How to Manage Excessive Sleepiness During the Day

Excessive daytime sleepiness (EDS) is persistent drowsiness and difficulty staying awake during the day. With excessive daytime sleepiness, you might doze off at inappropriate or unexpected times or wake up from nighttime sleep feeling unrefreshed. You may also feel irritable, have trouble focusing, or feel like you're constantly running on "empty" no matter how much sleep you get.

Up to 25% of adults report experiencing excessive daytime sleepiness. Lack of sleep is the most common cause of EDS, but sometimes it is a sign of an underlying sleep disorder or medical condition. Treatment for EDS includes lifestyle modifications, therapy, and medication.

Symptoms

The main symptom of excessive daytime sleepiness is chronic exhaustion during the day. People with EDS may wake up in the morning and feel groggy and unrefreshed, and those feelings may carry on through the rest of the day. Symptoms of EDS can range from mild to severe and vary from person to person and may include:

• Falling asleep involuntarily during the day or at inappropriate times
• Unrefreshing sleep 
• Difficulty waking up from sleep
• Irritability
• Anxiety 
• Memory problems
• Difficulty focusing 
• Brain fog
• Headaches
• Impaired decision making 
• Reduced productivity at school or work 

Causes of Excessive Daytime Sleepiness

Lack of sleep (sleep deprivation) is the leading cause of excessive daytime sleepiness. Sleep deprivation occurs when you don't get enough good-quality sleep. Adults typically need about 7 to 9 hours of sleep each night. Poor-quality sleep (e.g., tossing and turning at night), pain, and prioritizing other activities over sleep are common causes of sleep deprivation.

Other common causes of excessive daytime sleepiness include:

• Sleep apnea: A common sleep disorder that causes repeated pauses in breathing throughout the night, disrupting sleep. About half of people with obstructive sleep apnea report experiencing EDS.
• Insomnia: A sleep disorder associated with difficulty falling asleep, staying asleep, or both.
• Restless legs syndrome (RLS): A sleep-related movement disorder that causes uncomfortable sensations in the legs when sitting or laying down, particularly in the evening. People with RLS often feel a strong urge to get up and move around to relieve the discomfort in their legs, making sleep difficult.
• Narcolepsy: A chronic neurological disorder that disrupts your body's circadian rhythm (natural sleep-wake cycle). Narcolepsy can be associated with cataplexy (loss of muscle control), sleep paralysis, hallucinations while falling asleep (hypnagogic hallucinations), and severe excessive daytime sleepiness.
• Idiopathic hypersomnia: A sleep disorder associated with excessive daytime sleepiness and non-restorative sleep. People with idiopathic hypersomnia may sleep more than 11 hours a day and still feel extraordinarily tired throughout the day.
• Mood disorders: Many people with depression and anxiety report experiencing excessive daytime sleepiness.
• Medications: Certain medications can cause excessive daytime sleepiness as a side effect. These include sedatives, pain medications, anticonvulsants, antihistamines, and antidepressants.
• Lifestyle factors: An irregular sleep schedule, excessive caffeine or alcohol consumption, poor sleep habits, shift work, and stress can contribute to EDS. 

Risks of Excessive Daytime Sleepiness

While nearly everyone occasionally gets too little sleep and feels tired and sluggish the next day, excessive daytime sleepiness typically occurs after prolonged sleep deprivation or due to a sleep disorder that causes excessive sleepiness, such as hypersomnia. Over time, lack of sleep and poor sleep quality can impact your daily functioning and overall health.

Impacts on Daily Living

Excessive daytime sleepiness can impair cognitive function, making it difficult to focus and concentrate. This can lead to problems with work and school, increases your risk of accidents, and may impact your relationships.

• Reduced productivity: EDS can lead to brain fog, difficulty focusing, and memory problems, which may impact your performance at work or school.
• Increased accident risk: EDS can impair reaction time and coordination, putting people with EDS at a 2- to 3-times higher risk of experiencing a driving or occupational-related accident.
• Strained relationships: Nearly 90% of people with EDS report the condition affects their social and family relationships. Moodiness, decreased productivity, and a lack of energy to participate in socializing are common reasons why EDS strains relationships.

Impacts on Physical Health 

Your body restores and repairs itself while you sleep. Over time, getting too little sleep can have an impact on your short and long-term physical health. Research shows that people with excessive daytime sleepiness engage in physical activity less often and tend to consume high amounts of carbohydrates and saturated fats. The combination of these factors increases your risk of several health conditions, including:

• Cardiovascular disease: Sleep disorders associated with excessive daytime sleepiness can contribute to heart problems such as hypertension (high blood pressure), heart disease, and stroke.
• Weakened immune system: Chronic sleep problems may weaken your body's ability to fight infections and illnesses.
• Metabolic disorders: Disrupted sleep patterns and poor sleep can affect hormone regulation, increasing your risk of metabolic disorders such as obesity, metabolic syndrome, and type 2 diabetes.

Impacts on Mental Health

Excessive daytime sleepiness can also affect your mental health and emotional well-being. The constant feeling of exhaustion can make emotional regulation more difficult, leading to mood swings and irritability. It can also increase your risk of:

• Cognitive decline: EDS is associated with an increased risk of cognitive decline and neurodegenerative disorders, including dementia, Alzheimer's disease, and Parkinson's disease.
• Depression: Sleep deprivation can disrupt the balance of neurotransmitters (chemical messengers) in the brain, leading to symptoms of depression, including loss of interest in activities and disrupted sleep patterns.
• Anxiety: EDS can make it more difficult to cope with the stressors of daily life, increasing your risk of anxiety.

Diagnosis

During the diagnostic process for excessive daytime sleepiness, your healthcare provider must determine whether it is a standalone issue or due to an underlying condition. Healthcare providers who can diagnose EDS and disorders associated with sleep problems include:

• Board-certified sleep medicine physicians
• Behavioral sleep medicine specialists 
• Neurologists 

At your appointment, your provider will ask about your medical history and perform a physical examination to help identify the underlying cause of excessive daytime sleepiness. The Epworth Sleepiness Scale (ESS) is often used to assess the severity of your daytime sleepiness and guide treatment decisions.

The ESS asks you to rate your likelihood of dozing off or falling asleep (on a scale from 0 to 3) during eight scenarios, such as driving a car, reading, and watching television. Scores above a certain threshold (typically 10 or higher) may indicate excessive daytime sleepiness.

To look for an underlying cause, your healthcare provider may order diagnostic tests such as:

• Polysomnography: A comprehensive sleep study that monitors brain activity, breathing patterns, heart rate, and body movements during sleep.
• Multiple sleep latency test (MSLT): This test measures your tendency to fall asleep by measuring how quickly you fall asleep during daytime naps to assess the severity of excessive daytime sleepiness.
• Maintenance wakefulness test: This test measures your ability to stay awake in the daytime. For this test, you will sit in a quiet, dark room in the daytime to determine whether you can remain awake during the daytime hours.

Treatments

If an underlying condition is causing EDS, treating that condition may resolve excessive daytime sleepiness. Otherwise, treatment for excessive daytime sleepiness may include lifestyle modifications, therapy, and medications. 

Lifestyle Modifications 

Improving your sleep hygiene may help you sleep better at night and reduce excessive daytime sleepiness. Good sleep hygiene practices include:

• Regular exercise: Daily physical activity can improve sleep quality and reduce daytime sleepiness.
• Eat a nutritious diet: Eating a nutrient-dense diet with plenty of fruits, vegetables, fatty fish, lean proteins, and whole grains may help improve your sleep and overall health. Research suggests that drinking a glass of tart cherry juice or milk before bedtime may help enhance sleep quality and duration.
• Stress management: Stress can contribute to sleep problems. Practice stress-management techniques such as yoga, meditation, or deep breathing exercises.
• Morning sunlight: Exposure to sunlight in the morning can help you feel more alert in the daytime and help regulate your body's natural sleep-wake cycle.

Cognitive Behavioral Therapy 

Cognitive-behavioral therapy for insomnia (CBT-I) is an effective form of therapy for sleep disorders. CBT-I focuses on identifying and changing negative thoughts and behaviors contributing to sleep problems to help restore your body's natural sleep patterns, improve sleep quality and duration, and reduce excessive daytime sleepiness.

Medication

If you have narcolepsy, medication may be necessary to help manage it. Common medications for narcolepsy include:

• Stimulants: Stimulants such as Provigil (modafinil), Nuvigil (armodafinil), and Vyvanse (amphetamine) can increase wakefulness and improve alertness.
• Wake-promoting agents: Medications like Wakix (pitolisant) and Sunosi (solriamfetol).

Preventing Daytime Sleepiness

Prioritizing good quality nighttime sleep can help reduce excessive daytime sleepiness. Some tips for preventing daytime sleepiness include:

• Stick to a regular sleep schedule: Go to bed and wake up at the same time every day, even on weekends. 
• Create a relaxing bedtime routine: Calming activities can help your brain and body relax in preparation for sleep. This may include reading, taking a warm bath, breathing exercises, or listening to calming music.
• Optimize your sleep environment: Ensure your bedroom is dark, quiet, and cool. Darkness helps promote the release of melatonin, a hormone that regulates sleep. Noise and light can disrupt sleep. Aim for a comfortable temperature between 60 and 67 degrees.
• Screen-free evenings: Screens emit blue light that may interfere with sleep. Avoid watching television or using electronic devices an hour or two before bed.
• Avoid caffeine and alcohol: Caffeine and alcohol can interfere with sleep, especially when consumed close to bedtime. Alcohol may make you feel drowsy initially but can disrupt sleep later in the night.

When to See a Healthcare Provider

If you have ongoing symptoms of excessive daytime sleepiness, your healthcare provider can determine the cause and discuss possible treatment options with you. Seek medical care if you:

• Snore at night 
• Have trouble falling or staying asleep 
• Struggle to focus, concentrate, or carry out your daily activities 
• Wake frequently at night
• Fall asleep frequently during the day 
• Experience mood changes (e.g., irritability) 
• Wake up with headaches or grogginess

A Quick Review

Excessive daytime sleepiness (EDS) is an unshakeable feeling of tiredness that can impact your daily activities, relationships, work productivity, and quality of life. Sleep deprivation is the leading cause of EDS, but sometimes, it is a sign of an underlying medical condition or sleep disorder. 

In the short term, EDS increases your risk of accidents, causes irritability and mood swings, and affects work productivity and relationships. Chronic EDS increases your risk of heart disease, mood disorders, metabolic disorders, and neurodegenerative diseases. It also weakens your immune system, making you more likely to experience frequent infections (e.g., the common cold).

Treatment for EDS includes lifestyle modifications, cognitive-behavioral therapy, and medication. Early intervention and treatment can help improve sleep quality, reduce daytime sleepiness, and protect your short and long-term health.