Ask the Expert: Daytime Sleepiness

Dr. Larry Ayers, a Sharp-affiliated pulmonologist, answers frequently asked questions about daytime sleepiness.

What is daytime sleepiness?
Daytime sleepiness is a condition where an individual will tend to fall asleep at inappropriate times during the day.

What are the typical causes of daytime sleepiness?
The causes are usually fragmented sleep, where you have an interrupted sleep at night that you might not know. The other common cause is that you just don’t allow yourself to get enough sleep at night. In the college student, they have sleepiness because they’re up all night partying or they’re studying and so they’re chronically sleep-deprived. They try to make up their sleep on a weekend. You can have medical issues that cause sleepiness such as somebody who had recent surgery and they’re having poor sleep because of pain. Some people try to make up sleep by sleeping on a weekend and they may sleep eighteen hours a day on a weekend. And you can make up sleep for the first two or three days of the next week but you’ll eventually get back in the same problem.

What if the sleep problem is more severe?
If your sleep problem is due to sleep apnea, you can’t make it up on a weekend. You can sleep as long as you want and your sleep’s gonna be poor. Sleep deprivation, the most common cause that I see in my practice would be nonrestorative sleep such as sleep apnea where you’re interrupting your sleep all night long. And the other cause would be if you’ve restricted the number of hours you’re sleeping at night, anything that will interrupt your sleep at night.

What is sleep apnea?
Sleep apnea is a condition where your breathing when you’re sleeping actually stops or is reduced. You may be breathing and then stop for 10 or more seconds and then start breathing again.

What other common things can interrupt sleep?
If you have a noisy neighbor for a while and a dog barking, those little things like that will interrupt your sleep and you’ll be sleep-deprived. Those are common causes then you have some people who have a mixture of sleep deprivation and insomnia where they just can’t fall asleep and then they have to get up at six in the morning so they may only have three or four hours of sleep. They’ll be very sleep-deprived. So sometimes finding out what their sleep patterns are like.  Some people have sleep habits that just make them subject to very poor sleep. Some people are drinking lots of coffee during the day, drinking alcohol at night, so their sleep is fragmented because of the coffee. They may get to sleep early on in the night because of the alcohol. When the alcohol wears off their sleep is very fragmented again, so they’re getting very poor sleep. So there are medicines and drugs that people take that will interfere with the restorative sleep.

Can stress affect sleep patterns?
Stress will affect your sleep because it’ll usually cause you to have difficulty falling asleep. You can’t turn your brain off because you’re worried about this problem or that problem and over the course of several days or weeks you’ll feel sleep-deprived. And this can build up to the point that the individual will feel that there is no way I can ever be able to sleep normal. They sometime feel they are a failure at sleep and they work themselves into this situation, started out as stress and now it’s become a learned sleep insomnia. So those individuals need to see someone to try to get them on the right course to treat that.

Are sleeping pills a good solution to daytime sleepiness?
Sometimes they’ll be given a sleeping pill by a doctor. Works great for a few days and then they get the point where, well, I’m gonna need to take this forever. You don’t really solve the problem. The newer sleeping pills that you see advertised on television are supposedly less habit-forming than those that were used years ago. But they all have some addicting qualities. Not everybody needs to use those pills. Some people use them intermittently. And intermittent use is probably effective if you know it’s an insomnia that would be related to a stressful situation which would be short-term.

How can I assess my own sleep patterns?
You have to examine what you’re doing to yourself during the day, what your activity level is like, that you’re drinking and eating, things on your mind. If an individual is drinking lots of coffee, staying up late at night, drinking alcohol, they’re gonna have poor sleep and they’re gonna be eventually sleep-deprived. They’ll pay a price for it in the future.

How can I treat my sleep problems?
Get lifestyle changes where you try to get some sunshine exposure in the morning which resets your clock. We try to get some healthy activity, some exercise everyday for thirty minutes up to an hour if you can, not in the evening before you got to bed but let’s say earlier in the day. And frequently that helps improve the quality of sleep an individual gets. And try to eliminate or reduce the amount of caffeine one is taking. Now I say caffeine, most people think of coffee but there are some people that say ‘I don’t drink any coffee but I love chocolate, chocolate ice cream, chocolates.’ That has a lot of caffeine in it, so one has to be very sensitive to what one’s taking. So we always say hygiene habits would be exercise, morning sunshine, balanced diet, avoiding caffeine and alcohol in the evening.

What about caffeine?
Caffeine is not a remedy for daytime sleepiness. It can temporarily improve a person’s sleepiness for a few hours if they’re gonna have to perform, let’s say give a talk or something and they’ve been sleepy that night. They can have a cup of coffee, let’s say before — an hour before they give their talk. They’ll be much more likely to be alert. And caffeine is very effective. It is a very alerting type of a medication. But if an individual’s drinking four or five tall caffeinated beverages a day that’s probably not a good idea. If someone is sleep-deprived during the night and they take a short nap during the day and they function really fine after that I say go for it. If they take a nap and they have problems then falling asleep at night then that probably has a negative influence on them. If someone says ‘I need to take naps to function,’ and then they say that they snore a lot. Then I say, well, you need to take naps because there’s a medical problem here.

What is narcolepsy?
Narcolepsy is a neurological problem characterized by the need to take very frequent and/or short naps during the day. The individuals are so sleepy that they can almost lay down any time of the day and fall asleep within five or six minutes. And that is in spite of the fact that they may be going to bed at nine at night and waking up at six in the morning which most people would consider an adequate number of hours of sleep. So these people are very sleepy at times during the day.

How does that daytime sleepiness affect day-to-day life?
It affects the ability to perform, let’s say, work, drive, handle the usual activities. So narcolepsy is more than just daytime sleepiness. It’s a constellation of other symptoms too. These people have bizarre dreams. They may have what we call cataplexy where they sometimes feel paralyzed temporarily. And that’s a real medical condition that requires a sleep study in a formal sleep laboratory. It also requires a medication frequently.      

How do I know when I should see a doctor about my sleep issues?
If an individual is having to take frequent naps during the day and this has been going on for, say, a number of weeks or months or greater and they feel that they’re getting an adequate number of hours of sleep at night, then there’s something very abnormal with their sleep or they have some particular sleep condition that should be evaluated. Those individuals should be evaluated for the causes of their daytime sleepiness. It may be something simple that can be corrected. It may be something more complicated that would require medication.

What are voluntary vs. involuntary naps?
Some people will deny that they’re taking naps. And a lot of people when you ask the question of a patient, ‘Do you take naps?’. The individuals say, ‘No I do not nap, but I fall asleep all the time.’ So those are not voluntary naps. They’re involuntary naps. So a tendency to fall asleep at a meeting, falling asleep when there’s a passenger in a car, and this is in spite of the fact that they think they’re sleeping enough hours at night. That should be evaluated.

What are some hazards of daytime sleepiness?
Or you can be sleeping and not fall asleep and that sleepiness you’d be in the very lightest stages of sleep. In other words you would be sitting there and you’re not asleep. Your eyes are open but you may miss things that are going on in the environment. ‘I see things but, gee, how did I get here?’. You knew you weren’t sleeping. You were driving. But you actually were in a very light stage of sleep, enough so that you could respond, hopefully, to somebody who hits their brake lights. But you are in what we call a micro sleep. And this has been studied with truck drivers, bus drivers, long-distance drivers. They have done studies where they have brain waves – they’re monitoring their brain waves when they’re driving. People are driving at night and you find that rather than awake EEG brain waves, you find they’re awake in stage one, which is the lightest form of sleep, back and forth, back and forth, back and forth. And of course the individual, you ask him are you asleep? ‘No, oh, no’, but they are.

You can be sitting in a meeting and you will miss many things and usually you will realize it where someone will say something or someone may cough or laugh and you realize that you’ve been listening but you really haven’t been fully awake. So you’re in a very light stage of sleep. If you’re having excessive daytime sleepiness, you’re concerned, normally if you have a primary care doctor that would be the person you would see.

How would I know if I need to address my daytime sleepiness?
If this is long-standing, it’s been going on for months, it’s affecting your ability to work, that would be an indication that you should have this looked into.

For More Information
Sleep assessment is provided with physician referral only. To learn more, contact the Sleep Disorders Center directly, please call 619-740-4488.

To find a Sharp-affiliated physician, search for San Diego doctors or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm. To find general information about sleep disorders, visit Sleep Problems in Adult Health or read the Sleep Disorders News archive.