In this blog we will look into hypersomnia or increase in daytime sleepiness or excessive sleepiness and its relation with chronic fatigue and different sleep-wake disorders. We will discuss biological clock disturbance (circadian rhythm disturbance), sleep-wake problems, jet lag, delayed sleep phase syndrome, free run sleep-wake problems, and shift-work disorders with some useful tips to help these situations.
There are many causes of hypersomnia or increase in daytime sleepiness or feeling of sleepiness during the normal working hours or daytime. If one has a disturbed biological sleep-wake cycle it may affect daytime function. With that, there is associated low-grade fatigue but it may not be from chronic fatigue syndrome or fibromyalgia. The person may feel a non-specific, persistent, low-grade level of energy and endurance. It may be of a mild type and the person can keep on working but feels that he/she has to push him/herself to do it. Circadian rhythm disturbance can lead to sleep problems and health problems.
The body has a biological clock or circadian rhythm that one needs to understand it and preserve its natural rhythm. Circadian rhythm originates different parts in the brain that governs it when (time) we go to bed and when (time) we wake up. It is regulated by the light or sunrise and sunset. If circadian rhythm gets affected then we feel tired or fatigued and depending on what kind of change it is, it may be short lived or of longer duration. The common one that most people know of is jet lag. Usually traveling west is easier (in comparison to traveling west to east) like flying from New York to California in the USA or from Europe/Asia to America in international travel, which point west but when going east it is more difficult. This is because of our biological clock. Going west, the biological clock is going forward which is relatively easy to move. In the example of flying from New York to California the time difference is 3 hours, so the person going to sleep around 11:00 pm in New York when flies to California (3 hours behind New York time) will be having biological clock of 8:00 pm in California, but one can still be awake until 11:00 pm (biological clock 2:00 am), pushing 3 or more hours when traveling for vacation or business, but that person will wake up about 3 hours earlier than people living in California like 3:00-4:00 am if he is waking up around 6:00-7:00 am his usual time. This creates a sleep disturbance and sleep interruption leading to some daytime fatigue and tiredness, but it usually short lived. The general rule of jet lag is the number of hours in a time zone crossed is the number of days the jet lag takes to resolve, so in this case 3 time zones traveled will be 3 days to resolve one way. Similarly, when a person goes back home in this example, from California to New York, than another 3 days is expected for jet lag. This is short-term fatigue and hypersomnia should resolve.
Delayed Sleep Phase Syndrome
Please see a separate blog written on this earlier for more details. People usually have the waking up problem in the morning and have feelings of morning sleepiness. Delayed sleep phase syndrome is when one has the biological clock altered to a latter time of going to bed and cannot wake up normal hours and over sleeps. Think of college students or teenagers. Like going to bed late around 1:00 am-4:00 am and waking up 10:00 am-1:00 pm. When they wake up earlier there is a biological schedule time because of the job, school or social activities, they have sleep deprivation, which further leads to hypersomnia and fatigue. They tend to over sleep and catch up with their sleep on the weekend. Weekdays they feel as if they have chronic jet lag-like symptoms, as they are sleep deprived from waking up earlier and going to bed late.
Free Run Sleep-Wake Problem
Some may have free run disorder from a biological clock that works irregular. It is partly genetic and partly self-created because this person cannot go to bed at a fixed time and wake up at a fixed time. Many are blind people, as they do not get light stimulation. It is also seen in people with normal vision but have medical problems, which have affected their own sleep by staying awake over many years and sleeping irregularly. The sleep-wake cycle keeps on rotating and affects the activity especially when they get a cycle of going to bed during the daytime and up the whole night, but still has to work during the daytime. As the pattern is very irregular, it needs to be re-synchronized to normal sleep-wake cycle to perform a professional or social activity. This is one of the very tough disturbed sleep-wake cycles to correct, as most people who have it are not compliant and do what they want to do. But it does affect their health and they pay the price for it in the long run. Free run disorder needs professional help, as it is slow to improve.
Shift Work Sleep-Wake Problem
This is common in people working night shift or constantly changing working schedules from daytime or afternoon shift or night shift and who have to sleep during the daytime or at various times. For night shift, they generally work 10:00 pm or 12-midnight to 6:00-8:00 am shift. They cannot sleep very well during the daytime and have interrupted sleep and feels tired, but on the weekend or on vacation try to catch up on sleep or sleep at night time and then has no other issues if they are allowed to sleep at night time. For people working at night, when they come home they may want to use dark goggles to prevent morning light exposure. They may want to have the evening light exposure and preferably take a 1-2 hour nap prior to going to work and have bright light at the work place. This may help improve work efficiency and decrease the night time sleepiness. Still, the best solution if possible, is to work a daytime time shift.
Irrespective of the disorder, chronic sleep deprivation leads to health problems if continued over many years or decades. Please see the blog on sleep hygiene for further details. The goal is to improve sleep and prevent sleep deprivation as it takes a toll on the health leading to heart problems, diabetes, mental health problems, low immunity, poor digestion, heartburn, low-grade irritability and the possibility of malignancy. Incorporation of regular exercise, Ayurvedic diet and treatment, keeping sleep logs, sleep restriction therapy, Yoga and Pranayama may further help improvement of the sleep and circadian rhythm disorder slowly. There may be some setbacks at times but they can be overcome with regularity and discipline. Professional help may be needed in some cases. Understanding one’s own sleep cycle and its rhythm, and gradually tuning towards a 10:00 pm to 6:00 am sleep cycle may further help.