Problem Sleepiness: Get the Facts on Causes and Treatment

Problem sleepiness facts*

*Problem sleepiness facts medical author: Melissa Conrad Stöppler, MD

Problem sleepiness occurs when sleepiness during the day interferes with work or social functioning.
Symptoms of problem sleepiness may include difficulty concentrating, falling asleep while driving, or problems with emotional control.
There are a number of causes of problem sleepiness, including sleep disorders; other medical conditions; certain medications; substances like drugs, alcohol, or caffeine; or an altered sleep-wake cycle.
Sleep disorders include narcolepsy, insomnia, sleep apnea, and restless legs syndrome.
Sleepiness is a major cause of motor vehicle accidents, poor school performance, and depressed mood.
Shift workers are especially susceptible to sleepiness and its risks.
Treatment may consist of improving sleep hygiene and avoiding precipitating factors.

What is problem sleepiness?

Everyone feels sleepy at times. However, when sleepiness interferes with
daily routines and activities, or reduces the ability to function, it is called
“problem sleepiness.” A person can be sleepy without realizing it. For example,
a person may not feel sleepy during activities such as talking and listening to
music at a party, but the same person can fall asleep while driving home
afterward.

What are the symptoms of problem sleepiness?

You may have problem sleepiness if you:

consistently do not get enough sleep, or get poor
quality sleep;

fall asleep while driving;

struggle to stay awake when inactive, such as when
watching television or reading;

have difficulty paying attention or concentrating at
work, school, or home;

have performance problems at work or school;

are often told by others that you are sleepy;

have difficulty remembering;

have slowed responses;

have difficulty controlling your emotions; or

must take naps on most days.

How to Stay Awake Naturally

By Camille Peri
WebMD Feature

Reviewed by Brunilda Nazario, MD

With more and more of us getting less and less sleep, it’s tempting to reach
for a Red Bull or an espresso when we feel sleepy at work. But consuming
caffeine to combat sleepiness can lead to a vicious cycle.

The java jolt that helps you stay awake can take up to eight hours to wear
off. Caffeine can also reduce your sleep time, alter the normal stages of sleep,
and decrease the quality of your sleep.

How can you stay awake naturally? Try some of these 12 jitter-free tips to
take the edge off sleepiness.

1. Get Up and Move Around to Feel Awake

In one well-known study, Robert Thayer, PhD, a professor at California State
University, Long Beach, studied whether people were more energized by eating a
candy bar or taking a brisk 10-minute walk. Though the candy bar provided a
quick energy boost, participants were actually more tired and had less energy an
hour later. The 10-minute walk increased energy for two hours. That’s because
walking pumps oxygen through your veins, brain, and muscles.

If you work at a desk, get up frequently for short walks. At meal breaks,
walk to a restaurant or, if you bring your lunch, head for a nice spot to eat
it. Whether you take a walk outside or just in the building where you work, it
will make you feel more alert and refreshed….

What causes problem sleepiness?

Sleepiness can be due to the body’s natural daily sleep-wake cycles,
inadequate sleep, sleep disorders, or certain drugs.

Sleep-wake cycle

Each day there are two periods when the body experiences a natural tendency
toward sleepiness; during the late night hours (generally between midnight and 7
a.m.) and again during the midafternoon (generally between 1 p.m. and 4 p.m.).
If people are awake during these times, they have a higher risk of falling
asleep unintentionally, especially if they haven’t been getting enough sleep.

Inadequate sleep

The amount of sleep needed each night varies among people. Each person needs
a particular amount of sleep in order to be fully alert throughout the day.
Research has shown that when healthy adults are allowed to sleep unrestricted,
the average time slept is 8 to 8.5 hours. Some people need more than that to
avoid problem sleepiness; others need less.

If a person does not get enough sleep, even on one night, a “sleep debt”
begins to build and increases until enough sleep is obtained. Problem sleepiness
occurs as the debt accumulates. Many people do not get enough sleep during the
work week and then sleep longer on the weekends or days off to reduce their
sleep debt. If too much sleep has been lost, sleeping in on the weekend may not
completely reverse the effects of not getting enough sleep during the week.

Sleep disorders

Sleep disorders such as sleep apnea, narcolepsy,
restless legs syndrome, and insomnia can cause problem sleepiness.
Sleep apnea is a serious disorder in which a person’s
breathing is interrupted during sleep, causing the
individual to awaken many times during the night and experience problem
sleepiness during the day. People with
narcolepsy have excessive
sleepiness during the day, even after sleeping enough at night. They may fall
asleep at inappropriate times and places.
Restless legs syndrome (RLS)
causes a person to experience unpleasant sensations in the legs, often described
as creeping, crawling, pulling, or painful. These sensations frequently occur in
the evening, making it difficult for people with RLS to fall asleep, leading to
problem sleepiness during the day.
Insomnia is the perception of
poor-quality sleep due to difficulty falling asleep, waking up during the night
with difficulty returning to sleep, waking up too early in the morning, or
unrefreshing sleep. Any of these sleep disorders can cause problem sleepiness.

Medical conditions/drugs

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Certain medical conditions and drugs, including
prescription medications, can
also disrupt sleep and cause problem sleepiness. Examples include:

Chronic illnesses such as asthma,
congestive heart
failure, rheumatoid arthritis, or any other chronically painful disorder;

Some medications to treat high blood pressure, some
heart medications, and asthma medications such as theophylline;

Alcohol-Although some people use alcohol to help
themselves fall asleep, it causes sleep disruption during the night, which can
lead to problem sleepiness during the day. Alcohol is also a sedating drug
that can, even in small amounts, make a sleepy person much more sleepy and at
greater risk for car crashes and performance problems;

Caffeine-Whether consumed in coffee, tea, soft drinks, or
medications, caffeine makes it
harder for many people to fall asleep and stay asleep. Caffeine stays in the
body for about 3 to 7 hours, so even when taken earlier in the day it can
cause problems with sleep at night; and

Nicotine from
cigarettes or a skin patch is a stimulant and makes it
harder to fall asleep and stay asleep.

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Problem sleepiness and adolescents

Many U.S. high school and college students have signs of problem sleepiness,
such as:

difficulty getting up for school;

falling asleep at school; and/or

struggling to stay awake while doing homework.

The need for sleep may be 9 hours or more per night as a person goes through
adolescence. At the same time, many teens begin to show a preference for a later
bed time, which may be due to a biological change. Teens tend to stay up later
but have to get up early for school, resulting in their getting much less sleep
than they need.

Many factors contribute to problem sleepiness in teens and young adults, but
the main causes are not getting enough sleep and irregular sleep schedules. Some
of the factors that influence adolescent sleep include:

social activities with peers that lead to later
bedtimes;

homework to be done in the evenings;

early wake-up times do to early school start times;

parents being less involved in setting and enforcing
bedtimes; and

employment, sports, or other extracurricular activities that decrease
the time available for sleep.

Teens and young adults who do not get enough sleep are at risk for problems
such as:

automobile crashes;

poor performance in school and poor grades;

depressed moods; and

problems with peer and adult relationships.

Many adolescents have part-time jobs in addition to their classes and other
activities. High school students who work more than 20 hours per week have more
problem sleepiness and may use more caffeine, nicotine, and alcohol than those
who work less than 20 hours per week or not at all.

QUESTION

Why do we sleep?
See Answer

Shift work and problem sleepiness

About 20 million Americans (20 to 25 percent of workers) perform shift work.
Most shift workers get less sleep over 24 hours than day workers. Sleep loss is
greatest for night shift workers, those who work early morning shifts, and
female shift workers with children at home. About 60 to 70 percent of shift
workers have difficulty sleeping and/or problem sleepiness.

The human sleep-wake system is designed to prepare the body and mind for
sleep at night and wakefulness during the day. These natural rhythms make it
difficult to sleep during daylight hours and to stay awake during the night
hours, even in people who are well rested. It is possible that the human body
never completely adjusts to nighttime activity and daytime sleep, even in those
who work permanent night shifts.

In addition to the sleep-wake system, environmental
factors can influence sleepiness in shift workers. Because our society is
strongly day-oriented, shift workers who try to sleep during the day are often
interrupted by noise, light, telephones, family members, and other distractions.
In contrast, the nighttime
sleep of day workers is largely protected by social customs that keep noises and
interruptions to a minimum.

Problem sleepiness in shift workers may result in:

increased risk for automobile crashes, especially
while driving home after a night shift;

decreased quality of life;

decreased productivity (night work performance may be
slower and less accurate than day performance); and/or

increased risk of accidents and injuries at work.

What treatments and remedies can help problem
sleepiness?

Sleep-There is no substitute!

Many people simply do not allow enough time for sleep on a regular basis. A
first step may be to evaluate daily activities and sleep-wake patterns to
determine how much sleep is obtained. If you are consistently getting less than
8 hours of sleep per night, more sleep may be needed. A good approach is to
gradually move to an earlier bedtime. For example, if an extra hour of sleep in
needed, try going to bed 15 minutes earlier each night for four nights and then
keep the last bedtime. This method will increase the amount of time in bed
without causing a sudden change in schedule. However, if work or family
schedules do not permit the earlier bedtime, a 30 to 60 minute daily nap may
help.

Medications/drugs

In general, medications do not help problem sleepiness, and some make it
worse. Caffeine can reduce sleepiness and increase alertness, but only
temporarily. It can also cause problem sleepiness to become worse by
interrupting sleep.

While alcohol may shorten the time it takes to fall asleep, it can disrupt
sleep later in the night, and therefore add to the problem sleepiness.

Medications may be prescribed for patients in certain
situations. For example, the short-term use of sleeping pills has been shown to
be helpful in patients diagnosed with acute insomnia. Long-term use of sleep
medication is
recommended only for the treatment of specific sleep disorders.

If you’re sleepy—don’t drive!

A person who is sleepy and drives is at high risk for an automobile crash.
Planning ahead may help reduce that risk. For example, the following tips may
help when planning a long distance car trip:

Get a good night’s sleep before leaving

Avoid driving between midnight and 7 a.m.

Change drivers often to allow for rest periods

Schedule frequent breaks

If you are a shift worker, the following may help:

decreasing the amount of night work;

increasing the total amount of sleep by adding naps
and lengthening the amount of time allotted for sleep;

increasing the intensity of light at work;

having a predictable schedule of night shifts;

eliminating sound and light in the bedroom during
daytime sleep;

using caffeine (only during the first part of the
shift) to promote alertness at night; or

possibly using prescription sleeping pills to help daytime sleep on
occasional basis (check with your doctor).

If you think you are getting enough sleep, but still feel sleepy during the
day, check with your doctor to be sure your sleepiness is not due to a sleep
disorder.

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