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Sleep Disorders

Oversleeping!!!!

08/17/2011

Question:

I`ve been sleeping 12 hours a day now! Its been happening for about 2 weeks. I`ve put several alarms on and I dont even realize that they`re going off sometimes. I dont know if its my low iron levels that are causing this.

Answer:

It appears that the problem of prolonged sleep has been present for just two weeks. There are many potential causes for your complaints and determining the exact cause will require additional history and a physical examination, as well as possible testing. However, keeping the limitations of the information you provided in mind, I will try and go through the possible explanations for your excessive sleep.

You are correlating your symptoms with low iron levels (iron deficiency). I assume that you have a diagnosis of iron deficiency, that this is relatively new, and that the symptoms and the discovery of the low iron levels started about the same time. You don't mention the cause of the iron deficiency or whether you have other medical conditions. This would be important to know. If the development of iron deficiency occurs in a relatively short time period (days to weeks), and the body does not have enough time to adapt to the problem, severe fatigue may occur. While many individuals with iron deficiency have severely reduced energy and do not report sleepiness; others have sleepiness associated with iron deficiency. As such, it is possible that the relatively new iron deficiency can be the cause of your sleepiness. However, in the overall list of causes of excessive sleepiness, iron deficiency is not one of the more common causes.

It is more likely that you may have a primary sleep problem causing your sleepiness. The most likely explanation for oversleeping is increased sleep drive. Increased sleep drive can be due to chronic or short-term sleep deprivation. This is not the case with you, as you have been oversleeping for two weeks. This is enough time to normally take care of previous sleep deprivation or restriction. It is also possible that the oversleeping is due to non-refreshing sleep. That is, no matter how long you sleep, you are not refreshed because the quality of your sleep is poor due to a sleep disorder. Some common sleep disorders associated with unrefreshing sleep include obstructive sleep apnea (OSA) and a disorder called periodic limb movement of sleep (PLMS). This second disorder: PLMS is particularly relevant to your problem since it is aggravated in patients with iron deficiency. This disorder is characterized leg jerks during sleep that result in multiple arousals from sleep. Patients usually do not have any recollection of this, and the disorder is often diagnosed only on a sleep study. Another sleep-related condition that is aggravated by iron deficiency, and can worsen sleepiness, is restless legs syndrome (RLS). This condition is associated with an urge to move the legs while awake and can result in trouble falling asleep at night. Another important sleep condition that causes of sleepiness with oversleeping is "idiopathic hypersomnia." This disorder occurs over much longer period than two weeks; often is present for few years at the time of diagnosis. Narcolepsy is another condition that causes severe sleepiness and can be ruled out quickly in your case with a few questions.

Other nonsleep-related problems and conditions can result in excessive sleepiness. Depression, medication side effects and infections all can cause excessive sleepiness. Several disorders can cause excessive daytime sleepiness, though these are usually associated with normal night-time sleep duration. These include heart failure, inflammatory disorders, and hormonal imbalance such as hypothyroidism (low levels of the thyroid hormone).

If your sleepiness persists for 4-5 weeks, it would be imperative to seek evaluation from a Sleep Specialist. In the meantime, please carefully review your sleep arrangement and make sure that you are not experiencing disruption from your bed partner or pets. Make note of awakenings at night, and ask your bed partner whether you snore or not. The Sleep Medicine Specialist will need this information in addition to obtaining further medical history and performing a physical examination in order to determine if there may be a sleep disorder present. It's possible you may need to undergo a sleep study to establish a diagnosis.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University