its very strange as I am very motivated to want to get up and I am not in need of additional sleep. I`ve seen a doctor to explore the possibility that its depression but it does not seem to be. It seems that awakening is involuntary. I have vivid dreams that I`m able to remember very well and are quite complicated. Could you address what reasons might be the cause and if there`s any treatment that may be successful? I am sleeping my life away and it has caused me a divorce after 28 years of marriage and my wel cause me my career after 30 years with the same company. Please help!!!!Thank you.
Your main complaint is that of long sleep with excessive sleepiness. While there are some individuals that are considered “long sleepers” and normally require 9-10 hours of sleep per night, what you are describing is different and more likely related to an underlying condition that is making you very sleepy. Excessive sleepiness is quite common in modern society and has a number of potential causes, all of which can be treated with some degree of success.
Probably the most common cause of excessive sleepiness is simply a lack of adequate hours of sleep. Individual sleep needs vary, but most people require at least 7 1/2 to 8 hours of sleep daily to feel rested. This is obviously not the case for you and you are likely suffering from a primary sleep disorder. Common sleep disorders associated with daytime sleepiness include obstructive sleep apnea (OSA), narcolepsy, restless legs syndrome with or without periodic limb movements in sleep and a delayed sleep phase (usually resulting in inadequate sleep time).
Obstructive sleep apnea (OSA) is due to the recurrent complete or partial closure of the airway during sleep. As a result, individuals with OSA suffer from fragmented sleep and tend to feel unrefreshed upon awakening as well as sleepy and tired during the daytime. The main risk factors for the development of sleep apnea include being overweight and/or having specific anatomic abnormalities (such as large tonsils) that may narrow the airway. Aside from unrefreshing sleep and daytime sleepiness, individuals with sleep apnea often complain of loud snoring, headaches upon awakening, a poor sense of well-being, decreased ability to concentrate and reduced alertness. It is important to diagnose and treat this condition as treatment can improve symptoms and reduce the risks of long term complications associated with OSA. The diagnosis typically requires a sleep study.
Narcolepsy is a condition that is caused by the inability of the brain to regulate the sleep-wake cycle normally. Individuals with narcolepsy are very sleepy and often feel well-rested after obtaining sleep, but then become sleepy a short time later. They may also have "cataplexy," which is a sudden loss of muscle tone usually precipitated by a strong emotion such as anger or laughter. Narcoleptics may also have dream-like hallucinations during sleep or experience episodes of inability to move during sleep. The evaluation for narcolepsy typically also requires a sleep study as well as a daytime nap test.
People with restless legs syndrome have an irresistible urge to move their legs at night and during inactivity. This can lead to delays in getting to sleep and thus insufficient sleep time. Periodic limb movement disorder may or may not accompany restless legs syndrome and can lead to unrefreshing sleep and daytime sleepiness. Often times, an individual’s bed partner is the first to complain about restless sleep, with frequent leg jerks or kicks. These conditions can sometimes be diagnosed by obtaining a good history, though for periodic limb movements, a sleep study is often needed to make the diagnosis.
In the delayed sleep phase syndrome, the timing of the biological clock is out of sync with the desired sleep and wake hours. People with this condition typically are young and have a hard time falling asleep before midnight and waking up in the morning.
Aside from these conditions, numerous other factors may influence the quality of your sleep. These can range from the environment you sleep in (i.e. too warm, too loud) to other medical problems (i.e. heartburn or breathing problems) to medications you may be taking. Fragmented sleep from any of these conditions can lead to daytime fatigue and sleepiness. In some cases, no clear cause for sleepiness can be found and the condition is labeled as idiopathic hypersomnia.
To determine if there is sleep-related cause for your problems, a thorough history and physical examination are needed. A referral to a Sleep Specialist by your primary care physician is probably necessary to help sort out whether further testing is needed. Once a history and physical examination have been performed, the Sleep Specialist will decide if a sleep study is needed. If a primary sleep disorder is discovered, you should maintain hope as all of these problems are treatable with a fairly high degree of success.
To learn more about sleep or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The website Sleep Education.com also provides plenty of good consumer friendly information. Good luck and here's to good sleep!
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University