Excessive Sleepiness: Causes and Solutions for Your Symptoms

Q: Excessive Sleepiness: Causes and Solutions for Your Symptoms

Hello： First of all, thank you for your letter. <br>The stressors related to psychosomatic disorders can sometimes be subconscious, and patients may not be aware of them, only feeling physical discomfort. <br>However, I recommend that you rule out any physiological factors that m

Hypersomnia?

Hello Doctor, I experience a dull headache while sleeping and upon waking up, along with swollen and sore eyes.
I feel like I haven't had enough sleep.
About half an hour later, the symptoms worsen to excessive sleepiness, fatigue, and significant eye discomfort, making me just want to rest.
This occurs cyclically, peaking around lunchtime and before the end of my workday, during which I also tend to feel hungry, sometimes to the point of having low blood sugar that causes my hands to shake.
This fatigue and sleepiness have become severe enough to hinder my ability to work, with tightness in my head and swollen eyes making it difficult to think.
Previously, I had severe sleep apnea, which has been surgically reduced to mild, with a noticeable improvement in blood oxygen levels, but it is still not normal.
My fatigue has decreased from a score of 10 to 5, yet the aforementioned symptoms have not improved and have become more pronounced post-surgery.
I have consulted with ophthalmologists, neurologists, and ENT specialists, but none have provided relief.
Many patients at the clinic report excessive sleepiness, and some doctors suggest factors like medication, mental health, and lifestyle habits, but I have no issues in those areas.
Basic internal medicine tests have all come back normal, which is why I sought surgical intervention for the breathing issue.
I do not suffer from insomnia, have minimal anxiety, possess good emotional intelligence, and do not engage in excessive worrying.
My routine is regular, and I ensure at least 7 hours of sleep daily, including a nap.
Previous prescriptions for anti-anxiety and relaxation medications have had no effect, only increasing my sleepiness.
Honestly, doctors often inquire about stress levels, but I am confident that my stress is not higher than that of an average person.
This situation feels like an incurable condition.
I understand that mental stress can cause many symptoms, but aside from the persistent cyclic eye discomfort, fatigue, and excessive sleepiness, I do not experience any other issues.
However, the inability to work may indeed lead to long-term stress.
Can you suggest a direction for my future care?

Niming, 10~19 year old female. Ask Date: 2015/11/22

Dr. Li Zhengfeng reply Psychiatry

Hello: First of all, thank you for your letter.
The stressors related to psychosomatic disorders can sometimes be subconscious, and patients may not be aware of them, only feeling physical discomfort.
However, I recommend that you rule out any physiological factors that may be causing your discomfort.
Seeking out activities that bring some joy to your life may lead to unexpected improvements.
Wishing you a speedy recovery.

Reply Date: 2015/11/22

More Info

Excessive sleepiness can be a complex issue with various underlying causes, and it seems you are experiencing a combination of symptoms that significantly impact your daily life. Based on your description, you are dealing with headaches, eye strain, fatigue, and a sense of not feeling well-rested despite getting a reasonable amount of sleep. Additionally, you mentioned a history of severe sleep apnea, which has been surgically treated but still leaves you with lingering symptoms.

Understanding Your Symptoms
1. Headaches and Eye Strain: The headaches you experience upon waking and throughout the day, along with the feeling of eye strain, could be linked to several factors. These may include tension headaches, which are often exacerbated by stress, poor posture, or prolonged screen time. Eye strain can also result from excessive screen exposure, especially if you are not taking regular breaks.

2. Excessive Sleepiness and Fatigue: The excessive sleepiness you describe, particularly peaking around midday and before the end of your workday, could suggest several possibilities. One potential cause is a condition known as hypersomnia, which is characterized by excessive daytime sleepiness despite adequate or prolonged nighttime sleep. This can be related to sleep disorders, neurological conditions, or even metabolic issues.

3. Blood Sugar Levels: You mentioned experiencing symptoms of low blood sugar, such as shakiness and hunger. Fluctuations in blood sugar can lead to feelings of fatigue and lethargy. It may be beneficial to monitor your diet and ensure you are consuming balanced meals that stabilize your blood sugar levels throughout the day.

Potential Causes
- Sleep Disorders: Although your sleep apnea has been treated, other sleep disorders like narcolepsy or idiopathic hypersomnia could be contributing to your excessive daytime sleepiness. A sleep study might be warranted to explore this further.

- Chronic Fatigue Syndrome: This condition is characterized by extreme fatigue that doesn’t improve with rest and can be exacerbated by physical or mental activity. It often coexists with other symptoms, including headaches and cognitive difficulties.

- Medication Side Effects: You mentioned that medications prescribed for anxiety and relaxation have not been effective and may have increased your sleepiness. It’s essential to discuss these side effects with your doctor, as they may need to adjust your treatment plan.

- Psychological Factors: Even if you feel confident and do not perceive high levels of stress, underlying psychological factors can manifest physically. Chronic stress, even at low levels, can lead to fatigue and other physical symptoms.

Recommendations
1. Consult a Sleep Specialist: Given your history of sleep apnea and ongoing symptoms, a consultation with a sleep specialist may provide insights. They can conduct a thorough evaluation, including a sleep study, to assess your sleep quality and identify any potential disorders.

2. Monitor Your Diet: Keeping a food diary may help you identify any correlations between your diet and symptoms. Focus on balanced meals with adequate protein, healthy fats, and complex carbohydrates to maintain stable blood sugar levels.

3. Regular Breaks and Eye Care: If you spend a lot of time in front of screens, ensure you take regular breaks to reduce eye strain. The 20-20-20 rule is helpful: every 20 minutes, look at something 20 feet away for at least 20 seconds.

4. Physical Activity: Regular physical activity can improve sleep quality and reduce feelings of fatigue. Aim for at least 30 minutes of moderate exercise most days of the week.

5. Mental Health Support: Even if you feel your emotional state is stable, consider speaking with a mental health professional. They can help you explore any underlying issues that may contribute to your symptoms.

6. Follow-Up with Your Doctor: Keep an open line of communication with your healthcare provider. If your symptoms persist or worsen, further investigation may be necessary to rule out other medical conditions.

In conclusion, while your symptoms are multifaceted, a comprehensive approach that includes medical evaluation, lifestyle adjustments, and possibly psychological support may help you find relief. Your health is paramount, and seeking the right support can lead to significant improvements in your quality of life.

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