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Sleep Disorders

I need help with a sleep issue

12/08/2008

Question:

My fiance is 26 years old and can sleep for 36 hours straight. He has had sleep studies done and they told him that he does not have the chemical that tells your brain when to wake up and put him on adderall. This was when he was 16. He has had to see a psychologist every month since then, but the problem stills exists. Every few weeks he will sleep for a minimum of 36 hours. He has not been able to maintain a job do this problem and causes a serious strain on our relationship.

Answer:

Your main complaint is that your fiancé appears to have times of prolonged sleep, suggesting excessive sleepiness. While we can’t provide you with a diagnosis in the absence of additional history and an examination, we can provide you with some information regarding his problems. Excessive sleepiness is quite a common condition in modern society and has a number of potential underlying causes, all of which can be treated with some degree of success. He should not feel that needing 36 hours of sleep is normal.

When individuals report excessive sleepiness, there are a number of things to consider. 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. Primary sleep disorders need to also be considered and some of the more common ones that might cause sleepiness include obstructive sleep apnea (OSA), narcolepsy, idiopathic hypersomnolence, periodic limb movements in sleep and a delayed sleep phase (usually resulting in inadequate sleep time). Underlying psychiatric conditions can also cause sleepiness, particularly in cases such as depression and bipolar disease. While not entirely clear from your question, it sounds as though the sleepiness may have a cycle to it. If this is the case, then ruling out bipolar disease becomes important.

Aside from these conditions, numerous other factors may influence the quality of one’s sleep. These can range from the environment you sleep in (i.e. too warm, too loud) to your other medical problems (i.e. heartburn or breathing problems) to medications you may taking. Fragmented sleep from any of these conditions can lead to daytime fatigue and sleepiness. In addition, certain medications and medical conditions can make individuals feel tired and sleepy during the daytime, independent of their effects on sleep. In some cases, no clear cause for sleepiness can be found and the condition is labeled as idiopathic hypersomnia.

To determine the cause of your fiancés problems, a thorough history and physical examination are needed. A referral to a Sleep Specialist may be 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 evaluation by a sleep study is necessary. 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.

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Response by:

Meena S Khan, MD Meena S Khan, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
Clinical Assistant Professor of Neurology
College of Medicine
The Ohio State University