Dear Doc Column
1-23-18. Dear Doc, they talk about insomnia all the time, but I have the opposite problem: I sleep too much. I need 14 hours a night minimum just to function during the day, and even then I end up taking at least two naps/day. What’s wrong with me?
Sounds like you’re struggling with hypersomnia, the medical word for “sleeping too much.” Hypersomnia is defined as sleeping long hours at night. The sufferer sleeps so much it shortens their awake time and cuts into daytime activities. Hypersomnia can also mean having excessive sleepiness during the day; feeling tired or napping causes difficulty holding down a job or attending school. The sleepiness also results in problems with driving.
Excessive sleepiness has many causes. People who frequently switch work schedules can find themselves struggling to stay awake. Hypersomnia can also be caused by sedating medications, narcolepsy, sleep apnea, essential hypersomnia, and ironically insomnia (not sleeping enough causes sleepiness during the day).
Some medications cause sleepiness. If your drug regimen is making you sleepy, don’t just stop the medication! Ask your doctor about options. They might back off on the dose, change it from mornings to nights, or switch you to a similar but less-sedating alternative. Keep in mind that sometimes a pill’s sedating effect wears off after you’ve been taking it for a while.
Narcolepsy is an illness marked by intense sleepiness during the day. The sufferer has sudden attacks of sleepiness, often in unusual situations, like during sex or when at work; these naps are brief, five to ten minutes, and the person wakes up refreshed until the next sleep attack hits them. Other symptoms include sudden loss of muscle control when stressed or emotional, often causing the individual to fall, an experience called cataplexy; having hallucinations when falling asleep or waking up; and sleep paralysis, or the inability to move when half-asleep. Diagnosis involves a sleep study and certain blood tests. The best way to treat narcolepsy is scheduled naps during the day, plus medications to keep a person awake and help with cataplexy.
Has anyone told you that you snore or stop breathing when you’re asleep? If so, you might have sleep apnea. This condition occurs when a person has bouts of difficulty breathing when asleep. They don’t sleep well, which triggers problems staying awake during the day. In the long run, sleep apnea increases the risk of developing depression, heart disease, and other serious medical conditions. The best way to diagnose this problem is a sleep study. Treatment includes wearing a small breathing machine at night called a CPAP or BIPAP. Sometimes doctors will opt for surgery if the sleep apnea is severe. Occasionally stimulants are prescribed to help keep the person stay awake.
Essential hypersomnia is a fancy way of saying the person sleeps too much for no clear reason. No matter how much they sleep at night, the individual can’t seem to wake up during the day. The best treatments include scheduled naps, sleeping on a schedule, and sometimes taking a stimulant to keep awake.
There’s no doubt about it: insomnia, or the inability to sleep at night, causes daytime sleepiness. If you’re struggling with insomnia, work with your doctor to help improve your shut-eye. This might involve education about insomnia and sleep hygiene, seeing a therapist for cognitive behavioral therapy, considering sleep medications, and being evaluated for other causes of hypersomnia.
What’s the next step? If sleepiness is problematic enough to interfere with your day-to-day living, talk to your family doctor or internist. They’ll screen you for the conditions listed above and help arrange a plan of action, depending on the cause.