Excessive Daytime Sleepiness

What excess daytime sleepiness feels like

How tired you are each day can vary. Not getting enough sleep can make you feel tired and less motivated and energized.

In severe cases, you may be so exhausted that you fall asleep while doing everyday tasks. When EDS is that bad, it can be dangerous as you could fall asleep while driving or operating machinery. It’s possible to have EDS even if you think you’re getting a decent night’s sleep.

Symptoms you may have with EDS include:

• Memory loss
• Unable to concentrate or focus
• Slower reaction time
• Feeling irritable
• Difficulty learning or retaining new concepts
• Headaches
• Lightheadedness
• Loss of appetite
• Lack of judgment

The sleepiness quiz

Doctors recommend the Epworth Sleepiness Scale to see if you have EDS and how severe it is. You rank your likelihood of falling asleep during 8 common scenarios—like watching TV, talking to someone, riding as a passenger in a car. Your score is tallied and rated. For example, 5 means you have a “lower normal daytime sleepiness,” while a score of 24 is considered “severe excessive daytime sleepiness.”

Common causes

1 . Obstructive sleep apnea

Obstructive sleep apnea, or OSA, causes you to have apneas (absences of breathing) and/or decreased breathing rate while sleeping. Your oxygen level drops and you may wake up multiple times during the night.

OSA is from a blockage that prevents air from entering your upper airway. It’s most commonly caused by excess tissue around and in the neck, throat, and airway. Being overweight or obese increases your chance of having this excess tissue.

Very common: OES is most likely to affect adults 30–60 years old, occurring in 9% of women and 24% of men in that age group. People with obesity and the elderly are more likely to have OSA [Source: American Family Physician].

Symptoms you may have:

• Excessive daytime sleepiness
• Excessive snoring
• Waking up often during sleep
• Unable to pay attention during the day

Treatment and urgency: The majority of people with OSA are undiagnosed. If you have EDS and snore, tell your doctor as soon as possible. If left untreated, OSA can lead to serious health issues, including diabetes, stroke, and heart attacks. Treatment includes:

• Mouthpieces and devices that help open your airway while you sleep, such as a continuous positive airway pressure (CPAP) machine
• Surgery

2. Sleep deprivation

Sleep deprivation occurs when you don’t get enough quality sleep. You may not be giving yourself enough time to sleep. Or you may have a condition such as insomnia (difficulty falling or staying asleep), narcolepsy, or idiopathic hypersomnia. Some mood disorders, such as bipolar disorder, can also prevent you from getting enough quality sleep.

Very common: This is the most common cause of EDS.

Symptoms you may have:

• Daytime hyperarousal (when sleep deprivation is caused by chronic insomnia)
• Mood and behavior changes (short temper, anxiety)
• Difficulty concentrating
• Problems planning, organization, and judgment

Treatment and urgency: Sleep deprivation is not an emergency, but some causes should be identified and treated as soon as possible. Treatment depends on the cause. For example, if bipolar disorder is causing insomnia, your doctor will recommend mood-stabilizing medications or antipsychotics. If you have insomnia, you may have to change your bedtime routine and other daily habits, like limiting screen time at night or avoiding caffeine.

3. Depression

Depression causes overwhelming feelings of sadness, loss of self-worth, decreased interest in activities you once enjoyed, and thoughts of hopelessness.

Very common: Depression affects 1 in 15 adults annually. It occurs 1 in 6 people at some point throughout their life [Source: JAMA Psychiatry].

Symptoms you may have: 

• Isolating yourself from others
• Poor energy
• Loss of appetite
• Low self-worth or self-esteem
• Engaging in purposeless activities

Treatment and urgency: See a doctor or mental health provider if you have symptoms of depression, particularly if it's severe. Get help immediately if you have thoughts of suicide. Treatment includes:

• Talk therapy to help identify the underlying causes of your depression and how to work through it
• Antidepressant medications such as Lexapro or Prozac
• Treatments such as electroconvulsive therapy or ketamine infusions (usually only recommended when other therapies have failed)

4. Attention-deficit/hyperactivity disorder (ADHD)

ADHD is a neurodevelopmental disorder that is often diagnosed in childhood. There are two main types of ADHD: inattentive or hyperactive-impulsive.

People with inattentive ADHD tend to have difficulties engaging and finishing tasks, following instructions, and completing conversations. Those with hyperactive-impulsive ADHD tend to have excessive energy, interrupt others, and speak at inappropriate times. Some people have symptoms of both types.

Common: ADHD affects an estimated 9–10% of children in the U.S. [Source: CDC].

Symptoms you may have:

• Excessive daydreaming
• Fidgeting
• Forgetfulness
• Difficulty interacting with others
• Excessive talking

Treatment and urgency: See your doctor if you have symptoms of ADHD. Treatment includes:

• Cognitive behavioral therapy (CBT), which can help you better understand your illness and learn how to control your behaviors
• Medications that help with symptoms, like Vyvanse or Adderall

5. Narcolepsy

Narcolepsy is a sleep disorder that causes episodes of overwhelming sleepiness (“sleep attacks”) throughout the day. It affects the brain’s ability to control sleep-wake cycles.

There are two types of narcolepsy. People with type 1 experience cataplexy (episodes of muscle weakness triggered by emotions). They also have low levels of a brain hormone called hypocretin, which helps regulate states of sleep and awakening. Type 1 may be an autoimmune disorder. Type 2 is less understood and usually doesn’t cause cataplexy or low levels of hypocretin.

Relatively rare: Type 1 is more common than type 2.

Symptoms you may have:

• Cataplexy (type 1)
• Disrupted nighttime sleep
• Sleep paralysis
• Sleep-related hallucinations

Treatment and urgency: See your doctor right away if you have symptoms of narcolepsy. Sleep attacks can occur in dangerous situations, like while you’re driving. Treatment includes:

• Practicing good sleep hygiene, which includes avoiding stimulating tasks before bed, sleeping in a dark room without your phone or other devices, and trying not to stay up late.
• Medications that help keep you awake, such as modafinil and methylphenidate.

FAQs about daytime sleepiness

These are some frequently asked questions about daytime sleepiness.

Can depression cause daytime sleepiness?

Yes. Depression and other medical conditions, including other psychiatric conditions like anxiety, substance abuse, and bipolar disorder, can cause EDS. Sleep disorders like insomnia and narcolepsy and certain disorders like Parkinson's disease and multiple sclerosis can cause daytime sleepiness.

What medications can affect sleepiness?

Antianxiety drugs like benzodiazepines, antihistamines, anti-seizure drugs, sedating antidepressants, and antipsychotics can all cause sleepiness. Additionally, alcohol, narcotics, or stimulant withdrawal (such as caffeine and cocaine) can also cause sleepiness.

Why am I always tired after eating?

There are many theories that may explain sleepiness after eating a large meal. Large meals may activate the parasympathetic nervous system, which causes sleepiness. Insulin released to process sugar may also increase brain levels of tryptophan, an amino acid that can make you feel sleepy.