Causes of Excessive Daytime Sleepiness and Steps to Prevent It

We all get sleepy sometimes, but excessive sleepiness occurs when it disrupts our daily routines and activities or diminishes our ability to function at an optimal level. It’s a condition that affects many individuals and is related to abnormal sleep quality or quantity. Some people fall asleep repeatedly throughout the day and this is called excessive daytime sleepiness (EDS). This is not you simply feeling tired constantly. Instead, you may have regular naps during the day, fall asleep during the day, and later sleep for long periods throughout the night. When this happens, something is not quite right. Read on to learn more about this condition, and what you can do to remedy daytime sleepiness.

What Is Excessive Daytime Sleepiness?

Excessive daytime sleepiness is a condition that can be described as a person being unable to remain awake or alert, or an increase in their desire to sleep during the major awake period of the day. This may lead to the person falling asleep at “inappropriate” times.

Symptoms of Excessive Sleepiness

Some of the symptoms of EDS include:

• Struggling to focus or concentrate at work, school, or home
• Poor performance at school or workplace
• Finding it challenging to remain awake during periods of inactivity, like when watching TV or reading
• Finding it tough to remember things
• Feeling a need to take naps on most days
• Falling asleep while driving
• Sleepiness that others notice
• Risk-taking behaviors
• Difficulty making decisions
• Slower reaction time
• Trouble staying alert

Causes of Excessive Daytime Sleepiness

According to a clinical review in Mayo Clinic Proceedings, the causes of EDS are diverse, “and include inadequate sleep, sleep-disordered breathing, circadian rhythm sleep-wake disorders, and central disorders of hypersomnolence, such as narcolepsy. Furthermore, EDS could also be a symptom of an underlying medical or psychiatric disorder.

In more detail, these causes can include:

Inadequate Sleep

Different people need different quantities of sleep to feel rested. In general, most people need seven to eight hours of uninterrupted sleep to be able to remain alert the next day. If you are in the habit of sleeping less than four to five hours a day in general, that quantity of sleep is usually insufficient to maintain normal daytime alertness. As a result, excessive daytime sleepiness is more likely to occur. A lack of adequate sleep in a single night contributes to "sleep debt", which will increase until you get sufficient sleep. As sleep debt builds, EDS occurs.

Sleep-Wake Cycle Disturbances (such as Shift Work)

Your body’s circadian rhythm, which is the 24-hour internal clock, impacts your sleep-wake cycle. Shift work can throw off your circadian rhythm. In comparison to workers on the day shift, most night shift workers get less sleep over 24 hours. According to an article published in the Journal of Biological Rhythms, disruption of the circadian system resulting from night-shift work causes a misalignment between the circadian system and the external light-dark cycle and an imbalance between different levels of the circadian system.

The circadian rhythm functions with the release of cortisol which promotes wakefulness during the day and melatonin which promotes sleepiness at nighttime. These natural rhythms make it challenging to sleep during daylight hours and to stay awake during the night hours, even in well-rested people. Furthermore, night shift workers who try to sleep during the day experience frequent disruptions by noise, light, the telephone, etc.

Sleep Disorders

Excessive daytime sleepiness may be the result of sleep disorders. These may include obstructive sleep apnoea, narcolepsy, restless legs syndrome, and insomnia.

• Obstructive sleep apnoea occurs when your breathing is disrupted during sleep. Consequently, it can cause you to wake several times during the night and lead to poor quality sleep and excessive daytime sleepiness.
• Narcolepsy is a sleep condition that causes excessive sleepiness during the day, even though you get sufficient nighttime sleep. You could fall asleep at inappropriate places and times because of it.
• Restless legs syndrome is characterized by unpleasant sensations in the legs. These sensations frequently occur at night, making it harder to sleep or waking you, resulting in excessive daytime sleepiness.
• Insomnia typically refers to poor quality sleep that stems from difficulty falling asleep, waking up in the night and having difficulty falling back asleep, or waking up too early in the morning.

Alcohol

Alcohol is a sedating substance and it affects people differently. It can, even in small quantities, make some individuals more prone to sleepiness and increase their risk of performance problems, whether driving or working. For many people, it can also reduce sleep quality.

Medications

It’s possible that some medications may interfere with your sleep and lead to sleepiness. Some examples of such medications include antidepressants, sedating antihistamines, sedatives, and seizure medications.

Caffeine

Caffeine consumption, whether in coffee, tea, energy drinks, sodas, or medications, can make it more difficult not only to fall asleep but also to stay asleep. While caffeine can be a temporary fix that reduces sleepiness and increases alertness when you need it, it can worsen sleepiness and cause sleep interruptions. Caffeine remains in your body for roughly three to seven hours after ingestion. As such, even if you have caffeine earlier in the day, it may prevent you from falling asleep during the night.

Nicotine

The substance nicotine is a stimulant. As such, smoking cigarettes can make it harder to fall asleep and remain asleep.

Medical Conditions

Some chronic medical conditions could also interfere with your sleep and lead to excessive daytime sleepiness. Such conditions may include asthma, depression, heart failure, rheumatoid arthritis, or any other chronically painful disorder. You may also find that head injuries may also cause EDS.

Consequences of  Excessive Daytime Sleepiness

Constant sleepiness throughout the day can significantly impact your overall health and daily life. Some of the consequences can include:

• An increased risk of car and work accidents
• A decrease in work productivity or academic performance
• Diminished your quality of life
• Difficulty controlling your mood and emotions
• Social and relationship issues
• Developmental issues in children
• Older adults may increase their risk for falls
• May increase the risk of cognitive impairment, memory loss, and earlier mortality

Afternoon Sleepiness and Adrenal Fatigue

Adrenal Fatigue Syndrome (AFS) is the non-Addison's form of adrenal dysfunction, where the body's stress response cannot keep up with life's chronic stressors. Some AFS sufferers experience spikes in cortisol in the late afternoon and evening, which often leads to insomnia. With later stages of AFS, your Neuroaffect circuit of the NeuroEndoMetabolic (NEM) Stress Response, which comprises your brain, autonomic nervous system, and microbiome, can become dysregulated. By over-working to regulate stress, inflammation of the GI tract, an overload of the neurotransmitter norepinephrine, and over-activation of the autonomic nervous system can occur.

As a result, many symptoms can arise, including sleep maintenance insomnia and sleep onset insomnia, that can affect your day-to-day life. Imbalances in the autonomic nervous system tend to cause sleep onset insomnia in AFS patients. When this happens, the body is filled with the stress hormones from the day and cannot calm down enough to fall asleep.

Still, it’s important to note that sleep onset insomnia can have other causes as well, including:

• Metabolism dysregulation, like low glucose levels
• Hormonal imbalances, such as excessive estrogen
• Neurotransmitter imbalances, like a lack of GABA or serotonin
• Other adrenal problems, like cortisol dysregulation
• Taking medication like Adderal
• Taking glandular supplements and herbs, like Rhodiola, Maca, and ashwagandha
• Excessive intake of some vitamins
• Excessive intake of minerals, like copper, zinc, selenium
• Excessive systemic inflammation

Sleep maintenance insomnia (SMI) happens when you fall asleep but wake up regularly in the night, or you wake up too early in the morning to begin your day but can’t go back to sleep.

Persistent fatigue becomes dangerous when you experience sleep disruptions. Your overworked adrenals cause a lack of energy. With stress flooding the body with both norepinephrine and epinephrine, getting good sleep becomes difficult. An imbalance in neurotransmitters can affect the regulation of circadian rhythms. Restoring balance to your Neuroaffect circuit by addressing your AFS through recovery efforts can help alleviate excessive daytime sleepiness.

Identifying Excessive Daytime Sleepiness

Consult your physician if you feel sleepy during the day despite getting enough sleep. Also, see your doctor if you are experiencing excessive daytime sleepiness and are tired all the time, it’s affecting your daily life, or if you suspect it might be a sign of an underlying health issue.

Your physician will likely evaluate the possible causes and advise on the appropriate management options to tackle your condition. Also, it is important to identify the cause of your excessive daytime sleepiness to be able to alleviate your symptoms.

Furthermore, questionnaires such as the Stanford Sleepiness Scale and the Epworth Sleepiness Scale are two screening tests that a healthcare provider may use to assess daytime sleepiness in patients. A test score that is over 12 on the Epworth Sleepiness Scale, or if a patient has a history of falling asleep while driving, are strong indications that additional evaluation and patient work-up is needed. Sometimes a physician may present you with a referral to visit a sleep specialist or sleep disorder clinic for a comprehensive evaluation of the problem.

Management of Excessive Daytime Sleepiness

The cause of your excessive daytime sleepiness will determine the management approach that your healthcare provider will recommend. This may involve the following:

• Management may likely begin with your doctor recommending sleep hygiene tips and encouraging you to get more sleep or better quality sleep. This may involve strategic napping. To alleviate sleep onset insomnia, your doctor may recommend that you:
  • Avoid checking the time at night when you wake up, to avoid worsening your insomnia.
  • Let go of thoughts that keep you up and accept them.
  • Avoid drinking caffeine or alcohol later in the evening.
  • Establish bedtime rituals.
  • Participate in a soothing activity, like deep breathing, meditation, or yoga.
  • Sleep in an entirely dark room.
• Also, your medications might need to be adjusted, or your doctor may establish a therapy plan for any underlying condition that you may have. Underlying sleep disorders like sleep apnea could be managed with continuous positive airway pressure, or narcolepsy might be managed with stimulant medications, like slow-release methylphenidate.
• Other simple measures may include avoiding alcohol, especially in excess, and caffeine after mid-afternoon to minimize sleep disruption. Standing when possible could improve alertness. Furthermore, stay away from unnecessary medications that are sedating and avoid changing the timing of their administration.
• Supplements may also be beneficial in helping you tackle excessive daytime sleepiness. FermPlex A by Dr. Lam® is a unique blend of premium herbs, including ashwagandha, ginseng, holy basil, and peppermint infused with a bio-synergistic micro-organism foundational base. This supplement provides a probiotic and prebiotic effect and enhances the bioavailability of essential phytocompounds. It’s a synergy of bioavailable nutrients, beneficial yeasts, bacteria, and enzymes that can help to alleviate some of the symptoms of excessive daytime sleepiness.

The Takeaway

Excessive daytime sleepiness can have many causes, and it is important to manage those causes to prevent further problems and improve your quality of sleep. Some of these causes can include sleep apnea, insomnia, restless leg syndrome, late-stage AFS, and substances like caffeine, alcohol, and nicotine. See a doctor to help identify the cause of your sleepiness and develop a plan to manage it.

In the meantime, you can improve your sleeping habits by:

• Keeping your room cool and dark.
• Going to sleep at the same time.
• Establishing a relaxing bedtime ritual.
• Have a light snack before bed, like nuts to alleviate metabolism or hypoglycemia-related problems.

By identifying the problem and making good sleep a priority, you can help get your sleep issues under control.