Causes of Excessive Sleepiness

Simply put: problems with sleep, problems with the brain mechanisms that should keep one awake, or a combination of both.When sleepiness is severe and chronic, the following conditions are the major suspects:

Sleep apnea/related breathing abnormalities during sleep are the leading causes of severe sleepiness beginning or progressively worsening in adulthood. They are exceedingly common, can cause other serious medical complications and typically are quite treatable without medications.

Narcolepsy, a condition as common as multiple sclerosis, causes chronic, lifelong sleepiness and in some cases, symptoms related to altered timing of rapid eye movement (REM or 'dream') sleep or its component parts. Many narcoleptics recall vivid dreaming that begins within minutes of falling asleep, because they enter REM sleep too quickly. They may even begin dreaming when drowsy (hypnagogic hallucinations). Narcoleptics are more likely than normals to experience the paralysis normally restricted to REM sleep when first dozing off or upon awakening (sleep paralysis: frightening but harmless). Cataplexy involves attacks of muscle weakness (sagging face, bobbing head, inability to speak, buckling knees) triggered by emotions like laughter, excitement or anger: again, the paralysis of REM sleep occurring at the wrong time! Narcolepsy, a brain chemical imbalance, sometimes runs in families, usually beginning in the teens or twenties but occasionally in later life. It is treated by medications and avoidance of aggravating factors.

Idiopathic CNS (Central Nervous System) Hypersomnia probably can result from a number of different brain chemical imbalances with a similar consequence: chronic sleepiness, without the REM sleep-related symptoms typical of narcolepsy. Idiopathic hypersomnia can begin at the same age as narcolepsy. Its treatment is quite similar: medications and avoidance of aggravating factors. It is important to realize that many patients who have been misdiagnosed as idiopathic hypersomnia actually suffer from a subtle breathing disorder related to sleep apnea (Upper airway resistance syndrome) which is easier to treat in most cases than idiopathic hypersomnia, and it is easily missed by conventional sleep monitoring techniques. Hence, it is important to ensure that the sleep center at which you seek help is equipped to detect this very common condition.

Other causes of abnormal sleepiness include causes of sleep disruption other than breathing problems, insufficient sleep, head injuries, other brain disorders, alcohol, many prescribed and over-the-counter medications, some toxic chemicals, chronic infections, hormonal imbalances such as hypothyroidism, depression and other mood disorders. Often, treatable sleep disorders are misdiagnosed as 'chronic fatigue syndrome'.

Finally, all that looks like sleepiness may not be-For example, "low grade" seizure activity sometimes provokes staring spells, inattention, and confused, sluggish-appearing behavior mimicking sleepiness.

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Causes of Excessive Sleepiness