Causes of Excessive Sleepiness: Sleep Apnea, Narcolepsy

by Vikas Mittal Best Pulmonologist in West Delhi

What is daytime sleepiness?—Daytime sleepiness is feeling sleepy during the day, when most people are awake and alert. It can also present as day time tiredness, foggy feeling and easy fatigability, irritability, increased anger and short term memory lapses. In Children poor sleep and sleep deprivation does not exactly manifest as daytime sleepiness rather they might have trouble paying attention in school, be more active than usual, act angry or emotional.

What causes daytime sleepiness?

1. Poor sleep habits – For example, inadequate sleep at night or irregular sleep schedule.

2. A sleep disorder, e.g.:

1. •Obstructive Sleep apnoea, OSA – Stoppage of breathing for short periods due to obstruction of airway during sleep.

2. •Narcolepsy – Rare disorder where patient sometimes fall asleep/falls due to sleep suddenly during normal activities.

3. •Insomnia – Inadequate sleep quantity or quality due to trouble falling or staying asleep.

3. Things that disturb your sleep like sounds or lights in environment (crying of baby, TV), medical conditions (restless legs syndrome, any other body pain), shift work or jet lag or side effects of certain medicines

When should I see a doctor?—You should see board certified sleep specialist or a Pulmonologist /neurology doctor trained in Sleep Medicine if your day time sleepiness is getting frequent and persisting for more than 1 month a the daytime and its has started affecting your quality of life or if you fall asleep in the middle of normal activities or in a dangerous situation, such as while driving.

What are the tests done by sleep specialists?—Depending upon your history of your sleep problem the Sleep Specialist will decide if you need tests or not. The most common investigation required is a "sleep study"mainly done to confirm and objectify obstructive sleep apnoea. This test can be done at your home or require you to be admitted overnight in hospital in sleep laboratory. During the sleep study you are hooked up to a machine that monitor your oxygen levels, heart rate, breathing, and other body functions.

Asleep diary containing a log of your sleep time, duration for 2 weeks is also required to be kept if you complains of insomnia to keep a track of how you sleep each night.

What is the treatment options?—A sleep specialist treats daytime sleepiness depends on the cause:

●For poor sleep habits we need to do lifestyle changes and follow a sleep hygiene (see below)

●For obstructive sleep apnoea, OSA, positive airway pressure (PAP) devices are given which you wear at night. Best is to do it under supervision of a pulmonologist who is either having a certification/degree/fellowship in sleep medicine or trained in sleep Medicine from either Indian Academy of Sleep Medicine (ISDA) or Indian Society for Sleep Research (ISSR).

●Some medicines can help you stay awake in the daytime or sleep better at night.

● For OSA, most people don't need surgery except a few people like children with enlarged tonsils.

Can daytime sleepiness be prevented?—Following a sleep hygiene practices (see below) many of problems can be controlled. Also once OSA is diagnosed then being compliant with your PAP machine usage is important to prevent the development of complications.

What can I do on my own to feel better?—You can try having good sleep habits. This means that you:

1. Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.

2. Set a bedtime that is early enough for you to get at least seven to eight hours of sleep.

3. Use your bedroom only for sleep and intimacy.

4. Avoid caffeine within four to six hours of bedtime

5. Avoid the use of nicotine close to bedtime or during the night.

6. Do not drink alcoholic beverages within four to six hours of bedtime.

7. Reduce your fluid intake before bedtime.

8. Avoid strenuous exercise within six hours of bedtime.

9. Avoid large meals just before sleep, however if hungry, a light snack like milk/eggs etc before bedtime can help promote sound sleep.

10. Establish relaxing bedtime rituals (hot water bath, light massage etc)

11. Limit exposure to light, TV, laptop, mobile in the evenings.

12. Make your bedroom quiet by minimizing noise, avoiding loud music.

13. Keep the room at a comfortable temperature avoiding extremes in temperature.

14. Don’t go to bed unless you are sleepy.

15. If you are unable to fall asleep after 20 minutes or stay asleep for 20 minutes, leave your bedroom and engage in a quiet activity elsewhere. Do not permit yourself to fall asleep outside the bedroom. Return to bed when - and only when - you are sleepy. Repeat this process as often as necessary throughout the night.

16. Distract your mind. Lying in bed unable to sleep and frustrated needs to be avoided. Try reading or listening to light meditative music (YOG-NIDRA) or e-books. It may be necessary to go into another room to do these.

17. Have good sunlight exposure early in morning and exercise regularly (30 minutes brisk walk/Jog in early morning sunlight and maintain a healthy diet.

18. Avoid napping during the daytime. If daytime sleepiness becomes overwhelming, limit nap time to a single nap of less than one hour, no later than 3 p.m.