Drowsiness

The sensation of sleepiness that we usually feel before our night’s sleep, that paves its way into a slight lack of consciousness is termed as drowsiness. If you have had a poor night’s sleep, feeling drowsy is obvious. But feeling drowsy throughout the day can reduce the quality of life, impact our work profile, reduce performance, and deteriorate our overall wellbeing. Clinically is termed as excessive daytime sleepiness or hypersomnia which is the excessive urge to fall asleep and in severe cases, it is the fight to even stay up awake. Mostly, drowsiness is not a matter of concern until it interferes with our ability to performs our daily tasks, contribute to work, or even while we are sitting ideal. When drowsiness becomes a routine, the causes and manifestations should be considered as sustained levels of drowsiness that can hamper and make our daily life difficult. 

Most of the time depression, anxiety, stress, and boredom can all contribute to excessive sleepiness, but these ultimately lead to fatigue and apathy.

Usually, drowsiness is a symptom, but if ignored and not taken care of, it can lead to a chronic illness that affects the person not only physically, but mentally, socially, and spiritually as well. Ranging with a variety of causes, risk factors, and complications, it is important to note the slightest changes in sleep patterns and wakefulness in daily routine.  

Causes of Drowsiness

Anything that delays or interrupts the normal sleep cycle or pattern should be considered a cause of drowsiness. Things or causing factors that can cause irregular sleep patterns are:

• A disturbing sleep environment: uncomfortable bed, too many lumpy pillows, nightclothes are not comfortable, excessive lighting in the room, the inadequate temperature of the room, noises in and around the house, bright LED displays of clocks or anything in the room, snoring of partner, babies waking up at night time
• People who work on night shift and sleep during the day 
• Not getting enough sleep as per the prescribes hours: guidelines from AASM suggested a couple of sleep as mandatory as per age groups for well-being and sound mental state. These are as follows:

• Infants (4-12 months): 12-16 hours
• Children (1-2 years): 11-14 hours
• Children (3-5 years): 10-13 hours
• Children (6-12 years): 9-12 hours
• Teenagers (13-18 years): 8-10 hours
• Anyone 18+ years: 6-8 hours

• Irregular sleep and waking times or a disturbed circadian rhythm
• Having caffeine or heavy meals before bedtime: caffeine is a stimulant and can cause one to stay awake and thus disrupt the sleep routine, consuming any form of caffeine just before bedtime can make it difficult for one to sleep. 
• Alcohol consumption before bedtime: Alcohol alters the sleep cycle stages during the night and more influentially suppresses the rapid eye movement (REM) phenomenon during sleep. It can also suppress breathing during sleep
• Medications for chronic illness: either taking medicines for any chronic health issue or consumption of sleeping pills can sustain a state of drowsiness or a “hangover” sort of phenomenon the day following its consumption.
• Medical illness, hospitalization, and chronic pain 
• Presence of sleep disorders like sleep apnea, restless leg syndrome, periodic limb movements, narcolepsy, Sleepwalking and talking, night terrors and nightmares, REM disorder, bruxism (teeth grinding), enuresis (bedwetting)
• Drug or alcohol abuse
• Head injury or a neurological disorder
• Grief, stress 
• Traveling across different time zones
• Consumption of medications like anticonvulsants, antiemetics, antihistamines and sedatives or tranquilizers

Risk factors & complications

Risk factors for Drowsiness:

There is a certain predisposing factor that causes easy episodes of frequent sleep cycles or drowsiness in daily routine. There are: 

• Overweight
• Lower levels of physical activities
• Smoking and alcohol dependency
• Anxiety or depression
• People working for long hours and shifts
• Long haul drivers and commercial drivers
• People with untreated or undiagnosed medical illnesses
• People with diagnosed heart disease, brain conditions, and low thyroid function
• As per the American Sleep Association, men are more affected than women
• Medications with drowsiness as side effects
• Psychological trauma or disturbing childhood

Complications of Drowsiness:

• Depression 
• Lifestyle restrictions
• The increased amount of sick leaves from work
• Social isolation
• Triggers to many other diseases
• Severe headaches
• Stiff neck
• Multiple joint pain
• Convulsions or seizures
• Hallucinations or delusions
• Poor quality of life
• More susceptible to accidents while driving
• Immune function is reduced
• Mental changes include reduced attention span, loss of libido, becomes irritable, and has poor judgment

Symptoms of Drowsiness

The primary symptom of drowsiness is less energy, easy fatigue, and a constant feeling of tiredness. Other symptoms are:

• Difficulty in waking up from long periods of sleep
• Low energy
• Irritability
• Anxiety
• Loss of appetite
• Lack of concentration
• Lack of though processing
• Restlessness
• Loss of ability to function in the society, at the workplace, and family
• Malaise or lethargy

Diagnosis of Drowsiness

A primary review of symptoms and assessment of medical history is mandatory. Other outcome measures that are used to evaluate Drowsiness are:

• Epworth Sleepiness Scale: to quantify the severity of the condition
• Multiple Sleep Latency Test: measures the types of sleep experienced
• Polysomnogram: mapping of brain activity, heart rate, oxygen levels, and breathing function
• Electroencephalogram: to assess the electrical activities of the brain
• Head CT scan  
• Adrenaline, liver function, and blood tests

Treatment of Drowsiness

This purely depends on the cause of the manifestation. It is important to determine if the drowsiness is because of depression, anxiety, stress, medications or any other systemic or medical issue. For medications, it is always advisable to seek a prescription from a doctor to avoid any other health complications. The treatment strategies suggestive to overcome drowsiness are: 

• Medications like amphetamine, methylphenidate, and modafinil are stimulants and can keep one awake
• Lifestyle changes which majorly includes having a fixed sleep schedule
• If sleep apnea is present, it can be treated with continuous positive airway pressure (CPAP)
• Cognitive Behavioural Therapy (CBT)
• Graded Exercise Therapy (GET)
• Adaptive Pacing therapy
• Activity management
• Other drugs that are prescribed are clonidine, levodopa, bromocripitine and monoamine oxidase inhibitors
• Counseling and support groups
• Pacing activities
• Energy Envelope therapy: this is where individuals should stay within their energy zone and not push themselves beyond their capacity

Prevention of Drowsiness

• Having a nutritious diet that can keep the energy levels up during the day
• Prevent and reduce consumption of alcohol, caffeine, or any other sleep stimulants
• Increased consumption of vitamin c, vitamin b12, coenzyme q10, and magnesium
• Ensure at least eight hours of sound sleep
• Do not consume alcohol, caffeine, or heavy meals just before bedtime
• Keep all distractions or disturbances away while sleeping
• Keep the sleeping environment calmful and peaceful

Where can you get online treatment for drowsiness?

Thus, drowsiness if persistent can cause less function and reduce the overall quality of life. Most of the time drowsiness is successfully managed but cases where there is an underlying health issue or an undiagnosed condition, can take its worst form and manifest into complications that impact the person’s overall well-being. As easy as it management may seem, treatment and intervention under the supervision of a trained expert make it easier to eliminate the frequency of drowsiness without imposing any other health issues or complications. Too much sleepiness can always end up hampering the productivity of day to day life, identify and address it before it is too late and it becomes difficult to manage.