Diseases

Problem Sleepiness Information

Inadequate sleep

The amount of sleep needed each night varies among people. Each person needs a particular amount of sleep in order to be fully alert throughout the day. Research has shown that when healthy adults are allowed to sleep unrestricted, the average time slept is 8 to 8.5 hours. Some people need more than that to avoid problem sleepiness; others need less. If a person does not get enough sleep, even on one night, a "sleep debt" begins to build and increases until enough sleep is obtained. Problem sleepiness occurs as the debt accumulates. Many people do not get enough sleep during the work week and then sleep longer on the weekends or days off to reduce their sleep debt. If too much sleep has been lost, sleeping in on the weekend may not completely reverse the effects of not getting enough sleep during the week.

Medical conditions/drugs

Certain medical conditions and drugs, including prescription medications, can also disrupt sleep and cause problem sleepiness. Examples include:

• Chronic illnesses such as asthma, congestive heart failure, rheumatoid arthritis, or any other chronically painful disorder;

• Some medications to treat high blood pressure, some heart medications, and asthma medications such as theophylline;

• Alcohol-Although some people use alcohol to help themselves fall asleep, it causes sleep disruption during the night, which can lead to problem sleepiness during the day. Alcohol is also a sedating drug that can, even in small amounts, make a sleepy person much more sleepy and at greater risk for car crashes and performance problems;

• Caffeine-Whether consumed in coffee, tea, soft drinks, or medications, caffeine makes it harder for many people to fall asleep and stay asleep. Caffeine stays in the body for about 3 to 7 hours, so even when taken earlier in the day it can cause problems with sleep at night; and

• Nicotine from cigarettes or a skin patch is a stimulant and makes it harder to fall asleep and stay asleep.

Problem sleepiness and adolescents

Many U.S. high school and college students have signs of problem sleepiness, such as:

• difficulty getting up for school;

• falling asleep at school; and/or

• struggling to stay awake while doing homework.

• social activities with peers that lead to later bedtimes;

• homework to be done in the evenings;

• early wake-up times do to early school start times;

• parents being less involved in setting and enforcing bedtimes; and

• employment, sports, or other extracurricular activities that decrease the time available for sleep.

• automobile crashes;

• poor performance in school and poor grades;

• depressed moods; and

• problems with peer and adult relationships.

Problem sleepiness facts*

*Problem sleepiness facts medical author: Melissa Conrad Stoppler, MD

• Problem sleepiness occurs when sleepiness during the day interferes with work or social functioning.
• Symptoms of problem sleepiness may include difficulty concentrating, falling asleep while driving, or problems with emotional control.
• There are a number of causes of problem sleepiness, including sleep disorders; other medical conditions; certain medications; substances like drugs, alcohol, or caffeine; or an altered sleep-wake cycle.
• Sleep disorders include narcolepsy, insomnia, sleep apnea, and restless legs syndrome.
• Sleepiness is a major cause of motor vehicle accidents, poor school performance, and depressed mood.
• Shift workers are especially susceptible to sleepiness and its risks.
• Treatment may consist of improving sleep hygiene and avoiding precipitating factors.

Shift work and problem sleepiness

About 20 million Americans (20 to 25 percent of workers) perform shift work. Most shift workers get less sleep over 24 hours than day workers. Sleep loss is greatest for night shift workers, those who work early morning shifts, and female shift workers with children at home. About 60 to 70 percent of shift workers have difficulty sleeping and/or problem sleepiness. The human sleep-wake system is designed to prepare the body and mind for sleep at night and wakefulness during the day. These natural rhythms make it difficult to sleep during daylight hours and to stay awake during the night hours, even in people who are well rested. It is possible that the human body never completely adjusts to nighttime activity and daytime sleep, even in those who work permanent night shifts. In addition to the sleep-wake system, environmental factors can influence sleepiness in shift workers. Because our society is strongly day-oriented, shift workers who try to sleep during the day are often interrupted by noise, light, telephones, family members, and other distractions. In contrast, the nighttime sleep of day workers is largely protected by social customs that keep noises and interruptions to a minimum. Problem sleepiness in shift workers may result in:

• increased risk for automobile crashes, especially while driving home after a night shift;

• decreased quality of life;

• decreased productivity (night work performance may be slower and less accurate than day performance); and/or

• increased risk of accidents and injuries at work.

Sleep disorders

Sleep disorders such as sleep apnea, narcolepsy, restless legs syndrome, and insomnia can cause problem sleepiness. Sleep apnea is a serious disorder in which a person's breathing is interrupted during sleep, causing the individual to awaken many times during the night and experience problem sleepiness during the day. People with narcolepsy have excessive sleepiness during the day, even after sleeping enough at night. They may fall asleep at inappropriate times and places. Restless legs syndrome (RLS) causes a person to experience unpleasant sensations in the legs, often described as creeping, crawling, pulling, or painful. These sensations frequently occur in the evening, making it difficult for people with RLS to fall asleep, leading to problem sleepiness during the day. Insomnia is the perception of poor-quality sleep due to difficulty falling asleep, waking up during the night with difficulty returning to sleep, waking up too early in the morning, or unrefreshing sleep. Any of these sleep disorders can cause problem sleepiness.

Sleep-wake cycle

Each day there are two periods when the body experiences a natural tendency toward sleepiness; during the late night hours (generally between midnight and 7 a.m.) and again during the midafternoon (generally between 1 p.m. and 4 p.m.). If people are awake during these times, they have a higher risk of falling asleep unintentionally, especially if they haven't been getting enough sleep.