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Sleep Disorders

How Can I Lessen My Sleep?

01/16/2009

Question:

I am preparing for competitive examination and so I need to study quite a lot, but the problem with me is that I feel sleepy all the time. I have to sleep for 8 to 9 hours a day, and still feel sleepy and less attentive the whole day. What is wrong? I am an 18 year old girl and I don`t suffer from any disease except sinus problem. I don`t take any medication and I don`t have disruptive sleep or any other sleep disorder. At night I sleep at about 3 am till 11 am.

Answer:

Thank you for visiting NetWellness. Based on the limited information in your question, it is very difficult to gauge why you are so sleepy. Excessive daytime sleepiness (EDS) has many causes and there are a number of possibilities to consider. These can be broadly categorized into primary sleep disorders and problems that can affect your sleep that are not sleep disorders per se. One would ideally need a full interview and examination to determine the exact reason for your problem.

There are many causes of sleepiness in your age group. The list includes, but is not limited to, general medical problems, chronic pain, family issues, psychiatric diseases (depression & anxiety), sleep apnea (snoring, airway closure during sleep, absence of breathing during sleep), restless legs, insufficient sleep time, sleep cycle abnormalities, poor sleep habits, narcolepsy (sleep attacks) and a variety of other sleep disorders, some of them being inherited.

The most common cause of EDS is insufficient total sleep time or a lack of adequate sleep. Not sleeping enough hours (a condition called sleep restriction) is can lead to excessive sleepiness during the day and is easily fixed by increasing your sleep time. From your question, it appears that you may be getting enough sleep, though keep in mind that some individuals, especially those in your age group may need more than 8 hours per night to feel adequately rested (many often require 9-10 hours per night).

Some of the sleep disorders commonly associated with daytime sleepiness include obstructive sleep apnea (OSA), narcolepsy, 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 may 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 onset or when awakening or experience episodes of inability to move when trying to awaken. The evaluation for narcolepsy typically also requires a sleep study as well as a daytime nap test.

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 like you, and have a hard time falling asleep before midnight and waking up in the morning. This may lead to insufficient or inadequate sleep.

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 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.

As you can see, there are a number of possible explanations for your symptoms and it would best to undergo a thorough evaluation to determine how best to proceed. There is insufficient information from your question to make an accurate diagnosis and provide you with the correct management plan. You should probably discuss this problem with your primary care physician first and then seek the opinion of a Sleep Specialist if needed.

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Response by:

Steven  Kadiev, MBBCh Steven Kadiev, MBBCh
Formerly:
Assistant Professor
College of Medicine
The Ohio State University