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Admin DXD from Singapore asked a question

Should I be worried if I am falling asleep suddenly during the daytime?

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DxD

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I find myself sleeping suddenly quite often for the past few years. I am starting to believe it may be a problem. Whether I sleep 7-8 hours or lesser I still find myself falling asleep e.g. at work while doing work on computer screen, reading a book in the bus, etc. Is this something I should worry about?

DOCTOR’S ANSWER (3)

Hi Asksurp,

Thank you for your question. There can be many reasons why someone would experience excessive daytime sleepiness. As the potential causes are varied and have been well-covered by both Dr Tze Yong and Dr Ethan, I shall not be repetitious.

One of the most common cause of excessive daytime sleepiness (if you do not have poor sleep habit, sleep deprivation, insomnia and medical problems or are on medications that disrupt sleep) is Obstructive Sleep Apnoea or OSA.

Dr Tze Yong gave a very good and thorough explanation on OSA, which essentially is a condition where you stop breathing or choke for a short period of time repetitively during sleep. Common symptoms of OSA include:

  1. Snoring
  2. Mouth breathing
  3. Witnessed choking or gasping episodes by your bed partner
  4. Excessive daytime sleepiness
  5. Morning headache
  6. Difficulty in waking up
  7. Poor concentration
  8. Frequent urination at night

If you have most of the symptoms listed above, you should consult an ENT Specialist or a Respiratory Physician/Neurologist with an interest in managing Sleep Disorders.

An ENT Specialist will likely assess your upper airway to look for possible sites of obstruction during sleep. However, you will need an overnight sleep study (a test whereby you sleep with sensors attached to different parts of your body to monitor the quality of your sleep and your body activity during sleep) to confirm the absence or presence of OSA.

Is this something I should worry about?

Yes! If you have OSA, you get less oxygen to your heart and brain as a result of the frequent “choking episodes” during sleep. Moderate and severe OSA have been shown to have the following complications:

  1. Heart complications (Higher risk of high blood pressure, irregular heart beat and sudden cardiac death)
  2. Brain complication (Higher risk of stroke)
  3. Metabolic complication (Higher risk of Diabetes)
  4. Higher risk of being involved in Road Traffic Accidents (RTA)
  5. Reduced concentration and memory

Hope this helps answer your question. Many thanks.

0 142 views 0 Doctors agree Thu Jan 25 2018 10:07:14 GMT+0000 (UTC)

Hi Aksurp,

Thank you for your question. Daytime somnolence, poor concentration in the day, fatigue, dozing off easily are possible symptoms of obstructive sleep apnea, a condition whereby there is complete or partial obstruction of the airways during sleep.

During deep sleep, there is usually relaxation of the muscles of the airway, resulting in collapse of the airway. While this may be expected in everyone to some degree, the effect is often exaggerated in individuals with certain conditions including a larger tongue, enlarged tonsils, obesity etc.

As a result of the collapse of the airway, airflow into the lungs during sleep may be impeded, resulting in reduced oxygen levels in the blood. If there is no airway flow at all, apnea (a pause in breathing) occurs.

These apneic episodes result in hypoxia (lack in oxygen) and triggers an interruption in the sleep cycle. While complete awakening rarely occurs, this results in a inability to achieve deep sleep (NREM sleep) which is necessary for meaningful rest. Therefore, patients often find that they are poorly rested despite seemingly having slept through the night. Over long periods of time, this lack in oxygen can potentially impair mental functioning as well.

The common telltale symptom of OSA would include snoring although not everyone who snores has OSA and conversely, not everyone with OSA snores. Other symptoms include poor daytime concentration, excessive sleepiness, fatigue etc. OSA can also contribute to hypertension and other chronic diseases.

A useful screening tool would be the Epworth Sleepiness Scale. If you scored 9 and above, you should consider seeking medical advice.

You may want to see a ENT specialist or a Respiratory Physician who specialises in sleep disorders. They would be able to take a complete history and perform a physical examination on you.

From there, they may recommend that you undergo a sleep study- this will provide information about the quality of your sleep and help to diagnose OSA.

The gold standard treatment for OSA would be a continuous positive airway pressure (CPAP) machine, although certain patients may also benefit from surgical correction of anatomical abnormalities which contribute to OSA. Of course, if you are overweight, weight loss would also help in improving symptoms to OSA.

Hope this helps!

0 142 views 0 Doctors agree Thu Jan 25 2018 10:08:52 GMT+0000 (UTC)

Hi aksurp,

Like Dr Tze Yeong, top of my mind would be to rule out Obstructive Sleep Apnoea (OSA), which is a fairly common problem, especially amongst obese patients.

Falling asleep is regulated by two primary processes:

  1. Your body’s circadian rhythm, which causes an increase in sleepiness twice over a 24-hour period (in general, from midnight to 7 am, and between 1 pm – 4 pm)
  2. Your physiologic need for sleep, which is increased by sleep loss and sleep disruption.

Excessive daytime sleepiness/unintended sleep episodes can result if you’ve got disturbances to either of these sleep-regulating mechanisms.

The most common causes are:

  1. Primary sleep disorders (eg. OSA, insomnia)
  2. Medical conditions that disrupt sleep (eg. bronchitis, asthma, heart failure, and painful conditions such as arthritis/back pain)
  3. Side effects of medication/drugs (eg. caffeine, alcohol and nicotine)
  4. Lifestyle factors (eg. shift work)

Is this something I should worry about?

The main worry with falling asleep unexpectedly is life-threatening car crashes (if you drive) and industrial accidents.

It can also result in impairment to your work performance.

It’s for these reasons that I’d suggest for you to visit your polyclinic GP. He will be able to rule out causes for your unintended sleep episodes, and refer you to a specialist, if necessary.

Cheers

0 142 views 0 Doctors agree Thu Jan 25 2018 10:09:59 GMT+0000 (UTC)
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