FAQ’s about Excessive Daytime Sleepiness

WHY DO I FEEL SLEEPY ALL THE TIME AND WHAT SHOULD I DO ABOUT IT?

Excessive Daytime Sleepiness
A person can experience excessive daytime sleepiness (EDS) for many reasons. Sleepiness becomes problematic when individuals uncontrollably or unintentionally fall asleep in situations where they want (and often need) to stay awake.

The person who is experiencing EDS needs to recognize that this is a problem. Sometimes, it takes months or years for this to happen. Sleepy people often seek help only because their spouse or friend has insisted that they do so. It is often possible to mask sleepiness for long periods of time, or believe that sleepiness is not a problem. Individuals may not recognize the extent of their sleepiness because the problem develops insidiously over long periods of time. People can adjust to these slow changes and literally forget how it feels to be "normal." This can change abruptly when a person can no longer mask their sleepiness. Sleepy people often come to a physician only when they are desperate: they are about to lose their job, they have had near misses or actually experienced accidents due to falling asleep while driving or operating heavy equipment, or they can no longer keep up with their usual lifestyle activities.

Among the general population the most frequent reason for EDS is inadequate nighttime sleep (or in the case of shift workers, inadequate extended sleep). So, one of the first questions to ask is "Am I getting enough sleep?" Most adults need 7.5-8.5 hours of sleep per night to maintain optimal wakefulness during the day. Additionally, the same number of hours of sleep needs to be obtained each and every day. Contrary to popular opinion, one can't sleep less hours during the week (or the usual work/school days) and make up for the sleep loss on weekends (or non-work days). Studies have shown that a person's performance is affected the next day when as little as 2 hours of sleep have been lost for just one night.

A person who seems to be obtaining adequate sleep and is still having a problem with EDS, should bring this to the attention of their health care provider. Helpful information about preparing for a visit to discuss your sleepiness is offered by the National Sleep Foundation (to review this information, click here). A history and complete physical examination may be in order. Additional tests may be required, for example, a thyroid test to determine if this hormone is at adequate levels. If all the history, physical examination and usual tests are normal, people may be referred to a sleep center for further testing and a work up with a sleep specialist to determine the cause of EDS. Unfortunately, it may take some persistence before EDS is recognized as a problem by the primary health care provider. The 1993 National Institutes of Health National Commission on Sleep Disorders Research found that people are typically told to "get more sleep" by health care providers. This may help when the cause of EDS is inadequate sleep but if there are other reasons present, this advice is too simplistic. Presently, little information about the physiology of sleep or sleep disorders is presented in professional health care education so it is not surprising that the seriousness of this complaint may not be recognized.

When EDS persists, even though people are spending adequate time in bed and other health reasons have been ruled out, sleep center testing may be required. If a sleep disorder is present, people may not be obtaining adequate sleep quality even though they spend enough in bed every night. This is because the quality of sleep can be severely affected even when the time in bed (and apparently spent sleeping every night) seems adequate. For example, in some sleep disorders that cause excessive sleepiness during the day, the structure of sleep is severely affected because people spend very little time in deep sleep. Recording in a sleep center can determine if the structure of sleep is being disrupted and the probable cause of the EDS.

If it has been determined that sleep or nap studies are required, you may want to consult the information we provide in the FAQ section of our home page about sleep center testing. You can find a listing of Accredited Sleep Centers by clicking here