How To Diagnose Excessive Sleepiness?
For people juggling family, work, and a personal life, feeling exhausted may seem like it’s just par for the course. In fact, it’s estimated that 18 percent of adults suffer from feeling overly tired. While in many cases the condition can be remedied with a solid nap or a weekend of early bed times, when a lack of energy interferes with your productivity or causes forgetfulness or irritability regardless of how much you sleep, it’s time to talk to your doctor.
What Is Excessive Sleepiness?
Excessive sleepiness , or hypersomnia, occurs when sleepiness is severe enough to affect your everyday activities, like meeting deadlines at work or remembering to pick up milk on your way home. Symptoms of excessive sleepiness are different for different people, but the underlying commonality is that despite getting sufficient sleep, you are still tired. For example, you may sleep eight hours a night but struggle to stay awake during the day, or take regular naps during the day and still feel drowsy. You might even sleep 10 or 11 hours a night but wake up feeling groggy and disoriented.
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A doctor or sleep expert can determine whether you suffer from excessive sleepiness, and if you do, whether it’s caused by your sleep habits or a sleep disorder. It’s in your best interest to take your symptoms seriously and make an appointment with your primary care doctor to discuss your situation. Depending on the severity of your condition, your doctor may refer you to a sleep specialist for additional testing.
Your doctor will ask you for information about your sleep habits, such as:
• How long you’ve felt excessively sleepy
• How many hours you sleep on weeknights and weekend nights
• Whether you wake up regularly during the night
• If there have been any changes in your environment that could affect your sleep (such as a new baby or a new work schedule)
This information will help your doctor determine whether your excessive sleepiness is caused by behavior (such as your sleep habits ) or a disorder (like sleep apnea ). Your doctor may
also recommend a polysomnography, or sleep test, to gain deeper insight into your condition. From there, you and your doctor can work together to build a treatment plan to help you regain energy and enjoy your life.
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Narcolepsy is a sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, and in some cases episodes of cataplexy (partial or total loss of muscle control, often triggered by a strong emotion such as laughter). Narcolepsy occurs equally in men and women and is thought to affect roughly 1 in 2,000 people. The symptoms appear in childhood or adolescence, but many people have symptoms of narcolepsy for years before getting a proper diagnosis.
People with narcolepsy feel very sleepy during the day and may involuntarily fall asleep during normal activities. In narcolepsy, the normal boundary between awake and asleep is blurred, so characteristics of sleeping can occur while a person is awake. For example, cataplexy is the muscle paralysis of REM sleep occurring during waking hours. It causes sudden loss of muscle tone that leads to a slack jaw, or weakness of the arms, legs, or trunk. People with narcolepsy can also experience dream-like hallucinations and paralysis as they are falling asleep or waking up, as well as disrupted nighttime sleep and vivid nightmares.
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Narcolepsy with cataplexy is caused by the loss of a chemical in the brain called hypocretin. Hypocretin acts on the alerting systems in the brain, keeping us awake and regulating sleep wake cycles. In narcolepsy, the cluster of cells that produce hypocretin—located in a region called the hypothalamus—is damaged or completely destroyed. Without hypocretin, the person has trouble staying awake, and also experiences disruptions in the normal sleep-wake cycles.
Currently there is no cure for narcolepsy, but medications and behavioral treatments can improve symptoms for people so they can lead normal, productive lives.
Narcolepsy is diagnosed by a physical exam, taking a medical history, as well as conducting sleep studies. If you do have narcolepsy, the most effective treatment is often a combination of medications and behavioral changes. People who are diagnosed with narcolepsy should seek counseling through educational networks and support groups. Getting a diagnosis of narcolepsy and managing the symptoms can be overwhelming and the disorder is not well understood by the general public. It helps to learn best practices and access support through others who have the disorder.
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How much sleep do we really need? Each of us has a specific sleep requirement. Some people need nine hours every night in order to feel their best while others feel great with just seven. But imagine getting ten or more hours of sleep at night plus a couple of hour-long naps during the day and still feeling sleepy. There can be a number of reasons why this would occur but a sleep specialist would consider the possibility of a condition called “idiopathic hypersomnia," a serious and debilitating disorder with no known cause.
People with idiopathic hypersomnia may suffer either constant or recurrent episodes of extreme sleepiness. There are other causes of extreme sleepiness, such as narcolepsy, obstructive sleep apnea, movement disorders during sleep, and a variety of medications. Chronic sleep deprivation may also cause extreme sleepiness, but in this case getting extra sleep usually alleviates the sleepiness. This is called paying off a sleep debt. Idiopathic hypersomnia, in contrast, persists even after a sleep debt is paid off.
If you are experiencing extreme sleepiness, you should talk to your doctor about the duration and intensity of your symptoms. Your doctor may refer you to a sleep specialist who will take a complete medical history in order to rule out other conditions that may be involved. You may be scheduled to have a sleep study, in which certain criteria must be present for a diagnosis of idiopathic hypersomnia. They are:
• Having had symptoms for at least six months that have not occurred within 18 months of head trauma.
• The absence of medical or mental disease that may account for the symptoms, including other sleep disorders such as narcolepsy or post-traumatic hypersomnia.
• Normal polysomnography results.
• A Multiple Sleep Latency Test of less than 10 minutes.
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