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Sleep Disorders

Want to sleep night and day

04/04/2008

Question:

I am tired all of the time. I could sleep standing up or laying down. I could get tired driving or at the grocery store. My eye lids get so heavy, I just want to shut them. I get plenty of sleep. Way too much sleep. This has made me quit jobs and not do anything in the past. I sleep in a quiet environment at night. I stopped drinking anything at 6:00pm, so I would not get up to go to the bathroom  Now I am heavier than what I was (120 to 240), but it is the same feeling even when I was skinny. I felt the same way when I was younger (weighing 120). The doctor gave me Iron pills and all they did was make me throw up and go to the hospital from it. Those doctors said I was on an Iron overdose (too much Iron in my blood). I have tried everything. Why do I want to sleep all the time and don`t even care if I do? I cannot get anything done and I am feeling left out of the world by sleeping all of the time.

Answer:

You are suffering from severe daytime sleepiness. This is a pathological degree of sleepiness and requires attention from a Sleep Medicine Specialist. The most common reason for excessive daytime sleepiness is usually short sleep duration. In the presence of reasonable sleep duration (7-9 hours per night), which you seem to have by report, any degree of sleepiness is not normal.

Several disorders can cause excessive daytime sleepiness in the presence of normal sleep duration, not all of which are sleep disorders. Depression is a common disorder that causes patients to experience varying degrees of sleepiness. In some cases, chronic medical illnesses such as heart failure or inflammatory disorders can result in significant degrees of fatigue and sleepiness. Hormonal imbalance such as hypothyroidism (low levels of the thyroid hormone) can causes daytime fatigue. Certain medications may also make individuals drowsy. In the absence of reduced sleep duration and significant depression, medical or endocrine disorder, a disorder of sleep is highly likely, particularly if your main problem is that of sleepiness and not just fatigue. These disorders include sleep apnea, narcolepsy, and idiopathic hypersomnolence.

Sleep apnea is a common disorder characterized by recurrent episodes of airway obstruction during sleep resulting in sleep disruption. Patients typically do not remember these episodes and may provide very few symptoms other than daytime sleepiness and snoring, though other symptoms, such as a sensation of choking or gasping in sleep, restless sleep and morning headaches may also be present. Sleep apnea most commonly occurs in overweight individuals and thus, this should be considered in your case.

Narcolepsy is a disorder characterized by severe sleepiness along with other features that may include episodes of loss of muscle tone. Typically, during REM sleep, our muscles are inactive (except for our breathing muscles and eye muscles) and unable to move. In individuals with narcolepsy, this "paralysis" of muscles may occur during wakefulness (known as cataplexy, usually brought on by strong emotions) or during transitions between sleep and wakefulness (sleep paralysis). In addition, dreams may intrude up in these times as well (known as hypnagogic or hypnopompic hallucinations). Other symptoms of narcolepsy may include poor nighttime sleep and automatic behaviors (performing tasks without being aware of what you are doing or having recall of having done it).

Idiopathic hypersomnolence usually describes individuals who are very sleepy without an identifiable cause as to why this is the case.

It is important that you seek evaluation from a Sleep Specialist. The degree of sleepiness you describe is not something you should accept. Please carefully review your sleep duration and ensure that you are getting 7-9 hours of sleep. Make note of awakenings at night, and ask your bed partner whether you snore or not. The Sleep Medicine Specialist will need this information in addition to obtaining further medical history and performing a physical examination in order to determine if there may be a sleep disorder present. It's likely you may need to undergo a sleep study to establish a diagnosis.

It's worth seeking an answer to your problems as these are clearly affecting your quality of life and most of the above conditions can be treated and/or controlled.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University