Written by Jill Zwarensteyn, Editor
Nothing on this website is intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The contents of this website are for informational purposes only.
Do you feel like no matter how much rest you get, you still struggle to stay awake during the day? Those constant feelings of tiredness can impact your work and home life, which is why getting to the root of the problem is crucial.
There are a variety of factors that could contribute to your excessive daytime sleepiness. From lifestyle choices to medications and underlying conditions, we’ll explore the potential reasons why you feel sleepy during the day. We’ll also share treatments for chronic sleepiness, what you can expect when visiting a doctor, and answers to common questions related to this condition.
What is Excessive Daytime Sleepiness (EDS)?
Excessive Daytime Sleepiness[1] is described as the need to sleep during the day. Other names for Excessive Daytime Sleepiness include EDS and Hypersomnia.
However, this condition is different from fatigue or feeling sleepy all the time. EDS, rather, means that you’re not able to stay awake or alert during pivotal moments throughout the day, which may cause you to unintentionally fall asleep at inappropriate moments. Although it’s normal to feel extra tired from time to time, you could have EDS if this occurs daily for at least three months.
American Family Physician reports that an estimated 20 percent[2] of the United States adult population experiences EDS.
Symptoms of Excessive Daytime Sleepiness
To help distinguish whether you have EDS, you should carefully review any symptoms you experience. One symptom of Hypersomnia is when you regularly take naps without feeling recharged afterward. Other signs[3] include falling asleep while eating and talking or resting for long hours at night.
Possible Causes of EDS
The source of excessive sleepiness may be hard to pinpoint due to the abundance of possible causes. These include lifestyle habits, disorders, and medications.
Sleep Deprivation
According to American Family Physician, sleep deprivation appears to be one of the most common causes of EDS and can lead to impaired neuro-biological functions. They add that someone could experience symptoms of sleep deprivation after just one night of minimal sleep, while those with chronic deprivation may not be aware of their diminished cognitive abilities.
Poor Sleep Hygiene
Contrary to the title, sleep hygiene has nothing to do with how clean your bed is. Instead, it refers to how your sleeping schedule and habits could affect your sleep quality.
For example, if you have an erratic schedule and fall asleep at different times each night, then that will throw off your body’s internal clock.
These problematic sleeping habits[4] could lead to inadequate rest, making it harder for you to feel energetic when you’re awake.
- Background noise
- Sleeping in extreme temperatures
- Uncomfortable sleep space
- Excessive napping
- Too much time in bed
- Inconsistent sleep schedule
Working at Night
Finishing your work late into the night might seem productive, but it’s just the opposite. Our bodies run on a 24-hour sleep-wake cycle known as the circadian rhythm, and light is one of its most significant triggers.
When it’s light outside, this tells us to be awake and alert. Conversely, darkness causes this biological clock to increase production of hormones like melatonin that make us sleepy.
However, the light emitted from electronic devices like computers and tablets can throw off this circadian rhythm, causing you to feel more alert at night.
Learn More: How Shift Work Affects the Circadian Rhythm
Drugs
Any drug that artificially enhances or decreases energy levels could harm sleeping patterns and therefore, contribute to EDS. This is because drugs – regardless of whether they’re a stimulant or depressant – can impair your body’s ability to regulate its sleep cycle
Alcohol
A glass of wine might seem like a nice way to relax before bed, but you should consider swapping that out for a cup of tea instead. While alcohol can make you tired, it may also lead to disrupted sleep. Additionally, experts warn alcohol could also worsen Sleep Apnea.
Smoking
Not only can smoking lead to severe health issues like a stroke, heart attack, or cancer, it’s also not good for your quality of sleep. The nicotine in cigarettes has a stimulating effect, which could make it harder to sleep or disrupt rest. Smoking[5] also increases your risk of developing Sleep Apnea.
Lack of Physical Activity
When you don’t lead an active lifestyle, your sleep could suffer. According to health experts, regular exercise that involves moderate aerobic activity can increase your amount of deep sleep. They also add that exercise helps boost your mood and relieve stress, which should help you rest better[6].
Although exercise is important, you should avoid working out late in the evening. This is because the endorphins you get from exercise could give you a boost of energy that also keeps you awake.
Premenstrual Syndrome
Premenstrual Syndrome – or PMS – can come with a multitude of inconvenient symptoms[7], including fatigue and insomnia. Both of these PMS symptoms could certainly cause some women to feel extra sluggish during the day.
Obesity
Researchers have found evidence that links obesity to both sleep deprivation and poor sleep quality. Furthermore, they found that a higher weight increases your chances of developing Obstructive Sleep Apnea.
It’s also important to note how poor sleep could facilitate unhealthy eating habits[8]. According to researchers, the hormone that promotes hunger, ghrelin, increases when a person is sleep-deprived.
Read More: Obesity and Sleep
Medications
Certain medications you take may have side effects that could make you feel more tired than normal. You should familiarize yourself with the potential side effects of your medications and consult with your doctor if you have any concerns.
Be mindful of any medications that are stimulants, because taking them too close to bedtime could affect your rest.
Conditions and Illnesses that May Cause Sleepiness
Primary Hypersomnias
As previously mentioned, Excessive Daytime Sleepiness is also known as Hypersomnia, which translates to “too much sleep.” Hypersomnia is classified into one of two categories: Primary or Secondary[9].
Primary hypersomnias are rarer than Secondary ones, and according to the American Sleep Association, they affect less than 1 percent of the population.
Narcolepsy
Narcolepsy is the most common Primary hypersomnia diagnosis. This is a chronic condition, and EDS is often one of the first symptoms. In addition to daytime drowsiness and sleep episodes, Narcoleptic patients[10] may also experience a loss in muscle tone, sleep paralysis, changes in REM sleep, and hallucinations.
Idiopathic Hypersomnia
Idiopathic Hypersomnia is a neurological disorder that’s classified as a primary form of hypersomnia. While Narcoleptic patients typically feel refreshed after a nap, those with Idiopathic Hypersomnia[11] do not feel relief after resting.
Other symptoms may include sleep drunkenness, brain fog, and headaches. It is unclear what the cause of this hypersomnia is, though some patients have a family history of the disorder.
Klein Levin Syndrome
Klein Levin Syndrome is a rare disorder in which a person exhibits recurring patterns of excessive sleep in addition to cognitive and behavioral changes. People with Klein Levin[12] can sleep upwards of 20 hours a day for a few days or several weeks at a time.
Secondary Hypersomnias
Secondary hypersomnias are more common. These types of hypersomnia are usually a result of another condition.
Depression
Depression is a mood disorder that can cause prolonged negative feelings like sadness and hopelessness. People with depression may often experience sleep issues like insomnia or extreme tiredness.
Restless Legs Syndrome (RLS)
Restless Legs Syndrome is a type of sleep disorder in which someone feels an uncontrollable need to move their legs. Because this usually occurs at night, it can affect a person’s rest.
If you are having trouble with restless legs syndrome, take a look at our list of best mattress for restless leg syndrome.
Sleep Apnea
This disorder causes breathing to repeatedly start and stop[13] while a person is sleeping. There are three types of Sleep Apnea: Obstructive, Central, and Complex. Sleep Apnea can make it difficult to stay asleep since most patients frequently wake up during the night when their body catches on that they’re not getting enough air.
Insomnia
Insomnia is a common sleep disorder that prevents people from getting optimum rest. Patients either have trouble falling asleep, staying asleep, or they wake up too early. Any one of these issues can leave someone feeling groggy throughout the day.
For More Information: Best Mattresses for Insomnia
Fibromyalgia
Those with Fibromyalgia[14] experience musculoskeletal pain throughout their body. Fatigue is a typical symptom, as patients often wake up tired since the pain impacts their sleep quality. People with this condition may also experience Sleep Apnea, Restless Legs Syndrome, and diminished cognitive skills.
For More Information: Best Mattresses for Fibromyalgia
Hypothyroidism
Hypothyroidism[15] – or an underactive thyroid – means that your thyroid gland doesn’t produce enough hormones. Fatigue is among the signs of Hypothyroidism. Depression, which could also lead to EDS, is another symptom of this disorder.
Anemia
Anemia is a condition in which a person doesn’t have enough red blood cells to carry the appropriate amount of oxygen to body tissues. Fatigue and weakness are symptoms of Anemia.
A person can develop Anemia[16] by either not producing enough red blood cells or their body destroys the ones they have. Bleeding can also cause you to lose too many red blood cells.
Chronic Fatigue Syndrome (CFS)
Chronic Fatigue Syndrome (CFS) can cause extreme lethargy that lasts for at least a six-month period. Those with CFS[17] typically see their tiredness get worse with any physical or mental activity, and they also usually don’t feel recharged after sleep.
Periodic Limb Movement Disorder (PLMD)
When someone experiences Periodic Limb Movement Disorder (PLMD), they will move their limbs in repetitive movements throughout the night, which could impact their sleep in the process. This condition occurs in about 80 percent[18] of those with Restless Legs Syndrome. People with Narcolepsy and Obstructive Sleep Apnea may also experience PLMD.
Post-traumatic Brain Injury
Post-concussion syndrome can occur following a traumatic brain injury. According to researchers[19], the effects of this syndrome include headaches, sleep disturbances, neuropsychiatric symptoms, and cognitive impairment.
Medication Classes Commonly Associated with Daytime Sleepiness
Certain medications are also known to have daytime sleepiness as a side effect. Below is a list from American Family Physician that includes the types of medicines linked to daytime fatigue.
Medication Classes Commonly Associated with Daytime Sleepiness:
- Alpha-adrenergic blocking agents
- Anticonvulsants (e.g., hydantoins, succinimides)
- Antidepressants (monoamine oxidase inhibitors, tricyclics, selective serotonin reuptake inhibitors)
- Antidiarrhea agents
- Antiemetics
- Antihistamines
- Antimuscarinics and antispasmodics
- Antiparkinsonian agents
- Antipsychotics
- Antitussives
- Barbiturates
- Benzodiazepines, other γ-aminobutyric acid affecting agents, and other anxiolytics
- Beta-adrenergic blocking agents
- Genitourinary smooth muscle relaxants
- Opiate agonists and partial opiate agonists
- Skeletal muscle relaxants
When to See Your Doctor
Not only could Excessive Daytime Sleepiness be symptomatic of an underlying condition, but it also puts you at a higher risk of getting into a motor vehicle accident. It’s best to reach out to your doctor as soon as possible if you believe you may have this sleep problem. This way, your physician can properly diagnose your condition.
Preparing for Your Sleep Appointment
Your doctor will likely ask you plenty of questions about your sleep history, habits, and symptoms. To be prepared, it’s a good idea to come with enough information readily available.
Prior to your appointment, write down detailed notes about how you’re resting. These might include how many hours a night you sleep, how often you wake up, what your sleep schedule is, and any additional symptoms you’re feeling. This way, you won’t have to recall everything from memory when you get to the doctor, therefore contributing to a more accurate diagnosis.
Evaluating and Screening for Excessive Daytime Sleepiness
According to American Family Physician, when evaluating a patient for EDS, your doctor may use the Stanford Sleepiness Scale or the Epworth Sleepiness Scale. These questionnaires are completed by the patient, who rates their sleepiness in certain situations. For example, if a patient scores above a 12 on the Epworth Scale or has a history of falling asleep while driving, they will need to be evaluated further.
Additionally, doctors should look into the patient’s medical history and perform a physical exam and laboratory test. They should also go over any medications the patient is currently taking to see if those could be the cause of extreme sleepiness.
Next Steps After an Excessive Sleepiness Diagnosis
Once you’re diagnosed with EDS, your doctor will try to determine the root cause of your condition.
The first step will likely be a Polysomnography[20], a non-invasive test used to diagnose sleep disorders that’s typically performed at night. During a Polysomnography, researchers will monitor your brain waves, blood oxygen levels, heart rate, breathing, and eye and leg movements to help evaluate your sleep patterns.
This test is usually done if your doctor suspects you have Sleep Apnea, Periodic Limb Movement Disorder, Narcolepsy, REM Sleep Behavior Disorder, unusual sleep behaviors, or chronic Insomnia.
Learn more about preparing for a sleep study.
Diagnosis and Management of Conditions That Cause Excessive Daytime Sleepiness
Below is a table from American Family Physician that describes the overall testing process for diagnosing the cause of Excessive Daytime Sleepiness.
Treating Excessive Daytime Sleepiness
Treatment for EDS[21] depends on what is causing it. Treatment plans may be a mix of non-pharmacological and pharmacological methods. For instance, those with Obstructive Sleep Apnea may be treated with nasal continuous positive airway pressure (nCPAP) and weight loss, while patients with RLS or PLMD may use iron supplements, improve their sleep hygiene, and cut back on alcohol, caffeine, and smoking.
Are Energy Drinks Safe?
Some folks turn to energy drinks to help keep themselves alert, but health experts warn these could have serious health repercussions[22].
According to the National Center for Complementary and Integrative Health, the number of emergency-room visits due to energy drink consumption doubled between 2007 and 2011. They add that young people are particularly vulnerable to the dangers of energy drinks. It’s reported that college students who mix energy drinks with alcohol are more likely to binge drink, and kids who consume too much caffeine could comprise their developing cardiovascular and nervous systems.
It may also be unclear how much caffeine is in energy drinks or supplements since it’s not mandatory to list the amount on the label. Consuming too much caffeine can cause jitteriness, digestive issues, dehydration, heart and blood vessel problems, anxiety, and disrupt sleep patterns.
Find Out More: Caffeine and Sleep
Quantifying Excessive Daytime Sleepiness
There are two primary tests used to measure the effects of EDS on daily performance: the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test.
Multiple Sleep Latency Test (MLST)
This test[23] will likely be administered if your physician believes you may have Idiopathic Hypersomnia or Narcolepsy. During the test, you’re given 4-5 opportunities to fall asleep every two hours during the day. The specialist will examine your sleep latency (how fast you fall asleep) and how quickly you enter REM sleep.
An MLST is considered positive if a patient has an average sleep latency below 8 minutes with no more than one nap for Idiopathic Hypersomnia and two naps for Narcolepsy. The patient must also reach REM sleep.
Maintenance of Wakefulness Test (MWT)
The Maintenance of Wakefulness[24] Test is an exam performed during daytime hours that measures your ability to stay awake during situations that typically induce drowsiness. This test can also help determine how successful a patient’s treatment is.
Excessive Sleepiness and Workplace Accidents
Not only could tiredness result in more mistakes and reduced productivity, but it also increases the risk for workplace accidents and injuries[25]. This is because sleepiness impairs your cognitive abilities, which could be especially dangerous for folks whose jobs involve operating machines, driving a motor vehicle, flying a plane, working in the medical field, or serving in the armed forces. Even commuting to and from your home could become hazardous.
Research shows that sleep-deprived workers are 1.6 times[26] more likely to be injured on the job. Not only does EDS put yourself at risk but others as well. The Centers for Disease Control and Prevention recommends companies establish a workplace health program to promote good sleep among employees.
Excessive Daytime Sleepiness Among Children and Adolescents
It’s reported that sleep disorders linked to EDS are present in 25-40 percent[27] of children and adolescents. EDS can negatively impact school performance, relationships with family and friends, extracurricular activities, health, and driving.
The primary conditions[28] that could lead to EDS in teens are sleep deprivation, poor sleep hygiene, insomnia, circadian rhythm changes, chronic somatic pathologies, psychiatric disorders, movement disorders, respiratory disorders, parasomnias, and the use of drugs or medications.
Experts say that a young person may have EDS if they are snoozing more at night or during the day compared to others in their age group. Other warning signs are sleeping more than usual on weekends and vacations, difficulty waking up, or falling asleep at inappropriate moments like playing games or watching television.
To diagnose EDS, a doctor will need to review the patient’s medical history and conduct a physical exam. Feedback from teachers or caregivers may be included as well.
Although there is a range of treatment options for EDS in young people, including drug therapies, the health experts conclude that the preferred method is to implement behavioral and educational changes.
Frequently Asked Questions
Is excessive sleepiness common in women?
According to research, women experience better quality of sleep than men yet report more sleep-related issues. As mentioned earlier, one of the symptoms of Premenstrual Syndrome is increased tiredness. The scientists add that pregnancy and menopause[29] may also disrupt women’s sleeping patterns.
They found that some disorders linked to EDS are more common among women than men and vice-versa. For example, women are more likely to develop Restless Legs Syndrome, while men are more prone to REM Sleep Behavior Disorder and Kleine Levin syndrome.
Check Out Our Guide: Sleep During Pregnancy
How can I combat EDS when I work?
To ward off sleepiness at work, first, start by practicing good sleep hygiene at home. Maintain a steady sleep schedule, exercise regularly, avoid smoking, drugs, and alcohol, and don’t work or use your tech devices before bed.
In the event you still feel somnolent at work, these tips[30] should help you feel recharged.
- Stay hydrated
- Splash cold water on your face
- Limit your sugar intake
- Take regular breaks
- Connect with co-workers
- Work in a cooler space
- Play some music
- Take a walk
- Give yourself a massage
Why do I get sleepy after eating?
You may notice that after eating a large meal[31] you start to feel tired. According to scientists, the probable reason behind this is that more blood flows to the stomach to digest the food – meaning there’s less blood flow to the brain. The reduction in blood flow to the brain could cause you to feel lethargic.
Jill Zwarensteyn
Editor
About Author
Jill Zwarensteyn is the Editor for Sleep Advisor and a Certified Sleep Science Coach. She is enthusiastic about providing helpful and engaging information on all things sleep and wellness.
Combination Sleeper
Sources and References:
[1] James Brown, Himender K. Makker, “An approach to excessive daytime sleepiness in adults”, The BMJ, 2020.
[2] J.F. Pagel MD MS, “Excessive Daytime Sleepiness”, American Family Physician, 2009.
[3] “Excessive daytime sleepiness (hypersomnia)”, National Health Service, August 4, 2020.
[4] “Inadequate Sleep Hygiene”, Jefferson Univerisity Hospitals
[5] “The Link Between Sleep And Nicotine”, Henry Ford Health System, March 28, 2018.
[6] “Exercising for Better Sleep”, Johns Hopkins Medicine
[7] “Premenstrual syndrome (PMS)”, Mayo Clinic, February 7, 2020.
[8] Guglielmo Beccuti, Silvana Pannain, “Sleep and obesity”, National Center for Biotechnology Information
[9] “Hypersomnia: Symptoms, Causes, Definition and Treatments”, American Sleep Association
[10] “Narcolepsy”, Mayo Clinic, November 6, 2020.
[11] “Idiopathic hypersomnia”, National Center for Advancing Translational Sciences, February 1, 2021.
[12] “Kleine Levin syndrome”, National Center for Advancing and Translational Sciences, July 10, 2017.
[13] “Sleep apnea”, Mayo Clinic, July 28, 2020.
[14] “Fibromyalgia”, Mayo Clinic, October 7, 2020.
[15] “Hypothyroidism (underactive thyroid)”, Mayo Clinic, November 19, 2020.
[16] “Anemia”, Mayo Clinic, August 16, 2019.
[17] “Chronic fatigue syndrome”, Mayo Clinic, September 24, 2020.
[18] “Periodic Limb Movement Disorder (PLMD) in Adults”, Cleveland Clinic, July 21, 2012.
[19] Maria M. D’souza, Richa Trivedi, Rajendra Prashad Tripathi, “Traumatic brain injury and the post-concussion syndrome: A diffusion tensor tractography study”, National Center for Biotechnology Information, 2015.
[20] “Polysomnography (sleep study)”, Mayo Clinic, December 1, 2020.
[21] Dewey McWhirter MD, Charles Bae MD, Kumaraswamy Budur MD, “The Assessment, Diagnosis, and Treatment of Excessive Sleepiness”, National Center for Biotechnology Information, 2007.
[22] “Effects of Energy Drinks on the Cardiovascular System”, National Center for Biotechnology Information, Bishoy Wassef, Michelle Kohansieh, and Amgad N Makaryus, November 2017.
[23] “Multiple Sleep Latency Test – MLST”, Stanford Healthcare
[24] Karl Doghramji, Merrill mM. Mitler, James M. Youakim, “A normative study of the maintenance of wakefulness test (MWT)”, National Center for Biotechnology Information, 1997.
[25] “Sleep: An Important Health and Safety Concern at Work”, Centers for Disease Control and Prevention
[26] “Sleep Deficiency and Fatigue Causing More Workplace Injuries”, Eastern Kentucky University
[27] Judith A. Owens MD MPH, Debra Babcock MD, Miriam Weiss CPNP-PC, “Evaluation and Treatment of Children and Adolescents With Excessive Daytime Sleepiness”, National Center for Biotechnology Information, 2020.
[28] Matthieu Hein, Anais Mungo, Gwenolé Loas, “Excessive daytime sleepiness in adolescents: current treatment strategies”, National Center for Biotechnology Information, 2020.
[29] Vidya Krishnan, Nancy A. Collop, “Gender differences in sleep disorders”, National Center for Biotechnology Information, 2006.
[30] “How to Stay Awake at Work: Staying Productive When You Didn’t Get Enough Sleep”, Cigna, July 2018.
[31] “Does Eating Turkey Make Me Sleepy?”, Johns Hopkins All Children’s Hospital