Excessive Sleepiness: Is It Narcolepsy or Something Else?

A long-standing issue—excessive daytime sleepiness?!

Hello Dr.
Chen,
This is my first time writing to seek advice regarding sleep disorders.
I have been experiencing this issue since the third year of middle school, where I would unintentionally fall asleep during class.
Because I was afraid of falling asleep in class, I would take naps after school.
However, the problem did not improve and continued through high school and college, although it wasn't very severe.
Recently, I have noticed that I also tend to fall asleep while riding my scooter.
Occasionally, I can feel myself getting drowsy while riding, and I try to control it, but I find it difficult.
At home, while sitting and watching TV, I sometimes also fall asleep unintentionally.
There have been instances where I have dozed off while standing, but those occurrences are rare.

I have visited Chi Mei Medical Center a few times, but the doctor said it is not narcolepsy because my condition is not severe enough to be classified as such.
However, the doctor could not identify the underlying cause and only prescribed medication for depression.
Therefore, I would like to ask if I might have narcolepsy.
If so, where should I seek treatment? I am from Tainan.
Thank you!

Qia Zhu, 20~29 year old female. Ask Date: 2009/05/06

Dr. Chen Yuying reply Psychiatry

Hello, regarding daytime sleepiness, there are many potential causes.
First, the most common cause is "insufficient sleep syndrome," which refers to inadequate nighttime sleep leading to excessive daytime drowsiness.
If this is the case, it is essential to actively improve the quality and duration of nighttime sleep; a good night's sleep will result in better alertness during the day.
The second most common cause is "sleep apnea syndrome," where patients experience sudden cessation of breathing during sleep, lasting more than 10 seconds at a time, resulting in oxygen deprivation.
This condition is often seen in individuals who are overweight or have enlarged tonsils.
Symptoms include loud snoring, choking, or gasping for air during sleep.
Patients are often unaware of their breathing interruptions and may only feel fatigued during the day, while roommates or partners may notice the loud snoring.
Sleep apnea requires a comprehensive evaluation in a sleep laboratory.
The mainstream treatment involves using a continuous positive airway pressure (CPAP) device to reduce the frequency of breathing interruptions.
The third common cause is "narcolepsy," a condition where individuals suddenly fall asleep in inappropriate situations, such as at work or while driving.
Symptoms include sudden neck weakness leading to head drooping or falling backward asleep, and sudden leg weakness causing the person to collapse while standing.
This may also be accompanied by hallucinations or sleep paralysis (commonly referred to as "sleeping demons").
Due to its distinctive symptoms, narcolepsy often becomes material for movies or news reports.
Like sleep apnea, narcolepsy also requires a thorough evaluation in a sleep laboratory.
If diagnosed with narcolepsy, treatment typically involves central nervous system stimulants or tricyclic antidepressants.
In psychiatry, some patients with "depression" may also experience excessive sleepiness and fatigue without apparent reason, often accompanied by mood and appetite changes.
This requires a comprehensive assessment by a psychiatrist to determine appropriate treatment strategies.
In addition to the aforementioned causes, there are rare instances where medical conditions (such as liver dysfunction) can lead to fatigue and sleepiness.
Given your age and described symptoms, this is less likely, but if you have concerns, a full health check-up is advisable.
I recommend continuing to collaborate with your original physician to discuss whether your daytime sleepiness has improved with medication or if you need to undergo a detailed evaluation in a sleep laboratory (usually available at larger hospitals).
Thank you for your question, and I wish you a speedy recovery.

Reply Date: 2009/05/06

More Info

Dear friend,
Thank you for reaching out with your concerns about excessive sleepiness and potential sleep disorders. Your experiences of falling asleep during class, while riding a motorcycle, and even while sitting at home watching TV are indeed concerning and warrant further exploration.
Based on your description, it sounds like you may be experiencing symptoms that could be associated with narcolepsy or another sleep disorder. Narcolepsy is characterized by excessive daytime sleepiness, sudden sleep attacks, and in some cases, cataplexy (a sudden loss of muscle tone triggered by strong emotions). However, it’s important to note that not all cases of excessive sleepiness are due to narcolepsy. Other factors, such as sleep apnea, insufficient sleep, depression, or other medical conditions, can also lead to similar symptoms.

Given that you have been experiencing these symptoms since middle school and they have persisted into your college years, it is crucial to seek a comprehensive evaluation from a sleep specialist. A sleep study (polysomnography) may be recommended to monitor your sleep patterns and identify any underlying issues. This study can help determine if you have narcolepsy or another sleep disorder, such as obstructive sleep apnea, which can also cause excessive daytime sleepiness.

It’s also worth considering the impact of your mental health on your sleep. You mentioned that you were prescribed medication for depression, which can sometimes affect sleep quality and daytime alertness. Depression and anxiety can lead to disrupted sleep patterns, making it difficult to stay awake during the day. Therefore, addressing any underlying mental health issues is equally important in managing your sleepiness.

In terms of where to seek help, I recommend looking for a sleep clinic or a sleep medicine specialist in your area. Since you mentioned you are in Tainan, you can start by consulting with a local hospital that has a sleep medicine department. They can provide you with the necessary evaluations and treatments tailored to your specific needs.

In the meantime, there are several lifestyle changes you can consider to help manage your symptoms:
1. Sleep Hygiene: Establish a regular sleep schedule by going to bed and waking up at the same time every day. Create a relaxing bedtime routine to signal to your body that it’s time to wind down.

2. Limit Naps: While it may be tempting to nap during the day, especially if you feel excessively sleepy, try to limit naps to 20-30 minutes and avoid napping late in the day.

3. Stay Active: Regular physical activity can help improve your overall sleep quality and reduce daytime sleepiness. Aim for at least 30 minutes of moderate exercise most days of the week.

4. Mindfulness and Relaxation Techniques: Practices such as meditation, yoga, or deep breathing exercises can help reduce stress and improve your mental well-being, which may positively impact your sleep.

5. Avoid Stimulants: Limit caffeine and nicotine intake, especially in the hours leading up to bedtime, as these can interfere with your ability to fall asleep.

6. Healthy Diet: Eating a balanced diet and avoiding heavy meals close to bedtime can also contribute to better sleep quality.

In conclusion, while your symptoms may not currently meet the criteria for narcolepsy, it is essential to continue seeking answers and support from healthcare professionals. A thorough evaluation will help clarify your diagnosis and guide you toward appropriate treatment options. Remember, you are not alone in this, and there are resources available to help you improve your sleep and overall quality of life.

Wishing you all the best on your journey to better sleep and health.

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