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Sleep Disorders

Unusually hard time waking up

09/13/2007

Question:

I have a very hard time waking up or even being woking up by others. I am somewhat worried that it will effect my job once i am out of college and have no roomate to wake me up in the morning. I realize that i am in college and part of my problem could be that i dont get enough sleep, however my problem is not that i dont want to wake up in the morning, it is that i am literally unconscious when my alarms go off. I get up, turn them off, and lay back down not even knowing that they went off. Sometimes i wake up thinking they didnt go off and then my suitemate tells me later she heard them. I set 5 alarms every night, sleep ontop of the covers, and leave the lights on when i sleep in hopes that it will help arouse me when i unconsciously get up to turn alarms off in the morning. I have found that if the lights are off and i am under the covers i am less likely to wake up. I have also been known to respond to people who talk to me in my sleep and get up and do stuff (turning off alarms on the other side of the room), one time i even talked on the phone with someone and had no idea about it till i talked to them later. Literally, when i go to sleep at night it is a 50/50 chance if I`ll wake up to my alarms or not. I would just like to know if you think this is truely abnormal and if there is any kind of sleeping disorder like this, or if you think it is just a lack of sleep.

Answer:

Your story nicely describes what is called "sleep inertia" or "sleep drunkenness". This refers to a period of confusion following awakening from the regular sleep or from a nap. This impairment may be severe, lasting from minutes to hours and occurs when there is gradual disengagement from sleep to wakefulness. Also, short-term memory seems to be unreliable near sleep onset. Not remembering the ringing of your alarm clock is very similar to forgetting a telephone conversation or some news that you were told in the middle of the night.

The underlying mechanism is believed to be a state-dissociation. During state dissociation the brain is partially awake and partially asleep. The brain is awake to perform such complex behavior as holding a conversation or turning off alarm clocks, but asleep enough that the person does not realize what they are doing.

While 10-25% of the population is sleepy in the morning, there is a great variability in the extent and duration of sleep inertia between individuals. Sleepiness and worsening of sleep inertia is caused by:

You did not mention your usual sleep hours; however, you do acknowledge that you don't get enough sleep. There is a good chance that you have a delayed sleep phase, which is a common problem among young adults. People with a delayed sleep phase are known as "night owls". This occurs when the person prefers to stay up at night and to sleep during the day causing a disturbance in the biologic clock relative to the night and day environment. Because of social obligations, we need to be awake during the day hours. Therefore, people with delayed sleep phase don't get enough sleep and are chronically sleep-deprived.

If you have trouble getting the sleep you need, work shifts, or simply cannot seem to find the time for sleep, then these tips from the Canadian Sleep Society and others may be helpful to you:

If your problem is not improved with the above measures, I recommend you discuss it with your doctor. An evaluation by a Sleep Specialist may be necessary to determine how best to manage your sleep issues.

For additional information regarding sleep and sleep disorders, visit the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it. Good luck, and sleep well.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University