Facts About Problem Sleepiness

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Originally published by the National Heart, Lung, and Blood Institute (NIH Publication No. 97-4071). U.S. government work, public domain. Reproduced as archived reference, not current guidance.

FACTS ABOUT

Problem Sleepiness

WHAT IS PROBLEM SLEEPINESS?

Everyone feels sleepy at times. However, when sleepiness interferes with daily routines and activities, or reduces the ability to function, it is called “problem sleepiness.” A person can be sleepy without realizing it. For example, a person may not feel sleepy during activities such as talking and listening to music at a party, but the same person can fall asleep while driving home afterward.

You may have problem sleepiness if you:

n consistently do not get enough sleep, or get poor quality sleep;

n fall asleep while driving;

n struggle to stay awake when inactive, such as when watching television or reading;

n have difficulty paying attention or concentrating at work, school, or home;

n have performance problems at work or school;

n are often told by others that you are sleepy;

n have difficulty remembering;

n have slowed responses;

n have difficulty controlling your emotions;

or n must take naps on most days.

WHAT CAUSES PROBLEM SLEEPINESS?

Sleepiness can be due to the body’s natural daily sleep-wake cycles, inadequate sleep, sleep disorders, or certain drugs.

Sleep-Wake Cycle

Each day there are two periods when the body experiences a natural tendency toward sleepiness: during the late night hours (generally between midnight and 7 a.m.) and again during the midafternoon (generally between 1 p.m. and 4 p.m.). If people are awake during these times, they have a higher risk of falling asleep unintentionally, especially if they haven’t been getting enough sleep.

Inadequate Sleep

The amount of sleep needed each night varies among people. Each person needs a particular amount of sleep in order to be fully alert throughout the day. Research has shown that when healthy adults are allowed to sleep unrestricted, the average time slept is 8 to 8.5 hours. Some people need more than that to avoid problem sleepiness; others need less.

If a person does not get enough sleep, even on one night, a “sleep debt” begins to build and increases until enough sleep is

obtained. Problem sleepiness occurs as the debt accumulates. Many people do not get enough sleep during the work week and then sleep longer on the weekends or days off to reduce their sleep debt. If too much sleep has been lost, sleeping in on the weekend may not completely reverse the effects of not getting enough sleep during the week.

Sleep Disorders

Sleep disorders such as sleep apnea, narcolepsy, restless legs syndrome, and insomnia can cause problem sleepiness. Sleep apnea is a serious disorder in which a person’s breathing is interrupted during sleep, causing the individual to awaken many times during the night and experience problem sleepiness during the day. People with narcolepsy have excessive sleepiness during the day, even after sleeping enough at night. They may fall asleep at inappropriate times and places. Restless legs syndrome (RLS) causes a person to experience unpleasant sensations in the legs, often described as creeping, crawling, pulling, or painful. These sensations frequently occur in the evening, making it difficult for people with RLS to fall asleep, leading to problem sleepiness during the day. Insomnia is the perception of poor-quality sleep due to difficulty falling asleep, waking up during the night with difficulty returning to sleep, waking up too early in the morning, or unrefreshing sleep. Any of these sleep disorders can cause problem sleepiness. See page 4 for information on how to order fact sheets about the above sleep disorders.

Medical Conditions/Drugs PROBLEM SLEEPINESS AND ADOLESCENTS

Certain medical conditions and drugs, including prescription med- Many U.S. high school and college ications, can also disrupt sleep and students have signs of problem cause problem sleepiness. Examples sleepiness, such as: include:

n difficulty getting up for school; n Chronic illnesses such as asthma,

congestive heart failure, rheumatoid arthritis, or any other chronically painful disorder;

n falling asleep at school; and/or n struggling to stay awake while doing homework.

n Some medications to treat high

The need for sleep may be 9 hours

blood pressure, some heart medica-

or more per night as a person goes

tions, and asthma medications such

through adolescence. At the same

as theophylline;

time, many teens begin to show a

n Alcohol—Although some people use alcohol to help themselves fall asleep, it causes sleep disruption during the night, which can lead to problem sleepiness during the day.

preference for a later bed time, which may be due to a biological change. Teens tend to stay up later but have to get up early for school, resulting in their getting much less Alcohol is also a sedating drug that sleep than they need.

can, even in small amounts, make a

Many factors contribute to problem

sleepy person much more sleepy

sleepiness in teens and young adults,

and at greater risk for car crashes

but the main causes are not getting

and performance problems;

enough sleep and irregular sleep

n Caffeine—Whether consumed in

schedules. Some of the factors that

coffee, tea, soft drinks, or medica-

influence adolescent sleep include:

tions, caffeine makes it harder for n social activities with peers that many people to fall asleep and stay lead to later bedtimes; asleep. Caffeine stays in the body n homework to be done in the for about 3 to 7 hours, so even evenings; when taken earlier in the day it

can cause problems with sleep at night; and n Nicotine from cigarettes or a skin patch is a stimulant and makes it

n early wake-up times due to early school start times; n parents being less involved in setting and enforcing bedtimes; and harder to fall asleep and stay n employment, sports, or other asleep. extracurricular activities that decrease the time available for sleep.

Teens and young adults who do not get enough sleep are at risk for problems such as:

n automobile crashes;

n poor performance in school and poor grades;

n depressed moods; and n problems with peer and adult relationships.

Many adolescents have part-time jobs in addition to their classes and other activities. High school students who work more than 20 hours per week have more problem sleepiness and may use more caffeine, nicotine, and alcohol than those who work less than 20 hours per week or not at all.

SHIFT WORK AND PROBLEM SLEEPINESS

About 20 million Americans (20 to 25 percent of workers) perform shift work. Most shift workers get less sleep over 24 hours than day workers. Sleep loss is greatest for night shift workers, those who work early morning shifts, and female shift workers with children at home. About 60 to 70 percent of shift workers have difficulty sleeping and/or problem sleepiness.

The human sleep-wake system is designed to prepare the body and mind for sleep at night and wakefulness during the day. These natural rhythms make it difficult to sleep during daylight hours and to stay awake during the night hours, even in people who are well rested. It is possible that the human body never

completely adjusts to nighttime activity and daytime sleep, even in those who work permanent night shifts.

In addition to the sleep-wake system, environmental factors can influence sleepiness in shift workers. Because our society is strongly day-oriented, shift workers who try to sleep during the day are often interrupted by noise, light, telephones, family members, and other distractions. In contrast, the nighttime sleep of day workers is largely protected by social customs that keep noises and interruptions to a minimum.

Problem sleepiness in shift workers may result in:

n increased risk for automobile crashes, especially while driving home after the night shift;

n decreased quality of life;

n decreased productivity (night work performance may be slower and less accurate than day performance); and/or n increased risk of accidents and injuries at work.

WHAT CAN HELP?

Sleep—There Is No Substitute!

Many people simply do not allow enough time for sleep on a regular basis. A first step may be to evaluate daily activities and sleep-wake patterns to determine how much sleep is obtained. If you are consistently getting less than 8 hours of sleep per night, more sleep may be needed. A good approach is to gradually move to an earlier bed-

time. For example, if an extra hour If You’re Sleepy—Don’t Drive! of sleep is needed, try going to bed A person who is sleepy and drives is 15 minutes earlier each night for at high risk for an automobile crash. four nights and then keep the last Planning ahead may help reduce bedtime. This method will increase that risk. For example, the followthe amount of time in bed without ing tips may help when planning a causing a sudden change in schedlong distance car trip: ule. However, if work or family

n Get a good night’s sleep before

schedules do not permit the earlier

leaving.

bedtime, a 30- to 60-minute daily nap may help. n Avoid driving between midnight

and 7 a.m.

Medications/Drugs n Change drivers often to allow for

rest periods.

In general, medications do not help problem sleepiness, and some make n Schedule frequent breaks. it worse. Caffeine can reduce sleepiness and increase alertness, but only If you are a shift worker, the followtemporarily. It can also cause probing may help: lem sleepiness to become worse by

n decreasing the amount of night

interrupting sleep.

work;

While alcohol may shorten the time

n increasing the total amount of

it takes to fall asleep, it can disrupt

sleep by adding naps and length-

sleep later in the night, and there-

ening the amount of time allotted

fore add to the problem sleepiness.

for sleep;

Medications may be prescribed for

n increasing the intensity of light

patients in certain situations. For

at work;

example, the short-term use of

n having a predictable schedule of

sleeping pills has been shown to be

night shifts;

helpful in patients diagnosed with

n eliminating sound and light in the

acute insomnia. Long-term use of

bedroom during daytime sleep;

sleep medication is recommended only for the treatment of specific n using caffeine (only during the sleep disorders. first part of the shift) to promote

alertness at night; or n possibly using prescription sleeping pills to help daytime sleep on an occasional basis (check with your doctor).

If you think you are getting enough sleep, but still feel sleepy during the day, check with your doctor to be sure your sleepiness is not due to a sleep disorder.

WHERE TO GET MORE INFORMATION

For additional information on sleep and sleep disorders, contact the following offices of the National Heart, Lung, and Blood Institute of the National Institutes of Health: n National Center on Sleep Disorders Research (NCSDR)

The NCSDR supports research, scientist training, dissemination of health information, and other activities on sleep and sleep disorders. The NCSDR also coordinates sleep research activities with other Federal agencies and with public and nonprofit organizations.

National Center on Sleep Disorders Research National Institutes of Health Two Rockledge Centre Suite 7024 6701 Rockledge Drive, MSC 7920 Bethesda, MD 20892-7920 (301) 435-0199 (301) 480-3451 (fax) n National Heart, Lung, and Blood Institute Information Center

The Information Center acquires, analyzes, promotes, maintains, and disseminates programmatic and educational information related to sleep and sleep disorders. Write for a list of available publications or to order additional copies of this fact sheet.

U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES

Public Health Service

National Institutes of Health

National Heart, Lung, and Blood Institute

NIH Publication No. 97-4071

September 1997