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Excessive daytime sleep

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I pretty much feel sleepy for the whole day, here is something that will not happen in like 10 yrs ago;

1-my energy rarely sustain for the whole day even if i sleep 8~11 hrs i will be sleepy maybe 2 hrs after i woke up
2-once or twice per month i will be so sleepy that i required to sleep for almost the wholeday
3-feel like to throw up when i brush my teeth
4-subtle pain in the area about where gal is located

This issue annoyed me for pretty much 5 years, and my local doctors seems to have no expertise about the issue


Category: Internal Medicine Specialist

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello and thankyou for approaching DoctorSpring with your query.

I have gone through your case and I understand your concern.

Your history of excessive sleeping could be either due to Obstructive Sleep Apnea, anemia , hypothyroidism , depression, or a sleep disorder. The approach and diagnosis is time consuming and will require many tests unfortunately. So you will need to be patient in this regard.

In your case I suspect a possible Obstructive Sleep Apnea.

Obstructive Sleep Apnea (OSA) is due to the repeated collapse of the upper respiratory tract during your night sleep as a result of which the patient has interrupted breathing and disturbed sleep. Daytime sleepiness is a common feature of OSA and it may go unnoticed or diagnosed for a long time.
In your case you have probably undergone septoplasty surgery , which is nasal operation for septal deviation of the nose. Nasal septal deviation is one cause of nasal obstruction. Others being, nasal polyps, nasal turbinate hypertrophy. All these cause nasal obstruction and can cause OSA. I would recommend you get your self examined for any other cause of nasal obstruction as these tend to recur. OSA is the most likely cause of your excessive sleepiness.

I would like to know some additional information from you inorder to proceed further.

1.Do you SNORE loudly (louder than talking or loud
enough to be heard through closed doors)?
Yes No
2.Do you often feel TIRED, fatigued, or sleepy during
daytime?
Yes No
3.Has anyone OBSERVED you stop breathing during
your sleep?
Yes No
4.Do you have or are you being treated for high blood
PRESSURE?

5. Your body weight and height ?

6. Do you feel down / depressed often ?

7. Do you find it difficult to find pleasure in life in general ?

8. Are you overly worried or anxious ?

You can reply as followup

Thankyou.


Patient replied :

Thank you doctor

Answers:
1.No
2.Yes
3.Yes, happend many times before and i was awakened in the middle of the night and i thought i cant breath my throat was block by something, after a few seconds i start to realize i can breath
4.No

5. 143 lb / 177cm

6. Not always

7. I'm not sure because i can have lots of fun with friends but when i'm alone i need to archieve something to feel really good

8. Not really i think i'm quite confident of things


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Thank you for the additional information.

You do not seem to have feature of OSA (Obstructive sleep apnoea) or depression which are the two most common causes of excessive day time sleepiness. But still you will need evaluation for OSA as there is history of nasal growth in the past. Since you have sleepiness + fatigue a set of systemic condition need to be ruled out (For example anaemia , low Haemoglobin can make you feel fatigues all the time. ). The approach is step by step. That means do a few tests, physical examination and if needed go to the next stage. You will need to get in touch with your Doctor for this.

The first panel of tests are :

1. Complete Blood Count
2. ESR, CRP
3. Fasting Blood Sugar
4. Liver Function tests
5. Renal Function tests
6. Thyroid Function tests
7. ANA

Physical examination
ENT examination for OSA.

The next step would be a sleep study or Nocturnal polysomnography (PSG) which can be done later.

Meanwhile I recommend 2 simple approaches, which seem to work in many cases. It is maintaining an activity chart and planner where you list your plan for the day in 1 hour slots. Once accomplished the hour can be stricken off. Basically a planned day.
Second one is a moderate aerobic exercise for 40 minutes a day 5 days a week. Start for 10 mins and increase gradually.


Hope this helps
Feel free to ask followups
Thank you


Dr. Deepu Sebin Sebastian
Category: Select Speciality
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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