Do I Have Excessive Sleepiness?

Living with the symptoms of a sleep disorder can leave you feeling Beyond Tired®. Learn more from the NSF here.

 

Feeling overly drowsy during the day can come from poor sleep habits—or it could signal a sleep disorder. Learn more about the symptoms and solutions for excessive sleepiness.

 

Almost everyone has felt sleepy during the day at one time or another, especially when the previous night’s sleep has been interrupted or cut short. But approximately 20 percent of people experience what is known as excessive sleepiness (also called excessive daytime sleepiness, hypersomnolence or hypersomnia), a recurring feeling of significant drowsiness even when someone gets what should be enough sleep. 

 

Excessive sleepiness is the leading reason that people visit sleep clinics. People with excessive sleepiness tend to have poorer health than others and are at a higher risk of automobile crashes or workplace impairment issues. Understanding the causes and risk factors for excessive sleepiness, as well as the best way to treat it, can help you overcome this challenging situation.

 

What Is Excessive Sleepiness?

Excessive sleepiness is often diagnosed in association with other sleep disorders such as obstructive sleep apnea (OSA), narcolepsy, and even shift work sleep disorder. It is marked by feeling sleepy, drowsy, or groggy during the daytime. If you have excessive sleepiness, you may find it hard to stay alert at work or you may start drifting off at inappropriate times, even when you don’t mean to. You may also feel irritable or anxious.  

Excessive sleepiness is not just feeling tired. It’s not the same as fatigue, which is characterized by a lack of energy and a need to rest (but not specifically to sleep). It’s also different from depression, in which you may lose interest in normal activities that you used to enjoy.

Causes and Risk Factors

Presence of an undiagnosed medical condition, like depression, or a sleep disorder – such as OSA, restless legs syndrome (RLS), and narcolepsy – may put you at risk for excessive sleepiness, as they typically increase the likelihood that you may experience extreme daytime drowsiness. For these sleep disorders, it’s possible that excessive sleepiness may be the only symptom you are aware of, so it’s worth talking to your healthcare provider about what you are experiencing since it could be an indication of a bigger health problem.

Poor sleep habits are one of the common causes of excessive sleepiness. That could mean keeping an irregular sleep schedule, not getting enough hours of sleep, or experiencing disrupted sleep where you wake multiple times throughout the night. In addition, adolescents, older people, and shift workers are more likely to experience excessive sleepiness on a regular basis.

Certain medications may also pose a risk to developing excessive sleepiness. These drugs include:

• Antidepressants
• Antihistamines
• Antipsychotics
• Epilepsy drugs
• High blood pressure medication
• Muscle relaxants
• Opioids
• Alcohol

 

What are the Symptoms? 

Given that excessive sleepiness is itself a symptom, it’s not surprising that its primary characteristic is severe drowsiness. But what does that actually look like? If you’re experiencing excessive sleepiness, you may feel a deep tiredness that you cannot shake during the day—even to the point at which it interferes with your job, compromises schooling, and makes everyday activities harder. Excessive sleepiness may affect your relationships. In some cases, a person who suffers from excessive sleepiness may start falling asleep in potentially dangerous situations, such as while driving or operating machinery. Many individuals have workplace performance impairment as well as difficulty with motivation, memory and attention.

 

How Excessive Sleepiness Is Diagnosed

If you’re concerned that you may be experiencing excessive sleepiness, you may want to consider making an appointment with your healthcare provider or a sleep specialist. In order to figure out whether you have excessive sleepiness, a medical professional may ask you questions, such as:

 

• How long have you been experiencing daytime sleepiness?
• How long do you typically sleep on weekdays and weekends?
• How often do you tend to wake up during the night?
• Have there been any changes in your job that might be influencing your sleep?
• Are there any changes in your personal life, such as a new baby in your household? 

 

Your healthcare provider will also want to determine whether the root cause of your condition is medical, like OSA, or behavioral, such as not getting enough sleep. He or she may conduct a physical examination and possibly order lab tests to check for underlying conditions. 

 

To help establish the roots of your excessive sleepiness, your physician may also suggest that you get a polysomnogram (PSG). Also known as a sleep study, this test measures things like your brain waves, eye and leg movements, heart rate, breathing, and blood oxygen levels while you sleep. It’s usually administered at a hospital or sleep center and typically requires an overnight stay. A PSG can help determine whether you have any underlying sleep disorders that might be causing your excessive sleepiness. If the primary concern is whether or not you have sleep apnea, a home sleep study might be recommended.

 

Treatments 

The best treatment for your excessive sleepiness will depend on what exactly is causing it, so recommendations from healthcare providers can vary. If your sleep is being affected by something that’s considered behavioral, such as not having a regular sleep schedule, your healthcare provider may recommend lifestyle changes to help you get on the right track. 

 

But if your problem is the result of an underlying sleep disorder—such as OSA or RLS—your healthcare provider will likely focus on addressing that issue first in order to correct your excessive sleepiness. For example, the use of a continuous positive airway pressure (CPAP) device can help improve excessive sleepiness if you have sleep apnea, and a combination of medications and lifestyle changes may be able to control RLS, narcolepsy, and depression. Treating these sleep disorders may result in better, more satisfying sleep at night, and in turn, feeling more alert during the day. 

 

There are also prescription drugs, including:

• Modafinil and armodafinil: These stimulants can help you stay awake if other treatments aren’t effective in improving symptoms of excessive sleepiness. They change the action of various chemicals in the brain, altering neurotransmitters, like dopamine, to induce an alert state. 
• Amphetamines and methylphenidate: Similarly, both of these drugs are stimulants that may be used in treating narcolepsy or excessive sleepiness. They work by increasing the availability of dopamine and norepinephrine in the brain.
• Pitolisant: This medication acts on histamine wake promoting neurons in the brain to help you stay awake. Pitolisant is indicated for narcolepsy.
• Sodium oxybate:  This is a central nervous system depressant.
• Solriamfetol: This is a dopamine/norepinephrine reuptake inhibitor (DNRI). It is indicated for narcolepsy and OSA residual sleepiness.

Whatever the cause of your excessive sleepiness, the important thing to know is that there are treatment options. It may take a little trial and error, but by working with your healthcare provider you will be able to find a solution that’s right for you.