Feeling tired? You’re not alone. It’s the number one symptom patients report in my practice. Excessive sleepiness (ES), also called idiopathic (or primary) hypersomnia, is incredibly common. Understand though, common doesn’t always mean normal. Let’s take a closer look at some of the factors that might lead a person to seek help for ES.
Symptoms: Unremitting tiredness, inability to stay awake and/or maintain focus on tasks, irritability and/or lethargy.
Causes: There are many causes of ES. As with all illness, it’s important to first find the underlying cause. Here are a few reasons why people are frequently tired:
Sleep Deprivation – simply restricting the time you spend getting restful sleep, whether it be due to a busy schedule because of work, school or raising children; each can affect your ability to wake rested and have sufficient energy to tackle the day.*1
Poor sleep quality – lying in bed all night, is no guarantee you are getting adequate sleep. Insomnia is one of the most common causes of daytime sleepiness. As a result, people take sleeping pills, in order to fall asleep. Of course, taking a pill to sleep has it’s own side effects (see below).
Diet: Our diets have radically changed in a relatively short period of time, creating numerous health related issues that affect our bodies ability to regulate our hormones, fight off illness and infections, which may further stress our body’s defenses. Frequent and chronic illness will cause sleepiness throughout the day, making it more important to get adequate sleep at night.
Sugars (and other artificial sweeteners) are the worst culprits in that they create a surge of energy, only to rebound into hypoglycemia (a symptom of ES in and of itself) creating fatigue and lethargy, which, in turn, causes cravings for more sugar.
Caffeine, another stimulant, creates a rush of excitation for a limited time, only to come crashing down again, causing a similar side effect like sugar – cravings for more caffeine.
Stimulant herbs (taurine, guarana, etc.) are a recent addition to our modern diets, arising in sport drinks and diet pills. They also create stimulant effects that may affect sleep patterns at night, causing sleepiness during the day. 2
Exercise: As an exercise physiologist, I frequently prescribe exercise for my patients. We, as a culture, aren’t getting enough movement in our lives. Engaging in a regular exercise program promotes* higher sleep quality, thereby decreasing* daytime sleepiness. 5
Hormone Imbalances: Another common cause of ES is a disruption of the normal levels of hormones in the body. Cortisol, a stress hormone secreted from the adrenal gland has a diurnal rhythm – highest in the morning and gradually declining throughout the day. If those levels are out of balance, falling asleep at night may be difficult.
Melatonin is another diurnal hormone that acts opposite cortisol – highest before bed and lowest in the morning. Frequent travel through multiple time zones will alter the normal rise and fall of melatonin, causing sleep disturbances and sleepiness during waking hours.
Alcohol has been shown to affect REM sleep – the stage of sleep most associated with restfulness upon awakening. Suppressing REM cycles causes poor rest and recovery, sleepiness during the day and poor focus. 3
Medications: A side effect of many commonly prescribed drugs is fatigue. I can’t tell you how many patients I’ve see who are tired because another doctor has prescribed one (or more) drugs that cause drowsiness themselves or multiple drugs that when taken together, cause an interaction of sleepiness, lethargy and an inability to focus, etc.
Sleeping pills (Ambian, Lunesta, Sonata, Halcyion, etc.) list daytime sleepiness as a side effect. This is because these pills don’t allow for the natural circadian rhythms of the body to progress from awake to asleep. The patient will certainly fall asleep but frequently, awake feeling unrested.
Trauma: Either physical or emotional. Head trauma, from car accidents, sports injuries, work-related accidents, can each cause the brain to alter its normal function, creating sleepiness, dizziness and the like.
Almost everyone has felt the effects of an emotional trauma; be it a breakup, loss of a loved one, major changes at work or home. When you can’t “turn your brain off”, it affects your sleep. When you don’t sleep at night, your body wants to sleep during the day.
As we’ve now seen, there are many causes of excessive sleepiness. Addressing the root cause of ES is essential. Treatment will therefore be specific to the patient’s needs:
Poor diet – Improve* food choice as well as quality
Sedentary lifestyle – Find an exercise prescription suited to your current level of fitness and maintain a regular exercise schedule.
Hormone imbalances – Consider appropriate laboratory testing, to determine which hormones (and to what extent those hormones) are suboptimal.
Poor sleep quality – Learn about sleep hygiene; the environment we create to sleep, to improve* both the quality and quantity of restful sleep you require.
Alcohol – If you aren’t able to reduce* (or stop) your alcohol consumption, consider a treatment protocol, such as Motivational Interviewing, Cognitive Behavior Therapy or Alcoholics Anonymous.
As a naturopathic physician, I look to resolve my patient’s ailments with the least invasive (re: powerful) interventions first. If, after less invasive measures fail, only then will I move up the ‘Therapeutic Spectrum’. For example, I wouldn’t prescribe a benzodiazepine (halcyon) for insomnia, without first understanding WHY my patient is having difficulty sleeping. Less potent and dangerous options are available, such as lifestyle changes (meditation, exercise, diet, etc.), which have been shown to be as good (and frequently better) than drugs, without the unnecessary burden on the liver and kidneys, while completely circumventing the body’s own healing mechanism.
 Huxtable RJ. Physiological actions of taurine. Physiol Rev. (1992)
 BENNINGTON, J.H., AND HELLER, H.C. Restoration of brain energy metabolism as the function of sleep. Progress in Neurobiology 45:347-365, 1995.
 Scand J Urol Nephrol. 2011 Nov;45(5):359-64. doi:. Epub 2011 Jun 27. Quality of sleep and day-time sleepiness in chronic hemodialysis: a study of 400 patients.
 Passos GS, Poyares D, Santana MG, Garbuio SA, Tufik S, de Mello MT. Effect of acute physical exercise on patients with chronic primary insomnia. J Clin Sleep Med. 2010;6(3):270-275.