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Sleep Disorders

Always Sleepy and Tired

06/08/2010

Question:

My husband is having a problem lately with feeling sleepy and tired all the time, even though he sleeps 6 hours in every working day, and 8 to 9 hours on weekends. Also he has a problem with waking up for work on time. I tried everything with him, and he is really frasturated because he can`t even control it! For the record, he has blood pressure, but not too high. It goes up when he gets headches, sinus, etc. He`s 27 years old, 190cm, 115kgs, no diabetes, but he suffers from chronic sinusitis. Could that be the main reason?  

Answer:

Your husband suffers from excessive daytime sleepiness, also known as hypersomnolence. There are many possible causes for hypersomnia, though probably the most common reason in Western societies is chronic short sleep duration, or lack of adequate sleep on a regular basis. While there is some variation in the sleep requirements needed for each individual, most people need around 7-8 hours of sleep on a regular basis to feel rested. A lack of adequate sleep on a regular basis is often attributable to a combination of family and job demands as well as television and other recreational engagements. Subsequently, many individuals end up going to bed late, while simultaneously being required to awaken early to attend to their jobs and other responsibilities.

Individuals with chronic short sleep often try unsuccessfully to “make up” or pay their “sleep debt” on the weekends. This is never feasible or possible, and the affected individual suffers from excessive sleepiness. Consequences of sleepiness include significant negative effects on social and mental functioning, along with increased vehicular accident risk. Aside from functional impairment associated with sleepiness, short sleep duration has been associated with serious medical consequences. It has been recently reported that short sleep duration is associated with an inflammatory response, impaired immune system, and possibly increased risk of heart disease.

In the presence of reasonable sleep duration (7-8 hours per night), any degree of sleepiness is not normal. Several disorders that are not primary sleep disorders can cause excessive daytime sleepiness in the presence of normal sleep duration. Commonly, depression is a disorder that can make patients experience varying degrees of fatigue and sleepiness. In some cases, chronic medical illnesses such as heart failure or inflammatory disorders result in significant degrees of fatigue and sleepiness. Hormonal imbalance such as hypothyroidism (low levels of the thyroid hormone) can causes daytime fatigue and sleepiness as well. Sedating medications, such as antihistamines, sleeping pills, some antidepression medications and some antiseizure medications can also make individuals sleepy during the daytime.

Sleepiness in the absence of reduced sleep duration or other clear non sleep-related psychiatric or medical disease suggests that a primary disorder of sleep is highly likely. These sleep disorders include most commonly, sleep apnea, narcolepsy, and idiopathic hypersomnolence. Sleep apnea is a common disorder characterized by episodes of airway obstruction during sleep resulting in sleep disruption. Patients typically do not remember these episodes and provide very few symptoms other than daytime sleepiness and snoring, the latter reported by the bed partner. Narcolepsy is a disorder characterized by severe sleepiness along with other features that may include episodes of loss of muscle tone and sleep attacks.

Your husband appears to have some features of a short sleep syndrome. He achieves only 6 hours of sleep on weeknights and attempts to expand his sleep on the weekend only to obtain just normal sleep duration. He is not getting enough sleep on a regular basis and this is undoubtedly contributing some to his daytime sleepiness.

Additionally, your husband appears significantly overweight, has morning headaches, and has high blood pressure (at a relatively young age), all which suggests he is likely at risk for obstructive sleep apnea. The diagnosis of this condition requires a full sleep history, examination and a sleep study.

I recommend you have your husband expand his sleep to at least 7 hours per night during the week, and preferably 8 hours. He should also discuss his symptoms with his primary doctor to determine if referral for a sleep study is needed. Based on the information in your question, this is probably a good idea.

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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