It’s important to understand the potential causes of excessive daytime sleepiness (EDS), and why it shouldn’t be ignored. Some common sleep disorders can have serious effects on your health in the long term if they go untreated, and EDS can be an early warning symptom. Whether you suffer from EDS or not, good habits should be a priority when it comes to a full night of restful sleep.
Most of us can remember days when we may not have been as alert or wakeful as we wanted to be. There are a few examples of obvious circumstantial culprits for the occasional bout of excessive daytime sleepiness or EDS (also known as hypersomnia) being tired due to jet-lag after a lengthy flight, pulling an all-nighter to study for an important exam, or being kept awake by a noisy neighbor.
However, ongoing daytime sleepiness without any clear circumstantial cause is not only inconvenient and can impact productivity both professionally and personally, but can also indicate a potential underlying medical cause. EDS can affect anyone, regardless of age, race, or gender and should be investigated by a medical professional if it’s continuous despite improved, healthy sleep habits.
The average adult requires a minimum of seven hours of sleep per night in order to achieve optimal well-being during the day. Sleep can be categorized as good (restful) or bad (unrestful). Even if an individual achieves seven or more hours of sleep a night, if that sleep is disrupted—this may be due to a range of sleep disorders, from excessive snoring to night terrors—those hours of broken sleep will not result in restorative rest.
Although the National Sleep Foundation states that daytime naps can be beneficial as long as they’re kept short (no more than 30 minutes) and take place in the mid-afternoon when energy levels are most susceptible to dropping. Naps can also be detrimental to the quality of nighttime sleep and it’s not normal to consistently require lengthy naps during the day.
What Is Excessive Daytime Sleepiness and How Is It Different From Just Feeling Tired?
Approximately 20 percent of the population is afflicted with EDS. The symptoms of EDS are often self-diagnosed by individuals experiencing it as either depression (lack of desire to engage in activities or hobbies in general) or fatigue (lack of energy, feeling over-exerted and wanting frequent rest), both of which differ from EDS. It’s important to note that EDS itself is not defined as a disease, condition or disorder, rather it’s a symptom consisting of various sub-symptoms that may have one or more underlying causes.
EDS is defined as feeling drowsy, sluggish, or generally tired for an extended period of time; to the point that the affected individual may find themselves falling asleep in inappropriate places, such as at work or on public transit. Many affected individuals may gradually get used to their natural state of being constantly sleepy and choose to adapt rather than seek medical advice. This approach can be dangerous as a lack of restful sleep in the long term can seriously impact health and result in conditions from weight gain to cardiovascular diseases.
Unlike feeling tired due to a busy week or a few nights of disrupted sleep, EDS will persist even if the individual sleeps early at night and wakes up late during the day or takes several naps throughout the day to combat the sleepiness. A principal diagnosing facet of EDS, especially when it manifests itself severely, is that individuals may have a tendency to suddenly drop off to sleep even while consuming food or in the middle of speech.
Aside from being damaging to the individual’s health and overall quality of life over time EDS, if left untreated without the underlying cause being explored by a sleep specialist, can be hazardous to the world at large, as cognitive, psychological and behavioral functions eventually become impaired over time by a lack of sleep. Driving a vehicle of any sort while sleep deprived and potentially at risk of suddenly falling asleep could result in a severe or even fatal accident.
What Are the Most Common Causes of Excessive Daytime Sleepiness?
The most common, non-medical cause of EDS is poor sleeping habits due to personal lifestyle choices. The individuals in this scenario tend to be those who prioritize their careers or social lives as more important than getting the ideal seven-hour minimum of sleep per day, and catch up on sleep over the weekend or through occasional naps.
A lack of sleep is not something that can be simply repaid over time. So-called sleep debts accumulate over an extended period of inadequate sleep (poor sleep practices and deliberately minimizing sleeping hours), and manifest in EDS as well as all the associated negative physical, behavioral and cognitive effects of long-term sleep loss.
Chronic insomnia is a common sleep disorder that may be either psychiatric or medical in nature, and results in the inability to fall and stay asleep for long periods of time, with a tendency to awaken too early in the morning. Insomnia can have a variety of underlying causes, such as a mental illness (depression, anxiety, bipolar disorder, etc.) ongoing poor sleep practices, or circumstantial factors such as stress, a changing work schedule, or a new environment.
Broken or fragmented sleep due to sleep-related breathing disorders, or SRBD’s, is the most common physiological cause of EDS. SRBD’s are disorders that cause regular breathing to be interrupted or inhibited during sleep. Sleep apnea, which causes breathing to be obstructed or halted entirely during sleep, is the most typical of these disorders, and is categorized as either obstructive or central.
Obstructive sleep apnea results in choking or loud, aggressive snoring due to a blockage of the airways, as the lungs struggle to get enough air while the body is asleep, often waking up the affected individual in the process. These incidents of choking or extreme snoring may occur a few times or more than one hundred times during the night, depending on the severity.
Central sleep apnea is a result of an underlying medical issue in either the brain or the heart, in which irregular bursts of air are sent to the lungs which results in the body abruptly stopping breathing during sleep. Individuals who’ve suffered a stroke or are experiencing heart failure are most likely to be affected by this type of sleep apnea. Although the individual may simply resume sleeping after these breath-halting incidents, they’re just as likely to be woken up as the lungs struggle for air.
Individuals who sleep in a room with others tend to be more likely to get help for sleep apnea sooner than those who sleep alone, as the sudden choking and loud snoring that are characteristic of the disorder in its early stages can awaken sleeping partners.
However, certain symptoms in conjunction with EDS—such as awakening with a dry mouth, headache, or being abruptly woken up feeling short of breath during the night—are symptoms that can be self-diagnosed as potential markers of the disorder.
A severe manifestation of EDS is narcolepsy, a condition in which affected individuals fall asleep very suddenly and often without warning. The severity of the condition, which has been categorized simultaneously as a sleep disorder, neurological disease and an illness of the autoimmune system, ranges from mild (general EDS) to severe (falling asleep whenever overstimulated emotionally or physically, and potentially experiencing hallucinations and vivid dreams).
EDS may also be a side effect from taking certain prescription drugs, such as muscle relaxants, antipsychotics, and some antidepressants. Using stimulant-based narcotics such as cocaine or amphetamines may also be responsible for EDS, as these drugs forcibly keep the body awake for extended periods of time and are highly disruptive to sleep schedules.
Who Is Most at Risk from Excessive Daytime Sleepiness?
EDS can be caused by a variety of factors, as addressed earlier, ranging from personal choices, certain prescription medications, an undiagnosed sleep disorder or a serious medical condition. However, certain lifestyle practices, pre-existing conditions and injuries can increase the likelihood of being affected by a sleep disorder and, as a result, EDS.
Certain unhealthy lifestyle habits increase the chances of having a sleep disorder or a disease that disrupts sleep, such as smoking, high alcohol consumption, and use of narcotics. Inherent factors that increase the likelihood of a sleep disorder include race (African-Americans, Hispanics and Pacific Islanders are at greater risk than other races), congestion due allergies, a naturally thick neck, being male, a family history of sleep disorders (i.e. apnea) and slimmer than average airway passages in the throat, mouth, or nose.
Individuals suffering from diabetes, are overweight, are older (65+ years), and/or have suffered a mild injury to the brain are also at an increased risk for developing sleep disorders. Although women have a lesser risk than men overall, when a woman reaches the post-menopausal stage the risk of EDS and related sleep disorders and conditions increases.
Those who have an irregular sleep routine or have nightly habits of working (like going through documents or checking work emails), using mobile phones, eating, or watching television in bed are also at risk from EDS. Individuals with these tendencies eventually come to associate the bed and bedroom with other activities aside from sleeping, inadvertently conditioning the body and brain to associate the bedroom with being awake and pursuing other activities rather than being ready for sleep.
Healthy Habits for Restful Sleep
There are a variety of beneficial habits that can be adopted to promote healthy, undisturbed sleep and encourage good sleep hygiene. Even individuals who are suffering from a medical sleep disorder can follow good sleep hygiene routines to reduce EDS.
Although it may be tempting to take advantage of weekends and holidays to sleep late into the afternoon, keeping to set hours for waking up and going to sleep helps your internal body clock regulate itself and get used to a set sleeping schedule. A short nap in the middle of the afternoon—no more than 30 minutes—may be helpful for some, but for others napping dramatically detracts from the quality of their sleep at night and should be avoided.
The bedroom, and especially the bed, should be a sleep-only zone. The American Academy of Sleep Medicine recommends avoiding all electronic devices a minimum of 30 minutes prior to bedtime, and not heading to the bedroom unless you feel ready to go sleep. Creating a personalized bedtime routine—for example, lighting incense or settling down with a favorite book—can also encourage a restful night of sleep and condition the body to associate the routine with feeling sleepy.
Indulging in a heavy meal shortly before bed can also contribute towards poor sleep, as certain foods (especially foods that are fried, greasy, or acidic) can cause heartburn, and if your late-night meal contains caffeine or sugar it’ll interfere with your ability to get to sleep. For the same reason, consuming soda or other caffeinated beverages at night is best avoided. Alcohol may be classified as a sedative, but even a few glasses too close to bedtime may disrupt sleep later in the night when it eventually metabolizes.
Prolonged EDS without a clear cause should always be investigated by a sleep specialist to rule out potential underlying illnesses. However, even individuals who have specific sleep disorders, or other health conditions, can benefit from following healthy practices and routines to promote a good night’s rest. Restful sleep can promote improved well-being and mood, boost cognitive and memory function, and actually increase your ability to better process information and learn!