Drowsy all the time even after I sleep well. What’s wrong with me?
January 29, 2009 12:32 PM   Subscribe

It’s been for months now that I feel persistently drowsy during the day. It’s affecting my career in that I’m slower on the uptake and people don’t see me as very effective. Also I’ve gotten remarks on looking tired. As a result I’m not really very good at my work which is affecting my self esteem. So it’s really a problem I need to solve. Unfortunately none of the obvious causes and solutions seem to apply. I’m stumped and have been for a long time. It would be awesome if you could suggest a cause or solution I haven’t considered yet. If needed I’ll take that suggested cause or solution to my GP.

It’s a form of drowsiness where I feel an urge to let my eyes scrunch up as they can do when you yawn. Sometimes I find a private moment to give in to that urge to see if that clears it up. My eyes will scrunch up forcefully, all the muscles around my eyes will contract as if I’m trying to protect them from a strong light. I can hear the buzzing of the contracting muscles in my ear. I’ll start to yawn until there are tears in my eyes.
I feel persistently like this during the whole day.

Things I’ve tried to solve this:
- go to bed early. Mostly I’m in bed around 10 – 11 pm and sleep continuously until 5 or 6 am. Frequently I wake early, around 4 am, and can’t get back to sleep.
- General sleep hygiene:
o Not drink coffee (or tea) in the evening. Not drink coffee during the weekend.
o Not drink any alcohol in the evening. (My general drinking habits are to have two bottles of beer (0.33 l) during an evening now and then)
o Have a really dark and quiet bedroom.
- Drink coffee at work. A lot.
- Go to my GP. She just gave me a brochure on general sleep hygiene.
- Discuss it with a therapist. He told me to go to my GP.

Possible causes that I’ve considered:
- sleep apnea. According to my GF I don’t snore very much. Also I’m not overweight. So that doesn’t seem to be the case.
- A side effect of something. I was using minoxidil against hair loss. I stopped using it for a week. But unfortunately that didn’t stop the drowsiness.
- Psychosomatic causes. I’ve been through an emotionally intensive and difficult period recently. And in the past I’ve had a time where a spell of yawning led to an emotional release. At this time there doesn’t seem to be a release like that in store for me that ends the persistent drowsiness.

General information: I’m 40 years old and my body mass index is about 21.

You can reach me through drowsy.endlessly.drowsy@gmail.com
posted by anonymous to Health & Fitness (33 answers total) 13 users marked this as a favorite
Get some exercise. If they cared, my co-workers would know what days I exercised because the next day, I don't do the head-drop thing around 2pm.

Also, look into evironmental factors. My dad's old car had a small freon leak, and he almost passed out in traffic.
posted by notsnot at 12:43 PM on January 29, 2009

Just because you don't snore, and aren't overweight, does not mean that you don't have sleep apnea. I have many friends who are in excellent shape, and they have sleep apnea. Might not be a bad idea to look into this.
posted by snoelle at 12:46 PM on January 29, 2009 [1 favorite]

You can have sleep apnea without snoring and without being overweight, FYI. You should probably go back to your GP and request a sleep study, just to rule that out.

Standard MeFi medical inquiry, too: "how's your thyroid?"
posted by fairytale of los angeles at 12:48 PM on January 29, 2009

You don't mention your diet. I'm pregnant, and was diagnosed with gestational diabetes, and since I've been on that diet (basically eat more protein, and monitor your carbs, and most importantly eat a high-protein breakfast), I have more energy than I ever ever have. I'll never go back to the carb-heavy, meal skipping, candy eating maniac I was, because it meant I was constantly sleepy.
posted by dpx.mfx at 12:52 PM on January 29, 2009 [1 favorite]

drink water and lots of it.
posted by birdlips at 12:55 PM on January 29, 2009

yes, avoid high-carb food from 10AM to 3PM. Back in the day I'd eat a past lunch + bread + 16oz Mt Dew then wonder why I'd crash at 3:00.
posted by troy at 12:56 PM on January 29, 2009

You could have ypothroidism. Are you cold all the time? Is your skin drier than you remember it being before the drowsiness symptoms? Do you feel like you're in a fog? A simple blood test will tell you if there's a problem.
posted by wherever, whatever at 12:59 PM on January 29, 2009

Sorry, that's hypothyroidism.
posted by wherever, whatever at 1:00 PM on January 29, 2009

Stop drinking so much caffeine. Some people can't handle drinking lots of coffee without having it affect their sleep, even if they stop by early afternoon. I'm one of them. I used to drink lots of soda and coffee, and had sleep problems. So I cut back and made a rule that I'd drink no caffeine after 2pm or so. That helped only a little. I went through the misery of total caffeine withdrawal and quite soon after I noticed that I was sleeping *much* more deeply at night, waking up fewer times and most importantly, not feeling groggy in the morning. This meant I didn't feel the need to caffeine-ize myself in the morning.

Also, you describe your sleep schedule to be from around 10-11pm to 5-6am. That's eight hours at best. There's no shame in consistently needing 8 hours of sleep consistently. I find I function much better if I get 8 hours of sleep 4-5 times per week.
posted by bluejayk at 1:04 PM on January 29, 2009

Yeah, seconding the no caffeine at all thing as something worth trying. If I drink a little bit of caffeine, my sleep patterns are affected, independent of timing.
posted by Comrade_robot at 1:06 PM on January 29, 2009

Try Provigil. You should be able to get a prescription from your GP. Experiment with the dosage and watch out for interactions with caffeine.
posted by RandlePatrickMcMurphy at 1:12 PM on January 29, 2009

Standard MeFi medical inquiry, too: "how's your thyroid?"

Also, how are your iron levels? You're basically describing me when I'm iron deficient. Not that I'm saying you're anaemic or whatever, I have no idea what's wrong with you (none of us do). But these are the sort of standard tests your GP should be doing rather than fobbing you off with a pamphlet.

So go back to the GP and tell them that this is a real problem that is interfering with your quality of life, and be clear that you want to try and track down the cause. Both thyroid issues and mineral deficiencies are diagnosed via blood tests so that's the place you should start. A referral to a sleep clinic or ENT could be a next step, follow up on the snoring/apnoea idea, but your GP should do at least basic workup first to rule out an easily fixed physical problem.
posted by shelleycat at 1:14 PM on January 29, 2009 [1 favorite]

Also make sure you keep consistent sleep hours, even on the weekends. Sleeping in to catch up on sleep doesn't work.
posted by inigo2 at 1:38 PM on January 29, 2009

Drink coffee at work. A lot.

Stop doing that. Caffeine can take 12-16 hours to get out of your system.

Frequently I wake early, around 4 am, and can’t get back to sleep.

Mention this when you see your doctor.

sleep apnea. According to my GF I don’t snore very much. Also I’m not overweight. So that doesn’t seem to be the case.

Youre wrong on both counts. Thin people get apnea. Thats like saying "I cant have diabetes, Im not obese!" Snoring isnt the cause of apnea. Lots of non-snorers have apnea. It just happens that most snorers have apnea. Snoring is not a prereq for apnea.

Regardless, your GP will probably take blood and recommend a sleep study. Dont try to diagnose yourself over the internet. It wont work and it will only worry you. If youre at the point where internet strangers are telling you you have hyperthyroidism then its really time to press the little X on the corner of the browser and call a real doctor.
posted by damn dirty ape at 1:43 PM on January 29, 2009

- sleep apnea. According to my GF I don’t snore very much. Also I’m not overweight. So that doesn’t seem to be the case.

Wrong, wrong, wrong. My diagnosis was delayed by at least 15 years due to the fact that I am a relatively young, skinny, non-snoring female. Insist on a sleep study.
posted by availablelight at 1:47 PM on January 29, 2009

Seconding the avoiding high carb food (sugar, starches). I had a pretty similar problem to you - so much so that I was put on Provigil to stay awake during the day - and it turned out that I was prediabetic. Even in a non-prediabetic individual, eating lots of carbs releases lots of insulin, which leads to a drop in blood sugar and that constant sleepy feeling.
posted by chez shoes at 1:50 PM on January 29, 2009

I had unexplained drowsiness for a couple of weeks that was caused by just a bad pillow. I don't know how I didn't notice it, but I didn't. The health guy at work caught it when I went down for some allergy pills-- I figured maybe I was allergic to something that was making me sleepy so I wanted to try some claritin (I know it sounds silly, but I was so sleepy! I figured I'd try it once and it couldn't hurt). He just asked some simple questions and poked at my neck muscles and told me to get a new pillow.

Seems too simple, but that was it for me. Now, I had just moved and was using a different pillow. Have you changed your mattress or pillow lately? What if your pillow is just really old?
posted by ohio at 2:14 PM on January 29, 2009

Where do you live? If you're in a winter climate right now, you might want to read about Seasonal Affective Disorder. That often makes people tired and lethargic, among other things, for months at a time.
posted by Maarika at 2:21 PM on January 29, 2009

Totally, ask your GP.

In my experience, when I get to a point where I'm drinking a lot of caffeine, I reach a dreaded plateau of tiredness: without caffeine I'm cranky and tired, with caffeine I'm sleepy and jittery. I don't know if it's because the caffeine is affecting my sleep cycle, I've built a dependence, the warm milk in my coffee is relaxing, or something else entirely, but I find that after a while, coffee makes me want to take a nap. Then if I kick caffeine for a while I sleep better and feel much better in general.
posted by abirae at 2:24 PM on January 29, 2009

Tell your GP that this is becoming a serious problem that interferes with your ability to do your job. They should at least do the standard blood tests (CBC, etc.) to start with. If your doctor still brushes you off, see another doctor (don't know what country you're in/your insurance situation, so I understand that might not be possible).
posted by fructose at 2:54 PM on January 29, 2009

Tell your GP exactly what you have told us. And insist on a sleep test AND a thyroid test.

I have a slew of endocrine issues (insulin resistance and hypothyroidism) and now that these have been treated, I feel like a new woman. One of the things about insulin resistance is that eating lots of refined carbs makes you feel like crap. Now I stick to snacking on Weight Watchers low-fat yogurt, low-fat cheese sticks, dried fruit, and roast turkey.

And be sure you are drinking enough water. That's WATER - not coffee, tea, or soda. If you are dehydrated you will feel tired and out-of-it.
posted by Rosie M. Banks at 3:28 PM on January 29, 2009

Ditto on the non-snoring , not overweight and have sleep apnea situation. A sleep test is a good thing, cause as my doctor says: if you're getting 8 hours of sleep but still feel tired, something's wrong.
posted by anitanita at 3:47 PM on January 29, 2009

nthing sleep study.

nthing caffeine moderation.

And from the "if all you have is a hammer" department of my mind, mine turned out to be a congenital condition called a Chiari I Malformation. My cerebellar tonsils were compacting my brainstem. GPs, sleep scientists, and psychiatrists had all given different answers (the psychiatrist's was "you haven't decided to make a change in your life yet." Bastard.) So, if you have great insurance, get a cranial MRI.

When I was having real, physical sleep problems (including the dastardly Low Sleep Efficiency) I was tanking up on energy drinks (and nearly stopping my breathing in the evening with the evil Ambien, which is another story). When I got healthier, I looked at it objectively. Caffeine makes me jumpy and irritable. Sugar spikes my blood sugar, which crashes later. Ginseng tastes revolting, and there is so little peer-reviewed research on its efficacy that it causes dismay. I'm already taking B-vitamins. What's left? Assuming (big assumption) that there are no interactions between the ingredients in energy drinks, the answer is "taurine", and so I bought some taurine capsules and take two in the morning. I feel hyperfocused and catlike -- could it possibly be norepinepherinergic? Dunno. YMMV.

But do the sleep study first.
posted by quarantine at 4:01 PM on January 29, 2009

I find that when I am stressed, I feel drowsy and out of it, no matter how much sleep I get. In addition to that, I don't heal very well and get a bit clumsy. It was recommended to me to up my vitamin B / B-complex intake - it really makes a difference. Your GP can run a quick blood test for vitamin deficiencies as well as thyroid function, etc.
posted by blackkar at 4:06 PM on January 29, 2009

You are the first person to have described my eye and hearing phenomena or symptoms. I'm 64 and have experienced that eye-scrunching along with the rushing sound in the ears whenever I am "under the weather". I was never able to describe it very well. I think my doctor believed I was imagining things. But it is a very real feeling- no, it's a phenomena. It is unsettling. Lately, I've been experiencing this all the time - for months now, and have decided that this phenomena accompanies inflammation somewhere in my body. I, too am tired all the time, and have had many of the tests suggested above w/o result. That's all I got. I'm just freaking thrilled to finally hear my lifelong symptoms acknowledged. Maybe I'll try my doctor again. This probably has been no help for you, but I feel better. Thanks for posting.
posted by Hobgoblin at 4:41 PM on January 29, 2009

I have something similar in that when I get a lot of sensory input (in the form of, say, a new city or high-stress times at work), I need to find a spot where I can have a nap for about five minutes. Sometimes one minute will do - it's just the brain feels like it needs to reset. It seems I carry voices and conversations in my head until I have this mini-nap and all that head noise and mental fog goes. I have had the scrunchy eye thing too.

Like so many things in life, there probably isn't one simple answer, so it might be a good idea to give everything a try that's been suggested. I would second the reduction in caffeine and sugar too.
posted by stenoboy at 4:50 PM on January 29, 2009

Other blood tests could be useful as well. Some of my family have Coeliac's disease, which is an adverse reaction to gluten in the diet - one of the symptoms is constant drowsiness. Being sleepy a lot of the time is a symptom of so many things that it's really not much help to ask us when we don't know if there are any other problems you're having.
posted by fearnothing at 5:55 PM on January 29, 2009

I have something similar in that when I get a lot of sensory input (in the form of, say, a new city or high-stress times at work), I need to find a spot where I can have a nap for about five minutes.

Yeah, me too, but I don't actually think it's similar. IANAE, but this sounds to me -- in both your case and mine, as I know exactly what you mean about rebooting -- as autistic-spectrum-related symptoms (no, I'm not diagnosed, but when I read descriptions of high-functioning sufferers -- damn. Do you sleep better with a very heavy blanket, independent of the ambient temperature?)
posted by quarantine at 6:10 PM on January 29, 2009

More exercise and more sleep. At least eight hours of sleep a night. Really.
posted by exphysicist345 at 6:25 PM on January 29, 2009

There could be a number of causes, in various combinations, or just one (that you haven't thought of yet). Start with the basics and use the process of elimination.

You say you drink a lot of coffee, it could be as simple as this. I was just as addicted, sometimes as much as 6 or 7 cups a day. Slowly wean yourself off coffee and all caffeine. If you go cold turkey you'll get a whopping headache for a day or two and feel really lousy. But once your body has all the caffeine out of your system, you'll have more energy. I still drink coffee and cola sometimes, but I do so sparingly.

Diet and exercise: do you eat breakfast? I'm in my 30s and I never really learned until fairly recently that is really is true--you do need to eat breakfast to have energy throughout the day. Breakfast also keeps your body weight down/regulated. So eat it, maybe with coffee, but try with juice or water. And exercise! Twenty minutes of cardio, three days a week; you know the drill.

I'll also say water. Most people only drink water when they feel thirsty, but your body can be dehydrated without you feeling so. They say now that 8 glasses a day is an old wives' tale, but whatever--drink a freakin' gallon of water a day. It makes a big difference.
posted by zardoz at 6:26 PM on January 29, 2009

I've been persistently drowsy during the day for a few months, too. I can't get through the whole day without taking a nap, and often feel tired even when awake. Turns out I'm anemic. I'm now taking supplements prescribed by my doctor and hoping for improvement.

If your GP won't do more to explore the causes of this on a second visit, it's time for a new GP who will run some bloodwork and whatnot to help you solve this.
posted by not that girl at 9:28 PM on January 29, 2009

[This is a followup from anonymous.]

I’ve received a few emails from people with similar symptoms enquiring after a follow up. So here goes.

Context: I have a tendency to react with depressive symptoms to periods of high stress.

The doctor had me run through a battery of physical tests first. (thyroid, vitamine deficiencies, etc) These were mostly blood tests. That didn't turn up anything definite. I have a relatively high thyroid, apparently that’s why I never gain weight, but still with the normal range.

Then I did an extensive sleep research. I live in a country where a sleep study like this is insured for everybody. They had me do a set of timed video tests to measure my response time. Also I had to fill in a log wrt sleeping and body temperature and correlation with a movement meter on my wrist. After that they hooked me up with a tool that tracked my brainwaves, breathing, heartrate etc. for 24 hours. The end conclusion was that a long period of high stress left me with bad sleeping habits. As a result I kept waking up during the night even after the period of stress was over. At least they were able to see on the EEG of my sleep that I sleep deeply in the beginning of the night. Apparently that is the most important part of nightrest and crucial to being able to function at all.

Also they saw that I did not have sleep apnea. They noticed that I did not have enough exercise. Exercise according to them is not necessarily strenuous endurance but more walking and relaxed commute biking. Another thing I was chastised for was taking a nap in the afternoon. Doing that reinforces the waking up at night. They prescribed me something which they call sleep therapy; a specialist helps one develop healthy sleeping habits again.

Apart from the drowsiness thing the doctor (GP) prescribed me a very low dosage of an antidepressivum (seroxat) against some major life stress I was going through. (my on-off gf on another continent turned out to be pregnant, when the child was born she didn’t let me be the legal parent of my child, I ran the risk of being fired because of my drowsiness) Somehow that made a huge difference for me at a very low dosage. Even when I woke up at night I had that nice ‘heavy feeling’ that is a precursor to falling asleep pretty soon again. I.e. I was able to fall asleep again instead of being wide awake from 4 a.m. to 8 a.m. as if I had drunk a pot of coffee. Also it suppressed the ‘running thoughts’ during the times I was lying awake.

Situation now: I broke up with my GF one year after my daughter was born, still not her legal parent, but at least being able to see her regularly. So at least part of the cause of my stress is somewhat less. The antidepressivum dosage was upped from very low to low. I’ve been functioning much much better at work. Feeling clear headed, quick to respond. I still don’t exercise enough. Since the antidepressant made all the difference I did not go to the sleep therapist. (also because he had a 0.5 yr waiting list)

I’ve received some feedback on this question by mail on possible causes that I haven’t pursued:
- candida, a yeast infection, as a cause. I wasn’t sure whether that email was spam.
- gluten allergy as a cause

Obviously my story is just one anecdote. For you it might be sleep apnea, or a thyroid condition etc. Make sure causes are examined systematically. My advice is: do take care of it when you have similar symptoms. It’s easy to trudge on thinking nothing can be done. But I’ve experienced it as a serious impediment to my quality of life. And something can be done.
posted by cortex (staff) at 9:59 PM on January 29, 2009

I had similar issues when I turned 40 and it turned out to be gallstones. It's a simple couple of tests - abdominal x-ray and abdominal ultrasound.
posted by mktackabery at 7:14 PM on January 31, 2009

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