Tired All the Time? 8 Surprising Reasons Why

Skimping on sleep is one of the great scourges of our era, so it should come as no surprise that many of us feel tired regularly. But there are some people who feel excessively sleepy despite how many hours they carve out for shuteye. For these people, their fatigue is unmanageable and disruptive to their lives—and the cause is often a mystery. Doctors have a term for this condition: hypersomnia (also known as excessive daytime sleepiness). While the disorder can be debilitating, the good news is that there are ways to beat it. Shalini Manchanda, M.D., director of the IU Health Sleep Disorders Center, explains the possible causes and solutions.

Causes

There are a variety of issues that can lead to excessive daytime sleepiness or EDS. “Inadequate amounts of sleep is usually the answer,” says Dr. Manchanda, but it may not be obvious to people that they are lacking sleep. For many people, another health condition or circumstance may be causing them to lose sleep (or get poor quality sleep) without their realizing it. These underlying causes may include:

  • Sleep apnea—which occurs when a person’s airways are obstructed and breathing pauses temporarily and repeatedly throughout the night, resulting in poor sleep quality.
     
  • Narcolepsy—a neurological condition in which a person falls asleep anywhere and anytime without warning. These uncontrollable and sudden attacks of sleep typically disrupt sleep-wake cycles and nighttime sleep, which leads to excessive daytime sleepiness.
     
  • Chronic pain and other long-term health or psychological conditions that can interfere with nighttime sleep.
     
  • Insomnia—which leaves people sleep deprived.
     
  • Diabetes—which causes fluctuations in blood sugar that can interrupt sleep.
     
  • Shift work (long hours or night shifts)—which disrupts people’s body clock and leads to inadequate sleep.
     
  • Sleep movement disorders such as restless leg syndrome or those that cause people to hit, kick, or punch while sleeping.
     
  • Medications such as antihistamines and sleeping pills, which can throw off circadian rhythms.

Diagnosis

If you know you have a health condition that is affecting your sleep, your first order of business is to try to get that issue under control so that you can sleep easier. It may necessitate a visit to the doctor who treats you for that condition. If, however, you are unsure what is causing your EDS, ask your primary care physician for a referral to a sleep specialist. The specialist will want to hear about your symptoms and sleep history in detail. And don’t be shy. “People are always open about telling us that they snore, but they are often very embarrassed to tell us if they have a movement disorder that causes them to hit or be violent at night,” says Dr. Manchanda. “But we need to know about that because some of it can be dangerous.”

The sleep specialist will also most likely ask you to keep a sleep log for a week or two to get a more thorough sense of your sleep habits. Finally, you may need to stay overnight at a sleep center in order for the specialist to be able to fully analyze the situation and make an official diagnosis.

Treatments

If a clear cause is identified, take steps to address that underlying problem. In the case of sleep apnea, for instance, you may need to use a breathing apparatus at night and make lifestyle changes that can affect breathing during sleep (such as losing weight).

Dr. Manchanda also notes that, in general, it’s important for people with any sleep disorder to practice good sleep hygiene—which entails having a regular sleep and wake time, maintaining a consistent bedtime routine, and keeping your bedroom free of distractions and light at night.

Depending on the cause of your hypersomnia and symptoms, medications may be warranted. “We typically prescribe stimulant medications for people with excessive sleepiness to take during the morning hours,” says Dr. Manchanda. This helps them set their body clock so that they are better able to stay awake during the daytime and more likely to stay asleep during the nighttime. Unlike sleep-inducing medications that treat insomnia (which doctors recommend primarily for short-term use), stimulant medications may be needed indefinitely. “For these patients, the treatment may be lifelong,” adds Dr. Manchanda.

-- By Rachel Rabkin Peachman


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