What Is Excessive Sleepiness
Excessive sleepiness is often diagnosed in association with other sleep disorders such as obstructive sleep apnea , narcolepsy, and even shift work sleep disorder. It is marked by feeling sleepy, drowsy, or groggy during the daytime. If you have excessive sleepiness, you may find it hard to stay alert at work or you may start drifting off at inappropriate times, even when you dont mean to. You may also feel irritable or anxious. Excessive sleepiness is not just feeling tired. Its not the same as fatigue, which is characterized by a lack of energy and a need to rest . Its also different from depression, in which you may lose interest in normal activities that you used to enjoy.
Poor Quality Sleep Reduces Resilience
In a recent Johns Hopkins study, healthy women and men whose sleep wasinterrupted throughout the night had a 31 percent reduction in positivemoods the next day. Sleep interruptions interfere with deep, restorativeslow-wave sleep, explains lead researcher Patrick Finan, Ph.D. Ongoing insomnia could increase a persons risk of depression, he says, byweakening their emotional resiliencethe buffer of positive emotions thathelps people deal with stress and challenges of life.
Implications For Clinical Practice And Public Health Policy
In summary, our data indicate that obesity and weight gain play a key role in the development and chronicity of EDS, whereas weight loss is associated with its remission. Furthermore, EDS in individuals with depression is associated with objective sleep disturbances, while increased physiologic sleep propensity is an independent predictor of EDS. These data suggest potentially different etiologic mechanisms for the complaint of EDS in the presence of psychiatric disorders, i.e., physiologic hyperarousal vs. central nervous system hypoarousal. Future clinical studies should test whether the complaint of EDS in depression may respond better to treatments targeting mood and nighttime sleep disturbances rather than pharmacological agents increasing physiologic alertness, and whether extending sleep and/or enhancing alertness through pharmacological agents prevent EDS in individuals with physiologic sleep propensity. From a public health policy perspective, this study suggests that obesity, depression, and sleep disorders should be a priority in the prevention and reduction of EDS in the general population.
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Sleep And Mental Health
The relationship between sleep and mental health is complex and not fully understood. Disordered sleep, clinical depression, anxiety, and other psychiatric conditions are closely linked. People with sleep disorders are more likely to have depression, and other mental health diagnoses. Sleep disorders can also cause emotional changes. Mood disorders can also disrupt sleep, causing insomnia or hypersomnia .
The Centers for Disease Control and Prevention recommend at least seven hours of nighttime sleep for adults. Teens should get eight to 10 hours of sleep each night. A recent study found that teenagers were less likely to experience depression and suicidal thoughts when they went to sleep earlier. Teens who got fewer than five hours of sleep per night were 71 percent more likely to experience depression.
When To Talk To Your Doctor
You should see a doctor if youre feeling tired all the time, if excessive daytime sleepiness is affecting your day-to-day life, or if you believe it might be a sign of an underlying disorder.
Your doctor will run tests and ask questions about your sleep habits to attempt to pinpoint the reason for your sleepiness. They may also ask your bed partner whether you gasp, snore, or move your legs during the night. If they suspect a sleep disorder, they may refer you to a sleep specialist to run more tests.
Treatment methods for daytime sleepiness depend on the cause. The doctor will likely start by recommending sleep hygiene tips and encourage you to get more sleep. They may adjust the medications you take, and they will also work with you to develop a treatment plan for underlying disorders, which need to be treated in their own right.
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Effect Of Cpap On Eds And Symptoms Of Depression In Osa
Various conservative behavioral therapies are also used for OSA and CPAP is commonly chosen to treat OSA. Numerous studies have been conducted to evaluate the efficacy and/or effectiveness of CPAP in treating a wide range of OSA symptoms. Baseline sleepiness is the only factor predictive of compliance , and a high depression score is associated with non-compliance with CPAP . When nasal CPAP is titrated properly, hypopnea and apnea in patients with OSA syndrome are abolished completely, and arousal and oxygen desaturation disappear during CPAP once OSA is successfully treated . Since repetitive arousal or oxygen desaturation in brain tissue during sleep presumably contributes to the development of depression, a more complete understanding of the relationship between OSA and depression can be appreciated by examining changes in depressive symptoms .
Short-Term Treatment
Long-Term Treatment
These findings emphasize the importance of close follow-up of EDS and depressive symptoms once CPAP treatment is initiated in patients with OSA. It is regrettable that most of the current studies were related to OSA with depressive symptoms, and there is a lack of studies on CPAP for treatment of OSA comorbid depression. Skepticism has been expressed concerning the effectiveness of CPAP because of a lack of randomized controlled trials.
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Tips For Sleeping Better
Sleep problems can increase the risk of initially developing depression, and persistent sleep issues can also increase the risk of relapse in people who have successfully been treated for depression. As a result, taking some of the following steps can both help you sleep better, boost your mood, and help decrease some of the problematic symptoms of depression.
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Depression And Sleep: Understanding The Connection
Depression and sleep problems are closely linked. People withinsomnia, for example, may have a tenfold higher risk of developing depression thanpeople who get a good nights sleep. And among people with depression, 75percent have trouble falling asleep or staying asleep.
Which comes first? Either one can be the starting point, says Johns Hopkins sleep researcher Patrick H. Finan, Ph.D. Poor sleep may create difficulties regulating emotions that, in turn, may leave you more vulnerable to depression in the futuremonths or even years from now. And depression itself is associated with sleep difficulties such as shortening the amount of restorative slow-wave sleep a person gets each night.
If you have depression , daily stressessuch as financial worries, an argument with your spouse, or a jam-packed evening commutecould also lead to more nighttime wake-ups and more trouble getting back to sleep than someone without depression would experience.
Understanding the relationship between insomnia and depression can help you spot risks early, get the right help, and recover more fully if you are experiencing both. Youll feel healthy, well-rested, and able to enjoy life again. Heres what you need to know about depression and sleep:
Behaviorally Induced Insufficient Sleep Syndrome
Behaviorally induced insufficient sleep syndrome , or self-induced sleep restriction, is an individualized clinical entity in the ICSD-2 . BIISS requires three criteria: EDS complaint lasting at least three months, shorter than expected habitual main sleep episode and extended sleep when the habitual sleep schedule is not maintained . No epidemiological study has investigated BIISS prevalence in the general adult population. However, one study reported a 7.1% prevalence in outpatient clinic patients with a complaint of EDS . From computerized self-report questionnaires, estimated BIISS prevalence was 10.4% in a large Norwegian cohort of students and associated with severe self-reported depressed mood . Interestingly, the presence of BIISS was recently found to increase suicidal tendencies in Korean adolescents, even after controlling for BDI scores . The limitations of these studies are the use of self-report measures and cross-sectional designs. Longitudinal approaches are needed to confirm the causal relationship between BIISS and mood disorder development.
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Definition And Assessment Of Mood Disorders
However, these questionnaires should be interpreted with caution when assessing the presence and severity of depressive symptoms, higher scores being potentially without a diagnosis of mood disorder and vice versa. Similar scores using these questionnaires may also obscure important individual differences in the relative severity and frequency of somatic/affective versus cognitive symptomatology. Accordingly, we must emphasize that somatic and cognitive symptoms can be signs of physical illness and that self-report questionnaires often over-identify depression in clinical populations , such as patients with central hypersomnias.
Excessive Daytime Sleepiness In Depression And Obstructive Sleep Apnea: More Than Just An Overlapping Symptom
- 1Department of Psychology, Zhenjiang Mental Health Center, Zhenjiang, China
- 2Department of Psychiatry, Zhenjiang Mental Health Center, Zhenjiang, China
Excessive daytime sleepiness is a significant public health concern, with obstructive sleep apnea being a common cause, and a particular relationship exists with the severity of depression. A literature search on OSA, depression, and EDS was performed in PubMed. The chosen evidence was limited to human studies. Available evidence was systematically reviewed to ascertain the association of EDS with depression and OSA according to the general population and some specific population subgroups. In addition, effectiveness of continuous positive airway pressure was analyzed as a standard therapy for improving EDS and depression in patients with OSA. In the general population, patients with OSA, and some other subpopulations, the review contributed to: delineating the prevalence of EDS substantiating the relationship of EDS and depression presenting the relationship between EDS and OSA and revealing that the duration of CPAP is crucial for its therapeutic effects in improving EDS and depressive symptoms in patients with OSA.
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How Is Depression Diagnosed
Depression can only be diagnosed by a medical professional, so people experiencing symptoms of depression should talk with their doctor, counselor, or psychiatrist. They may ask about the severity of the symptoms and how long theyve persisted. They may also suggest tests that can help them to better understand your situation and monitor changes or improvements over time.
A provider may also refer patients to a specialist in sleep disorders to help determine if there is an underlying sleep disorder, such as sleep apnea or restless leg syndrome, that may be causing depression or contributing to symptoms.
Tips For Coping With Depression
In addition to talking to a provider about treatments for depression, there are several steps you can take on your own:
- Exercise: Low-intensity exercise, even walking 10 minutes a day, can lead to improvements in mood and physical health. For some people with mild to moderate depression, exercise can work as effectively as an antidepressant.
- Support: Experiencing depression can feel isolating and hopeless, so remember that youre not alone. Spend time with others, talk about what youre experiencing, and try not to isolate yourself.
- Be realistic: Even with effective treatment, symptoms of depression may improve gradually.
Having depression can increase thoughts of suicide. If you or someone you know is in crisis, the National Suicide Prevention Lifeline provides 24/7, free and confidential support.
National Suicide Prevention Lifeline
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Incidence Persistence And Remission Of Eds
As stated above, up to 30% of the general population complains of EDS, depending on the definition used., For example, 8% to 10% of the general population has moderate-to-severe complaints of EDS., Using this latter definition, we found that the incidence of EDS is about 8% and that it is very likely to remit , with only about 38% persisting with the complaint after a long follow-up. This scenario is similar to that of poor sleep, which is more likely to remit, while insomnia is a highly persistent disorder., Thus, this study further suggests that EDS is a symptom rather than a disorder per se .,,
Types Of Depressive Disorders
Significant feelings of sadness or a loss of interest in their normal daily activities are common in all depressive disorders. Specific forms of depression vary based on the severity of symptoms and the situation in which they develop.
The most well-known type is major depressive disorder, and it is marked by symptoms that affect a person virtually every day for an extended period of time. It commonly involves sleep disruptions.
Persistent depressive disorder, also called dysthymia or chronic depression, may involve fewer symptoms than major depression, but symptoms last for at least two years and any symptom-free period lasts no longer than two months.
Other types of depression, such as premenstrual dysphoric disorder and seasonal affective disorder tend to come and go over shorter periods but can also involve significant sleeping problems.
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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 may also disrupt womens 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.
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How Are Depression And Sleep Related
Depression and sleep are closely connected. Almost all people with depression experience sleep issues. In fact, doctors may hesitate to diagnose depression in the absence of complaints about sleep.
Depression and sleep issues have a bidirectional relationship. This means that poor sleep can contribute to the development of depression and that having depression makes a person more likely to develop sleep issues. This complex relationship can make it challenging to know which came first, sleep issues or depression.
Sleep issues associated with depression include insomnia, hypersomnia, and obstructive sleep apnea. Insomnia is the most common and is estimated to occur in about 75% of adult patients with depression. It is believed that about 20% of people with depression have obstructive sleep apnea and about 15% have hypersomnia. Many people with depression may go back and forth between insomnia and hypersomnia during a single period of depression.
Sleep issues may contribute to the development of depression through changes in the function of the neurotransmitter serotonin. Sleep disruptions can affect the bodys stress system, disrupting circadian rhythms and increasing vulnerability for depression.
Fortunately, people who are treated for major depression often report improved quality of their sleep.
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Obesity And Depression Have Role In Excessive Daytime Sleepiness
Obesity and depression not only lack of sleep are underlying causes for regular drowsiness, according to Penn State College of Medicine researchers. They say the findings could lead to more personalized sleep medicine for those with excessive daytime sleepiness .
As much as 30 percent of the general population experiences EDS daytime drowsiness or sleepiness occurring most of the day that can include irresistible sleep attacks. Feeling overly tired during the day can reduce job productivity and increase errors and absenteeism and may lead to more serious issues like car crashes.
Previous research has associated EDS with obesity, depression and sleep apnea, but the new study is the first to use physiologic sleep data to infer causation and investigate mechanisms. It is also the first observational study of EDS over several years.
The researchers measured self-reporting of EDS at baseline and again an average of 7.5 years later in 1,395 men and women. Study participants completed a comprehensive sleep history and physical examination and were evaluated for one night in a sleep laboratory. The researchers also recorded sleep, physical and mental health problems and substance use and determined whether participants were being treated for physical and mental health conditions.
The association between body mass index and sleepiness was independent of sleep duration, meaning obese people may be tired during the day no matter how much they sleep at night.
The Complex Relationship Between Narcolepsy And Depression
People with narcolepsy are at an increased risk of being diagnosed with depression. Some studies indicate as many as 57 percent of people with narcolepsy have depression.
Sleep deprivation is closely linked to depression. One study found that disordered sleep in teenagers preceded depression 69 percent of the time. People with narcolepsy have low levels of a hormone called hypocretin in the fluid around the brain. This contributes to being chronically under-rested and experiencing severe excessive daytime sleepiness, and it may also contribute to feelings of depression.
People with type 1 narcolepsy also report more vivid dreams. These dreams can prevent fully restful nighttime sleep.
Depression and narcolepsy also share several of the same symptoms. For example, about 40 percent of young adults and 10 percent of older people with depression experience hypersomnia, which also includes excessive daytime sleepiness. This overlap of symptoms may contribute to misdiagnosis and the diagnostic delays frequently experienced by people with narcolepsy.
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Obesity Depression Have Role In Excessive Daytime Sleepiness
- Date:
- Penn State Milton S. Hershey Medical Center
- Summary:
- Obesity and depression not only lack of sleep are underlying causes for regular drowsiness, according to researchers. They say the findings could lead to more personalized sleep medicine for those with excessive daytime sleepiness .
Obesity and depression not only lack of sleep are underlying causes for regular drowsiness, according to Penn State College of Medicine researchers. They say the findings could lead to more personalized sleep medicine for those with excessive daytime sleepiness .
As much as 30 percent of the general population experiences EDS daytime drowsiness or sleepiness occurring most of the day that can include irresistible sleep attacks. Feeling overly tired during the day can reduce job productivity and increase errors and absenteeism and may lead to more serious issues like car crashes.
Previous research has associated EDS with obesity, depression and sleep apnea, but the new study is the first to use physiologic sleep data to infer causation and investigate mechanisms. It is also the first observational study of EDS over several years.
Obesity and weight gain predicted who was going to have daytime sleepiness, said Julio Fernandez-Mendoza, assistant professor of psychiatry at the Sleep Research and Treatment Center at Penn State College of Medicine. Moreover, weight loss predicted who was going to stop experiencing daytime sleepiness, reinforcing the causal relationship.