If I could sleep – Why can’t I stop falling asleep at work?

 

Do you ever feel like a zombie during the day? I often do. Why can’t I stop falling asleep at work?

You may have just had an isolated rough night of sleep or a long night out, but if your daytime sleepiness is ongoing you could have one of a number of chronic sleep conditions keeping you awake at work.

What causes excessive sleepiness and how do you stay awake at work? Aside from the fact that it can affect your work performance, for many people it can be outright dangerous in some professions.

What would you do if you were sleepy all day and couldn’t stay awake? Let’s explore the causes, what I do to deal with it, and what is recommended to help you stay awake during the daytime and treat excessive sleepiness.

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Why can’t I stop falling asleep at work – The causes of excessive sleepiness

I am constantly about to fall sleep at work. It’s a struggle to stay awake and stay focused on my work.

When my boss tried to explain what needed done, it was hard to capture everything he was trying to explain. Even though my eyes were open my brain still felt foggy and drifted.

I felt a vacant stare on my face and tried to look like I was in control but trying to stay on task wasn’t easy.

For most people feeling sleepy during the day may not be a common thing. You may have a rare night you didn’t sleep well or stayed out too late and being tired at work is just a temporary thing without any long term effects.

But, for many people it can be as common as getting up in the morning. The mental and physical effects can feel debilitating and chronic and can have many causes.

What is excessive sleepiness

First understand that excessive daytime sleepiness is not the same as fatigue. Sleepiness is the feeling of wanting to go to sleep. You feel drowsy. Your eyelids feel heavy and want to close and you feel like you could doze off any minute.

Usually, the longer you stay awake, the more you feel like sleep.

Fatigue in contrast is a feeling of low energy, tiredness or exhaustion. You may feel like you are mentally or physically drained and find it difficult to have the energy to work at what you need to do.

Excessive daytime sleepiness, or EDS, as defined by the American Academy of Sleep Medicine, is an inability for you to maintain a wakeful and alert state during the major waking episodes of your day.

In simpler terms, an uncontrollable need to sleep or urge to fall asleep during your daily activities. You may experience:

• heavy eyelids
• hard to keep your head up
• difficulty focusing and connecting your thoughts or completing tasks
• forgetting things and losing track
• lack of motivation
• falling asleep or needing to nap during the day

What are the causes of excessive sleepiness

For many of you, just like me, there are common underlying causes for EDS. About 20 percent of the U.S. population experience excessive daytime sleepiness according to the National Sleep Foundation.

Among the most common causes, Sleep deprivation is often a cause for falling asleep at work, along with obstructive sleep apnea and certain medications you may be taking. Particular medical and psychiatric conditions can also be causes.

If your sleep schedule is inconsistent because you work long hours or have a varied schedule that doesn’t allow you to go to sleep and wake at the same time every day it can be hard to sleep when it is time to go to bed.

Your mind and your body aren’t in tune and your sleep cycle, or circadian rhythm, isn’t used to that schedule. So, now you may lie awake trying to go to sleep which in turn can make you anxious and make it even harder to go to sleep.

If you work long hours and you just plain skip, or shorten how much sleep you get to keep up with your work schedule then you are building sleep debt. This sleep debt must be paid back by adding sleep back in somewhere to catch up.

Maybe you just like to stay up late and watch TV or study for school or maybe you stay out late with friends and you just need to make it through your day. These can be temporary and changing your behavior and following good sleep hygiene can help.

But, maybe you can’t sleep at night. For some people, the causes of excessive sleepiness aren’t so simple. Chronic conditions such as Insomnia, narcoplepsy, sleep apnea, hypersomnia, and depression can all be causes for EDS.

Insomnia

You may have insomnia if you have difficulty falling asleep, staying asleep or wake up too early. Poor quality sleep may also indicate you have insomnia. This can in turn lead to excessive daytime sleepiness and falling asleep at work.

About 10% of adults have chronic insomnia, which means they experience problems falling asleep or staying asleep at least three nights a week or more for at least three months or longer.

Insomnia is most often caused by:

• Poor sleep habits, also called sleep hygiene
• Depression or anxiety
• stress
• certain disorders that affect the heart, lungs, muscles, bones and chronic pain

Narcolepsy and excessive sleepiness

A chronic neurological condition that is associated with excessive daytime sleepiness is narcolepsy. It affects your brain’s ability to regulate the sleep-wake cycle.

If you suffer from narcolepsy you find it difficult to stay awake for a long period of time. Along with an overwhelming drowsiness, sleep may occur suddenly at any time, no matter what you are doing and may come with no warning.

The exact cause in not clear but there is some thought that it may be related to a loss of Orexin in the brain. This is a chemical released in your brain to stimulate certain regions to keep you awake.

Symptoms experienced may include:

• Excessive sleepiness during the day
• Sudden loss of muscle tone/muscle weakness triggered by emotion (cataplexy)
• Sleep paralysis – temporary inability to move or speak, usually only a few seconds or minutes, as you are waking or falling asleep
• Changes to REM sleep
• Hallucinations – these are usually when falling asleep or waking up and can occur with sleep paralysis. Images can be vivid and may be frightening at times. For example you may feel as if there is someone in your room and because it happens as you are waking or falling asleep it may blur what is imagined or real at the time.
• Insomnia and fragmented sleep
• Automatic behavior – you may briefly fall asleep for only a few seconds or minutes while performing a task and continue the task while asleep, not knowing it. Performance during this time degenerates and you cannot recall what you did.

You can have narcolepsy with cataplexy (type1) or without cataplexy (type2). Almost everyone with cataplexy (type 1 narcolepsy) have low levels of hypocretin that controls REM sleep and supports sleep.

Sleep apnea and excessive sleepiness

Another chronic condition with symptoms of excessive daytime sleepiness is sleep apnea. The most common form being obstructive sleep apnea which occurs when your throat muscles relax and block your airway causing you to stop and start breathing while you are asleep.

You may find yourself falling asleep at work if you have sleep apnea. Other signs you may have sleep apnea can be:

• Snoring
• waking up gasping or chocking
• a dry mouth or sore throat when you wake up
• have trouble concentrating during the day
• depression, irritable or other changes in mood
• high blood pressure
• decreased libido

Not everyone who snores has sleep apnea but if it is loud enough to disrupt sleep you should consult your doctor. Also, see your doctor if you or your partner observe you wake up gasping, have pauses in your breathing while you sleep or experience excessive daytime drowsiness.

Hypersomnia and excessive sleepiness

If you have hypersomnia, you may not only find it hard to stay wake at work during the day, you may also find it harder to wake up in the mornings and you may sleep longer.

You may lapse into repeated naps during the daytime which could occur while working, eating or holding a conversation and still not feel rested from the events.

You could have trouble waking up in the mornings and feel able to fully function. You may also experience:

• anxiety
• decrease in energy
• restlessness
• slow speech
• slow thinking
• loss in appetite
• hallucinations
• memory problems

Hypersomnia can be caused by other sleep disorders such as sleep apnea or narcolepsy. It can also be caused by drug or alcohol abuse, certain medicines you take as well as other health conditions that can add to the problem.

Depression and excessive sleepiness

Depression is a double-edged sword in that, while it can cause sleep loss, it is also a recognized cause of excessive daytime sleepiness.

Depression and sleep problems are so closely linked that you may have a 10 times greater risk of depression if you have a sleep disorder such as insomnia and 5 times more if you have sleep apnea.

There is also evidence that suggests EDS and depression share some of the same genetic traits. In fact, in certain populations EDS is a predictor and risk factor for depression.

You may have sleep apnea, insomnia or another sleep disorder and depression at the same time and not be aware of it. If so, and left undiagnosed, it becomes more complicated to treat and get relief from your symptoms.

Tell your doctor about all of your sleeping habits to be sure of a complete diagnosis. These signs may signal a talk about depression with your doctor is needed:

• Daytime sleepiness
• loss of energy
• you don’t enjoy doing things you usually like to do
• feeling sad, helpless or hopeless
• you find it hard to concentrate and remember things
• suicidal thoughts

Medications that make you drowsy

There are many common medications that can make you sleepy. Both prescription and over the counter drugs included. They are used to treat a variety of conditions. Among these are:

• antidepressants
• antihistamines – sleep aids and allergies
• anti-emetics – nausea and vomiting
• antipsychotics – depression
• anticonvulsants – seizures
• alpha and beta blockers – high blood pressure
• benzodiazepines – anxiety and insomnia
• muscle relaxers
• drugs for Parkinson’s disease
• prescription pain medicines – including opioids

If you think you can’t stay awake during the day because of your medicine, ask your doctor about what’s best for you.

In addition, there are some medications that affect sleep at night, which in turn may cause you to feel sleepy during the daytime.

 

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How to treat excessive daytime sleepiness

For many of us staying awake at work is just a short term problem and can be fixed with a few adjustments to our behaviors.

Treatment for excessive daytime sleepiness depends on its cause and severity and requires an accurate diagnosis by your doctor.

Based on the diagnosis of the cause of your condition and your individual health needs your doctor may recommend specific treatments and could include:

Insomnia treatment

Insomnia may be primary or secondary. Primary means it is not caused by another medical or psychological condition. Secondary means it is the result of another medical problem.

• Treatment of other disorders contributing to insomnia if present
• Good sleep hygiene
• Cognitive-behavioral therapy
• Sleep aids

Narcolepsy treatment

If you are diagnosed with narcolepsy there is no cure. There is however treatment that can control the excessive daytime sleepiness and cataplexy in most people. Medications and lifestyle changes your doctor may prescribe to control your symptoms could include:

• Modafinil – a central nervous system stimulant and primary treatment used to reduce your sleepy feeling during the day
• Amphetimine-like stimulants – used as a secondary treatment when modafinil is not effective
• Antidepressants – which have fewer side effects than amphetamines
• Sodium oxybate – (gamma hydroxybutyrate or GHB) a strong and highly controlled sedative taken twice at night

• Take short scheduled naps when you are usually the sleepiest
• Keep a regular sleep schedule – wake up and go to sleep at the same time every day
• Avoiding caffeine and alcohol several hours before bed
• Also avoid smoking, more so at night, as nicotine is a stimulant also
• Exercise 4-5 hours before bed for at least 20 minutes
• Avoid eating close to bedtime, especially heavy meals
• Wind down before bed with a relaxing routine
• Keep a cool and comfortable sleeping area

Sleep apnea treatment

If your daytime sleepiness is caused by obstructive sleep apnea, which is the most common form, several options are available. Your doctor may just recommend to stop smoking and lose weight if your case is mild or treat any allergies you might have. In moderate to severe cases treatment options can include:

• Continuous Positive airway pressure (CPAP) – a machine that has a flexible air tube and mask you wear to create pressure to keep your airways open while you sleep.
• Oral dental appliances – worn in your mouth, these adjust your jaw to move it forward and help relieve snoring and sleep apnea.
• Neuro-stimulation therapy – this new type of treatment uses an implant that stimulates nerve muscles to control airflow and reduce or eliminate sleep apnea.

Many people successfully use a CPAP machine to help with sleep apnea.

I found it difficult to work with a CPAP machine myself. Having a mask strapped to my face all night limited my sleep positions and I did not feel comfortable having the air forced into me like a balloon. It did improve my condition.

But the oral appliances have advantages of being comfortable and easy to wear, They are quiet, portable and easy to care for. They may be an option if you are intolerant of the CPAP machine.

I have not used the neuro-stimulation therapy option at this time for my sleep apnea and can neither approve nor disapprove of it but it does show advantages worth asking your doctor about.

Hypersomnia treatment

Hypersomnia may be caused by other sleep disorders such as narcolepsy. When there is no known cause it is termed ideopathic hypersomnia or IH.

Some people can be helped through behavior changes and other treatments with use of medications such as cognitive behavioral therapy (CBT).

Your doctor may prescribe off-label treatments normally used for treating other sleep disorders such as narcolepsy. Off label simply means that these medications are approved to treat your symptoms because they have shown to be effective in treating sleepiness of other sleep disorders associated with IH.

Not all people get complete control of their symptoms as reactions may vary from person to person and in some people medications may stop working after some time. There may also be undesirable side effects.

Many off-label treatments need more study in people with IH.

Medications used to treat IH can include:

• Xywav – a combination of calcium, magnesium, potassium and sodium oxybates, which is used only in specific cases because of side effects
• Stimulants – modafinil, methylphenadate or amphetamine
• Anti-depressants such as monoamine oxidase inhibitors
• Other medications such as clonidine, levodopa, and bromocriptine

Treating hypersomnia with depression

A common condition with hypersomnia is Atypical depression (AD). Unlike the classic symptoms experienced with melancholic depression, if you have AD you may feel excessively hungry and want to eat constantly (hyperphagia).

Hypersomnia along with rejection sensitivity are also associated with AD. You may feel totally rejected for simple things such as an unanswered email for example. With Atypical depression your mood may improve after having positive events.

There is some evidence that shows exercise can help reduce hypersomnia in people with AD, although there was no improvement of insomnia symptoms in the study.

Treatments for hypersomnia could include treatment options for the hypersomnia itself along with these individual or combined options for treating the depression:

• counseling – this could include cognitive behavioral therapy (CBT), CBT for insomnia (CBTi) or interpersonal therapy (IPT)
• Medication – antidepressants
• Brain stimulation therapy – this may be an option for some people when counseling or medication does not work. These therapies can only be provided by a trained professional.

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How to stay awake at work

How do I stay awake at work? As for me, I usually start my day with coffee any way. If I had a rough night sleeping I usually end up drinking an extra cup at work or a caffeinated soda, followed by a cup of green tea at lunch.

I find the theanine in green tea helps me focus when I’m tired. And then, sometimes I will eat Jalapeno with my lunch. It always helps wake me up and get my blood pumping.

Then, I usually have a snack or two during the day when I start to feel like I am struggling to stay awake. Most important for me is that I try to keep my mind engaged and physically active during the day. I take breaks from my desk and walk around.

Last of all I go outside at lunch and stretch a few minutes. My job has no windows and the fresh air and light help a lot.

But how do I compare to what is recommended to stay awake at work, and what should you do? Here are what is suggested:

• stay hydrated
• splash cold water on your face
• reduce your sugar intake – sugar may give you an initial rush but will crash after a time
• take breaks
• stay cool
• turn on music
• take a walk
• massage pressure points
• caffeine
• go outside in the light – light is an important stimulus that regulates your sleep cycle and tells your brain to be awake
• exercise
• stay active
• stretch
• snack on healthful foods
• deep breathing
• take a nap
• make your work space brighter
• energizing smells such as eucalyptus, peppermint, bergamot, lemon or camphor, even coffee smell

Which of these do you use to stay awake at work?

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Conclusion

The consequences of falling asleep at work are many. Poor performance, social perceptions or hazardous conditions if operating equipment can have undesirable results to say the least. Then there are the health concerns and how you feel.

Causes for falling asleep at work can be a range of issues such as sleep deprivation, Insomnia, sleep apnea, narcolepsy, hypersomnia, depression, even restless legs. Maybe your just bored or not engaged by your job.

Why I can’t stop falling asleep at work may be different from why you can’t stop falling asleep at work.

I know I can’t stop falling asleep at work because I have an unusual schedule ( I start my day at 2AM) and sleep deprivation issues because of it. I also wake frequently at night, but I am still working on that.

I follow good sleep hygiene (and a sleep aid one night a week) to get sleep at night and use a variety of the recommended methods to stay awake during the day.

And as always, I trust my doctor as an important part of my healthcare decisions. Only he or she knows me as good as I know me and can best guide me.

You too can get the sleep you need and stay awake at work even if you have a sleep disorder. If you think you have a sleep disorder talk to your doctor to discuss your concerns and get the right treatment for you.

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How do you keep from falling asleep at work?

Let me know in the comments below.

 

Goodnight!

The information on this page is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have questions regarding your health you should seek the advice of your health care provider.

 

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references

Narcolepsy

https://www.mayoclinic.org/diseases-conditions/narcolepsy/symptoms-causes/syc-20375497

Is it fatigue or do you really have narcolepsy

https://health.clevelandclinic.org/tired-tell-fatigue-narcolepsy/

Narcolepsy fact sheet

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Narcolepsy-Fact-Sheet

Excessive daytime sleepiness in sleep apnea: it’s not just apnea hypopnea index

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586951/

Excessive daytime sleepiness

https://www.aafp.org/afp/2009/0301/p391.html

Obstructive sleep apnea

https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

Hypersomnia information page

https://www.ninds.nih.gov/Disorders/All-Disorders/Hypersomnia-Information-Page

Hypersomnia in mood disorders: a rapidly changing landscape

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526256/

Excessive daytime sleepiness among depressed patients

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066783/

What you should know about the relationship between oversleeping and depression

https://health.clevelandclinic.org/what-you-should-know-about-the-relationship-between-oversleeping-and-depression/

 

What to do when medication makes you sleepy

https://www.health.harvard.edu/drugs-and-medications/what-to-do-when-medication-makes-you-sleepy

 

Which sleep apnea treatment options for you

https://www.sleepapnea.org/treat/sleep-apnea-treatment-options/

Sleep apnea

https://www.mayoclinic.org/diseases-conditions/sleep-apnea/diagnosis-treatment/drc-20377636

What treatments are available

Medicines for idiopathic hypersomnia and narcolepsy

 

Sleep: an important health and safety concern at work

https://www.cdc.gov/workplacehealthpromotion/initiatives/resource-center/pdf/WHRC-Brief-Sleep-508.pdf

What workers and employers can do to manage workplace fatigue during COVID-19

https://www.cdc.gov/coronavirus/2019-ncov/hcp/managing-workplace-fatigue.html

Excessive daytime sleepiness in sleep disorders

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506799/

Fatigue or daytime sleepiness

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919674/

How to stay awake at work: staying productive when you didn’t get enough sleep

https://www.cigna.com/individuals-families/health-wellness/how-to-stay-awake-at-work

Exercise treatment of sleepiness in depression linked to immune system chemicals

https://www.bbrfoundation.org/exercise-treatment-sleepiness-depression-linked-immune-system-chemicals