Too zombied to come up with a creative title.
April 20, 2011 7:42 AM   Subscribe

I'm worried I'm going to be fired because I'm so tired.

I'm so embarassed and confused about this... I am really tired almost all of the time. I don't know what to do and I'm extremely worried it's going to get me fired from my (first, real, wonderful) job.

I graduated from college last spring, and started working 9-to-5. I had a small office without a window and occasionally (2 or more times a day) would nod off in front of my computer screen and fall asleep at my desk for up to 15 minutes at a time. This usually happened when I was stuck on a problem that I couldn't solve (I'm a web programmer), but also at other times too.

Whenever this happens I try so hard to fight it but it never works - changing from work to surfing the internet for a few minutes, getting up and getting tea or going to the bathroom doesn't really fix it. I usually fall asleep and snap out of it 10-15 minutes later.

I changed positions within the company, and now share an office with others, and it has lots of windows and is very bright. The work is even more interesting, as I essentially have my dream job, although it is still sitting at a computer all day. But I still have this problem. A few months after starting the new position, my project manager called me into her office and explained to me that another woman in the department had seen me nodding off at my desk and told her about it. (!!)

Hearing this made me super anxious and embarassed to the point of tears and nausea - i try to work hard and in general be a good employee, usually skipping going out for lunch in order to make up time I've zombied out.

My wonderful PM who is so concerned for me wanted to let me know that that happened so I could get it checked out. When I said it could be because I don't get enough sleep at night she thought it was more serious than that (she's in a medical field, and suggested I go to the doctor).

I go to bed around 11 (fall asleep basically right away) and set my alarm around 7am, which turns into 8:00 or later. I've been skimping on showers, breakfast and packing lunch in the morning in order to hit the snooze button (I unfortunately picked up this bad habit from my boyfriend).

I nod off over a book on the bus and/or train on my 35-45minute commute. When I take naps after work (6 or 7 pm), it's really difficult not to stay in bed after a nap and sleep the whole night, so I've been just trying to suffer through the end of the day instead. If my boyfriend is working late, I either stay up til 11:30 and wait for him to get back, or get woken up by him coming in the door anyway. I've found if I go to bed hours earlier I still feel the same, so I've just started doing what I want to do after work instead (watch movies, play games, programming projects, crafts, cooking things, wait for boyfriend, etc) rather than just sleeping my life away. If I let myself sleep an unlimited amount on weekends I'll be in bed til 1 or 2, but I'll feel good after, except awful about sleeping so damn late and wasting the whole day.

For lunch at work I have leftovers or get sushi/salad or buns from a chinese bakery for lunch, but i still don't usually take time to eat breakfast (I know, I know... but I just want the sleep instead). I don't feel any better when I do, and it mostly just makes me hungry for lunch earlier. I cook and eat a big meal (usually chicken, some kind of rice/grain, and salad or veg) when I get home.

As for exercising... I've been alternating between being really good and really bad. I used to run in the morning (when I had class at 10am), but I can't bring myself to give up an extra hour of sleep anymore. I'm fighting a losing battle to get my exhausted self to work out after work. When it got really cold I switched from running to hot yoga and at my best was going 3-4x a week. I really wanted this to make a difference in how I felt but it didn't really.

I was taking Celexa for depression/anxiety and am seeing a psychiatrist to work on changing my meds for other reasons. She switched me to taking Buproprion for a couple months (I was so excited when I heard it might make me 'more energetic'!). I felt the same on that as I did without anything at all, so I was switched back, and may be trying something new in the near future. The celexa still gives me infinite crazy vivid dreams.

I told my psychiatrist and doctor about this sleeping 'issue', and they each sent me for various blood tests, with no result. My doctor said that if I wanted I could go in for a sleep study, but didn't think it was necessary because I wasn't overweight and didn't snore or show other symptoms.

I'm unbelievably embarassed about being seen like this at work. My PM told me that a few other people noticed me nodding off during our department meeting a few weeks ago, and there's another meeting today and I'm very very worried about it. I usually drink 2-4 cups a day of herbal or caffeinated tea and while I don't really want to start buying coffee or drinking a ton of caffeine, I'm going to buy a big coffee for this meeting and maybe start up a red bull habit to see if it gets me anywhere, although I don't like all the sugar.

The more I think about this and the more my project manager mentions it to me, the more I feel the urge to quit my (perfect, amazing) job in embarassment. I'm so worried about being fired and this ruining my professional career before it even starts. That is hard for me to think about and I've been in tears over it many times.

TL, DR: I'm so sorry this is extremely long and ramble-y. I have the feeling i'll be told to sleep more (and good god do I want to).
I'd like to get some idea of whether this is worth seeing my doctor again, or a different doctor like my PM suggested, or if I should quit my job before I'm fired (sort of joking... sort of...), or if turning my life into just sleep-work-eat-work out daily will help, or maybe some advice on workday hacks (caffeine powder? 5 Hour Energy?) Thanks so much in advance.
posted by sarahj to Health & Fitness (58 answers total) 11 users marked this as a favorite
Best answer: My doctor said that if I wanted I could go in for a sleep study, but didn't think it was necessary because I wasn't overweight and didn't snore or show other symptoms.

I'm not a doctor or anything, but don't you think you should get a sleep study????? Sleep is not working for you like it should, and you're nodding off during the day to make up for it. This is a no-brainer to me.

I mean, maybe you're having seizures in your sleep, maybe you have non-obvious apnea, maybe, for any variety of reasons, you're not getting enough of each sleep stage. Maybe you have narcolepsy. See a sleep doctor.
posted by zeek321 at 7:48 AM on April 20, 2011 [5 favorites]

Best answer: You need to go to bed earlier is my first response.

And if you're generally tired all the time, make sure you have your Vitamin D tested. Check your blood test results and see if you were already tested for that. If not, explicitly request a Vit D check to see if that could be part of the issue.

Also, try going for a walk outside when this starts to happen. When I feel that mid-afternoon crash coming on around 2:00 or 3:00, I take off for about 10 minutes and walk, socialize with people for a couple of minutes, and then come back to my desk.

Also, picking up a heavy caffeine habit probably won't help and could in fact make this issue even worse and drinks like Red Bull often have more caffeine in them than a regular cup of coffee. Drink a cup of coffee if you think that would help, but don't suddenly start downing four 5 hour energy shots/day or anything.

And, I agree with zeek321, it may be worth considering a sleep study if nothing else and normal changes to your routine don't help.
posted by zizzle at 7:50 AM on April 20, 2011

(I apologize for my tone, but I spent months experiencing "unrefreshing sleep" and it was hell on earth. My heart goes out to you. See a specialist. Do not quit your job. Do not be embarrassed. This is a puzzle to be solved, not a moral failing.)
posted by zeek321 at 7:51 AM on April 20, 2011 [3 favorites]

Best answer: Go to bed earlier, and for goodness sake, stop skipping breakfast lunch and/or dinner! How is your body supposed to have any energy if you keep skipping meals??
posted by Grither at 7:54 AM on April 20, 2011 [2 favorites]

Best answer: A couple random thoughts. First, definitely keep talking to your doctor. Has your thyroid been checked? Its the standard mefi suggestion, but it's true; a wonky thyroid will definitely make you exhausted. And why not go for the sleep study - do you have anything to lose? But that kind of exhaustion/falling asleep definitely doesn't sound normal for anyone without a newborn at home, so I'd keep looking into it.

As for staying awake, if you don't want the sugar, there are several sugar-free energy drinks. Sugar free Redbull (light blue can) and sugar free Rockstar burner (dark blue can) are my favourites, but you have to be ok with all the fake-sugar substitues (asparteme, splenda, etc). And to be honest, I'm not sure these will fix the underlying problem.

In the short term, for really boring meetings, I make sure I have something to play with. My phone and iPad work well (i can always take notes on the ipad, or even paper, for example). Failing that, a thumbtack being pressed into my thigh will work, although it's not the most pleasant experience.

Deliberately full bladders will also keep me awake. Drink tons of water - that's a good habit to get into regardless :)
posted by cgg at 7:54 AM on April 20, 2011 [1 favorite]

Best answer: Agreed about the sleep doctor, but I find it very interesting that you waited two thirds of your very long post to mention your depression/anxiety meds. Depression meds often make people very groggy in the first place, and that's without considering that depression is certainly something you should be considering as very possibly causing you to have no energy at work.

Also, modafinil, tell your psychiatrist to give you modafinil. It's a much better option than caffeine.
posted by eggyolk at 7:54 AM on April 20, 2011 [1 favorite]

Best answer: Seconding getting a sleep study. Think about it. This is affecting your life. It should be examined by professionals who are best able to get you the appropriate care.

And just because you're not overweight doesn't mean you can't have apnea. But maybe you have narcolepsy or something else. Getting a proper diagnosis might help you protect your job under the Americans with Disability act.

I was in this boat a year and a half ago. I was written up for falling asleep on the job. But then I got diagnosed with sleep apnea through a sleep study, got a CPAP machine, sleep really well and now I never fall asleep at work. It was a very positive move I made in my life.

So do only costs you one or two nights of sleep in a sleep center.
posted by inturnaround at 7:57 AM on April 20, 2011 [1 favorite]

Best answer: This happened to me since I've been a kid.
I was even laid off from my favorite job by HR while my boss was on travel (he was pissed)

I talked to many doctors about this and they all told me I was depressed and needed more exercise.
Eventually I ended up with a doctor who was concerned.
Sent me to a sleep specialist.... had various sleep tests done

And. Diagnosed with narcolepsy. My other symptoms are weak.muscles when angry or surprised (cataplexy),
Waking up paralyzed for a few seconds.... and occasionally hallucinations when falling asleep.
Not all narcoleptics have all these symptoms and some have it worse.

Other sleep disorders such as sleep apnea can also cause tiredness throughout the day.
The two people I know with sleep apnea are actually skinny. It does not just affect overweight people.

Also other medical conditions can cause fatigue. Glad to see you had blood tests.

In any case, for some reason, people get pisses when you nod off at work like you're doing it on purpose.

See a doctor. You don't want to be let go like I was.
posted by KogeLiz at 7:58 AM on April 20, 2011

Don't quit. Go to bed earlier, and try to note when you're starting to get a little heavy-lidded and get up, stretch, move around. If you are allowed, try using an iPod.

I know you said you have trouble motivating yourself for exercise, but that would probably help, as well. How about instead of a gym or running, do you like any sports? Join a soccer league or something similar that will get you out in a fun, social way for a few hours a week.

The meds most likely do have an affect here, as well, especially if they are messing with your REM dreaming.
posted by rich at 7:59 AM on April 20, 2011

Many people will tell you take vitamins and go to sleep earlier.
They don't understand that's not always the answer. I tried everything.
But if you feel like these things could help you, go ahead and try them first.
But I don't see why you wouldn't want to have a sleep study/MSLT done to rule out serious sleep disorders.
posted by KogeLiz at 8:00 AM on April 20, 2011

This sounds like me, years ago -- I used to doze off all the time at work. Most embarassingly, in small meetings. I thought everyone was this tired all the time, too, and it was a character flaw on my part that I couldn't fight it off.

Turns out, I had sleep apnea. According to my brainwave patterns during the sleep test, I never got down to the really restful part of the sleep cycle because I stopped breathing every few minutes.

I had a sleep test, then got a CPAP machine, and it was a WHOLE NEW WORLD. I stopped falling asleep all the time. My relationship with caffeine changed *dramatically*. I felt less stupid and more awake.
posted by rmd1023 at 8:01 AM on April 20, 2011 [1 favorite]

Yeah, I had an experience pretty much exactly like rmd1023's. I drink coffee in reasonable amounts now, I am more attentive all day long, and I haven't dozed off during the day in a long time. I feel like a different and much better person now.

Definitely ask your doctor about the sleep study.
posted by AkzidenzGrotesk at 8:07 AM on April 20, 2011

Best answer: 2nd ing to ask about modafinil. Man, I sound like a pharmaceutical company shill. "Ask your doctor about Provigil." But I have heard good things about it's use for narcolepsy, and I know several people in science fields who would love to get a prescription for it. It never hurts to ask.

nthing the sleep study. It's only one night, and it might change your life.

For food, you can try stashing little snacks at work so that you can eat when you get in to the office or have skipped a meal. I keep a box of Luna bars near my door and some protein bars in my car for this purpose. Trader Joes sells little packets of almonds that are a great snack.

Also, caffeine isn't the worst thing in the world. If your stomach can handle it, coffee with soy or almond milk is delicious. Other people love greet tea. Or Earl Gray. Or chai. As a stopgap measure until you get your sleep issue sorted out, it may be very helpful.
posted by ladypants at 8:08 AM on April 20, 2011

My friend was diagnosed with Narcolepsy after years and years of being somewhat tired all of the time. She started taking meds and is now fine. Maybe see if you can get tested for this?
posted by darkgroove at 8:10 AM on April 20, 2011

Best answer: Nthing the sleep study. I've got a friend with narcolepsy, who didn't have any symptoms other than falling asleep at inappropriate times (such as when driving a car!). Once he was diagnosed, he says it's an amazing difference.

You may need to be explicit to your doctor. "I'm falling asleep all the time" sounds like it could also mean "I'm tired." Say "I fall asleep at my desk enough that my supervisor called me out on it and I'm afraid I will lose my job if I keep sleeping."

Hunger makes me incredibly sleepy, so I'm also nthing the idea that you should eat breakfast, especially with protein in it instead of a bunch of carbs -- carbs give you quick energy and then a crash, while protein is a bit more slow-release. I take mine in to work and eat it at my desk when I get in, which helps me not get hungry until lunchtime, and I also keep small bags in my desk with an ounce of nuts in each that I can grab and munch about 10:30-11:00 if I'm getting hungry.

Also, I take a small dose of buproprion (off-label for ADHD) and (a) larger doses give me horrible insomnia, and (b) the "energy" part doesn't kick in for about 5 hours after taking it - and consists of me not getting sleepy at 3 P.M. like I normally do (low point in the circadian rhythm), rather than giving me lots of energy.
posted by telophase at 8:12 AM on April 20, 2011

Best answer: didn't think it was necessary because I wasn't overweight and didn't snore or show other symptoms

Dude, the symptom is that your sleep is broken.

I'm not overweight and I don't snore and I had sleep apnea. If switching meds doesn't fix it, by all means, go and get checked out.

I finally made the appointment for a sleep study when I fell asleep behind the wheel on the way to work. This stuff sucks, but it's fixable -- you don't have to choose between sleeping your life away and being exhausted all the time.
posted by *s at 8:16 AM on April 20, 2011 [2 favorites]

Best answer: You are experiencing a medical problem. Right now, you don't know what it is, but you need to keep seeing your doctor, or get a new one, and get at least a tentative diagnosis, in writing. It sounds like something is causing your sleep to not be refreshing the way it is supposed to be.

Then you need to take the documentation, in writing, in to your HR department and share with them that you have a documented medical problem. Sign up for the paperwork for FMLA, because if you're going to do sleep studies and the like, you may need to take intermittent FMLA leave to get it all figured out. Sometimes medication roulette may cause you to miss a day or two of work while you get it figured out, that's what intermittent FMLA leave is for: to protect your job while you focus on getting better.

In the meanwhile, talk to your boss and HR about how thankful you are that they pointed this out to you because they were right, it is a serious medical problem, and you are committed to getting better. You will not get fired if you have your medical problem documented.

As for how to go day-to-day, my own history with non-refreshing sleep led me to the following strategies: taking a tiny dose of Amitriptyline about an hour before I wanted to go to sleep (so, around 8:30-9:00pm), sleeping with a white noise machine, getting an alarm clock with a light attachment to gradually brighten my room as the alarm time neared, opening my blinds as soon as I got out of bed, drinking two cups of coffee per morning, setting my phone alarm to go off once per hour while I'm at work and getting up and moving (walk around the building) once per hour, eating fruit for breakfast, having mostly protein for lunch, getting an anti-eye-fatigue screen for my computer at work, and turning off anything with a screen at least an hour before bedtime.
posted by juniperesque at 8:22 AM on April 20, 2011 [7 favorites]

Definitely push for a sleep study.

My doctor said that if I wanted I could go in for a sleep study, but didn't think it was necessary because I wasn't overweight and didn't snore or show other symptoms.

I had a serious issue go undiagnosed for years because I wasn't overweight, so a slew of doctors didn't connect the dots. I dream that no one else will have to go through that hell. You are having sleep issues, a study can go a long way in figuring out what the problem is.
posted by Zophi at 8:24 AM on April 20, 2011

Sleep study.

I had a friend who for whatever reason never entered the right phase of sleep, or not for long enough, anyway. She would sleep 10-12 hours a night, take a 2 hour nap, and still be exhausted. She's on meds and is doing much better now.
posted by kestrel251 at 8:27 AM on April 20, 2011

My doctor said that if I wanted I could go in for a sleep study, but didn't think it was necessary because I wasn't overweight and didn't snore or show other symptoms.

I'm barely overweight and have apnea. It's linked with being overweight, but regular people get it too. I'd get the study. Actually, I would think it irresponsible for a doctor to not order the study considering your symptoms. In fact, I don't think a GP can diagnose nacolepsy or apnea by inspecting you. Randomly falling alseep is the #1 symptom.
posted by damn dirty ape at 8:28 AM on April 20, 2011

Best answer: At some points in your post you question the seriousness or legitimacy of your sleep troubles. Don't do that. It's a legitimate health problem. And you're lucky in that your PM sees it that way too. Don't be afraid to work with them to get any reasonable accommodations you might need, while also making sure you are getting everything done they need. I second looking into your options for medical leave.

Keep seeing your psychiatrist regularly. In my experience, when the current meds and treatments aren't working, this should be at least every two or three weeks in order to regularly asses and tweak treatments until it's working. Don't rule out a sleep study. You don't have to be overweight to have physical sleeping problems. And speaking of the physical aspects of sleep, do you have a good mattress and pillow?

Also do you get excercise? This can help tremendously with one's mood, which in turn can help you get sleep, and it can also get you energized for the day. You might think it would just tire you out, but it can really help your energy level throughout the day. Try getting in some excercise in the morning before work if you don't already, which I'm guessing you don't since you've been sleeping as late as you can get away with. Once you get in the routine, it may get a lot easier to get up and do it. I especially recommend biking to work, or part way, like to a bus or train stop, if it's too far. Fresh air is great.
posted by gauchodaspampas at 8:31 AM on April 20, 2011

I just want to re-emphasize Juniperesque's response. Make sure your employer knows you are aware of the problem and are seeking medical attention for it.

Exercise will definitely help too. I understand wanting to sleep in in the morning, but it's also great to do at night. Even just a nice, gentle walk. Do you walk home from the bus or train? Try going a longer route.
posted by apricot at 8:37 AM on April 20, 2011

Nthing that you need to go in for a sleep study. My ex had severe sleep apnea and didn't snore-- nodding off all the time is a pretty classic indicator of sleep apnea.

There are other things that may help too-- you need to eat breakfast, you should try going out for a walk at lunchtime, you need to eat dinner and go to bed earlier. You said you've had blood tests done-- in addition to thyroid problems, vitamin D deficiency can cause fatigue.

This is a medical problem, and while I sympathize with your feeling of embarrassment, don't quit your job, (try to) stop feeling like it's your 'fault' for doing something/not doing something. You can make some lifestyle adjustments, and that's all to the good, but you need to 1) do the sleep study (seriously) 2) get a second opinion/see a specialist and 3) make sure that you tell your psychiatrist about this issue and consider adjusting your meds.

Also, agree with others: tell your employer you're aware of the medical problem impacting your performance, and that you're taking active steps to deal with it.
posted by Kpele at 8:42 AM on April 20, 2011

I had the same problem for a while, you need a bigger engine. Make daily exercise a priority, you will have a lot more energy once your body adjusts to it (probably a few weeks).
posted by BobbyDigital at 8:42 AM on April 20, 2011

You need to take this seriously as a medical problem. If this is a medical issue, and it's not actually affecting your work performance, you might have rights under the Americans with Disabilities Act and/or your state and local laws.
posted by yarly at 8:42 AM on April 20, 2011

Best answer: I would make a change to your eating, sitting and sleeping habits, just to rule out the major causes of generic fatigue. Definitely eat a breakfast (ideally not cereal, bacony or cheesy), start eating lean proteins and vegetables (especially for lunch), go outside and sweat for a half hour 4-5 times a week (starting slow, like walking or a casual bike ride, building up as your body becomes more accustomed) and getting up for walks around the office during the work day, and go to bed a little earlier. It doesn't sound as though you are falling asleep randomly (like when you're driving), just when you are bored or not motivated - which is incredibly common. Maybe try one of the popular hours-long energy shots to see if that perks you up in the short term (so that you are awake and alert at work until you get this figured out).

Exercise can really REALLY give you all-day energy that you'd never expect until you have some for a bit. And good food that fuels your body cleanly just makes you feel better and more inclined to exercise. It's hard to believe these small things can have such a profound effect until you experience it for yourself.

After this if you continue having issues, then a sleep study might be in order or perhaps a medication adjustment. I would just make a few simple lifestyle changes to see first. And it's cheaper!
posted by dozo at 8:43 AM on April 20, 2011 [1 favorite]

Best answer: I felt this way during my first job, which I found boring and unchallenging and required me to wake up way earlier than my "normal" waking hours. I'm going to share something with you that helped me through: the toilet nap.

The toilet nap is the perfect way to get through an extremely sleepy spell while you're at work. As soon as you've found that you're close to nodding off, go to the toilet, get into a stall and take a short 10 minute nap while you're sitting there. It will be uncomfortable; this is fine. You're just looking to reset whatever the "sleepy" bit is and get on with your day. It saved me from nodding off at my desk innumerable times.

Everybody else has great suggestions for how to fix the root cause, but the toilet nap could allow you to get through your day without the embarrassment of nodding off at your desk while you figure out the root cause.
posted by kdar at 8:48 AM on April 20, 2011 [4 favorites]

Best answer: Your PM is a medical professional and has told you she thinks this is a health issue for you. This is good. This means that your boss doesn't think you're slacking off when you fall asleep at work, and doesn't think you should feel embarrassed by the situation: she thinks you should get medical help.

So, get medical help. Take your lack of sleep seriously: you're not just having trouble finding a schedule that works for you, you're having serious sleep problems. Find a doctor who will take your lack of sleep seriously: a healthy adult who is exhausted after 8 hours of sleep and can easily sleep for 14 hours is not experiencing normal sleep, even if she is a healthy weight and doesn't snore. Insist on a sleep study. Do as much as you can to have your doctor(s) coordinate with your psychiatrist on meds. Talk to your pharmacist about all the meds you are taking, and ask if there is anything he can tell you about side effects involving sleep (pharmacists, in my experience, often either know more than MDs about the minute details of meds or are more willing to discuss the details with patients). Ask your doctor to refer you to a sleep specialist or neurologist.

And, crucially, tell your PM what you are doing. She doesn't think you should be embarrassed or quit over a medical issue, but she will likely lose patience if she doesn't think you're addressing the problem or taking it seriously (even if what you're really doing is cringing with embarrassment and racking your brain trying to solve the problem). You don't need to tell her details of appointments or test results, but do say something like, "I wanted to follow up on our conversation last week about my nodding off during that meeting. You're right, it absolutely is a medical issue, and I'm taking steps to address it. I have an appointment with my PCP for next week, and am scheduled to see a sleep specialist next month. I'm pretty embarrassed by the whole situation, so if I don't talk about it a lot, that's why--but I am taking steps to make sure I'm solving the problem, and will try to check in with you periodically to let you know how it's going."
posted by Meg_Murry at 8:49 AM on April 20, 2011 [11 favorites]

Best answer: Nthing the sleep study. The worst case scenario is that they find out that "well, it's not apnea/siezures/nighttime alien abduction, so we're at a loss," and you'll be no worse off than you are now. (I mean, it still sucks, but at least you'll have more information about what it's not, and information of any kind is always good.)

In the meantime -- I may sound like a zealot here (because I've been saying it on all sorts of sleep threads), but a magnesium supplement may help. I was having the insomnia from hell last year, and among the ka-squillion suggestions, someone said magnesium may help; they specifically said it would help stop me from waking up in the middle of the night (which was a big part of my problem). I didn't notice it doing that as much, but what I did notice was that whatever amount of sleep I did get, it was better sleep. My insomnia resolved itself finally, but I still take the magnesium, because it's helped with occasional bouts ever since (it's easier for me to get back to sleep if I do wake up, among other things).

Still get the sleep study, but if it's going to take a while for them to make an appointment for you, it can't hurt to do this as well in the meantime.
posted by EmpressCallipygos at 8:50 AM on April 20, 2011

From your description, it doesn't sound like this is run-of-the-mill afternoon dozeys.

It sounds like you have insurance.

Go back to your doctor (or maybe to a different doctor, since it sounds like the one you talked to wasn't taking you seriously). Get the sleep study referral. Ask if there are other things you and your doctor can do to address the problem---and make sure your doctor understands that it is having a significant impact on your life (not just being a hassle).
posted by leahwrenn at 9:16 AM on April 20, 2011

Best answer: I agree with everyone else that you should seek help from a specialist. If you aren't sleeping well and it's negatively impacting your life, then you should be doing everything that you can to fix it. Your quality of life is so much better when you're well-rested; it's not a trivial problem at all.

One thing that jumps out at me is that you are going to bed at 11:00 and getting up at 7:00. On paper, this sounds like a solid eight hours, but you aren't falling asleep precisely at eleven and you also say that you have given up on that bedtime anyway, since it doesn't seem to help. 8.00 hours might not be the right amount of sleep for you, too.

Any specialist you see is going to suggest courses of action apart from getting a sleep study done, and one of those is going to be making sure that you have a REGULAR schedule that budgets ENOUGH sleep. They are also going to want to make sure you are eating regularly, because NOT eating regularly DEFINITELY causes exhaustion.

Go to bed at 10:30 every night. Stop hitting the snooze in the morning. (This is hard, but it helps me to just jump out of bed when the alarm goes off, rather than lie there and think about how I'd like not to move.) Don't sleep in late on weekends. And eat consistent, healthy meals, because of course you will be more tired when you're undernourished. The point is to establish a consist, healthy schedule.

This will prepare you for your meeting with a sleep specialist, because they will probably want to make sure you are doing these things anyway.

Also, if you are going to meet with a specialist you should ideally avoid caffeine. From my experience, it's not a huge deal if you have a single cup in the morning, but one of the things they will want to rule out is that caffeine is affecting your sleep. So I would ignore the suggestions to use energy drinks. They are fine for some people but not if you want to see a sleep specialist in the near future.

Good luck!
posted by Kutsuwamushi at 9:53 AM on April 20, 2011

Is your iron level ok? I am less tired since I got my hematocrit up.

Also, does just sitting make you doze? It does me, tired or not, sitting seems to send my brain a "nap" signal. Desk jobs are tough that way. I chew gum or suck lozenges sometimes to stay alert.
posted by Knowyournuts at 10:10 AM on April 20, 2011 [1 favorite]

Also! If you can arrange to get a balance ball to sit on instead of a desk chair, you will probably not successfully fall asleep at your desk again. Talk to HR, this is an extremely reasonable and common accommodation for many of us desk-jockeys for lots of reasons.
posted by juniperesque at 10:22 AM on April 20, 2011

Best answer: Definitely get the sleep study! This is your job we are talking about. And you have insurance now, so this is the time to do it. If you lose your job, you will lose that, too (and think about trying to afford your meds, therapist and doctor without health insurance!).

By the way, what time during the day are you taking your medications? My therapist had me switch all of mine to the morning and it really helped me actually fall asleep at midnight or so rather than three in the morning. Which is when I would fall asleep before. Seriously. Then, I couldn't get up in the morning because I would just keep falling back to sleep when I tried!

Oh, and move the alarm clock away from the bed, where you cannot reach it until you get up! When I was experiencing my worst sleep issues, I'd hit that snooze button even when I knew I shouldn't because it just felt impossible to get up--but when I did get up and move around? I'd find I could get going and was far less likely to go back to bed.

Also, as noted above, check to see if your thyroid was tested by your doctor, and even if it was, find out what the results were. What does your doctor consider "within normal range"? Some doctors still go by "old" ranges, whereas quite a few people who were considered within ranges before are now diagnosed as having thyroid issues. And even with the wider ranges, there is subclinical thyroid disease. So check with your doctor and see an endocrinologist if you are borderline.
posted by misha at 10:31 AM on April 20, 2011

Oh, yes, and the balance ball is a great idea; I was going to suggest the possibility of a standing desk.

B vitamin complex is also helpful if you are low on energy, though of course you need to get most of your requirements from your diet. Don't skip meals!
posted by misha at 10:33 AM on April 20, 2011

Everything else seems to be covered but please ditch the snooze clock. Man, those things have to be second only to electric lighting in terms of causing poor sleep patterns. They don't give you an extra hour of any kind of restful sleep. And your body won't ever learn "this is wake up time" while you one.
posted by 6550 at 10:42 AM on April 20, 2011

while you use one
posted by 6550 at 10:43 AM on April 20, 2011

My doctor said that if I wanted I could go in for a sleep study, but didn't think it was necessary because I wasn't overweight and didn't snore or show other symptoms.

Falling asleep during the day is the classic symptom of a sleep disorder. It's the only symptom you need to go for a study, plenty of thin healthy people have apnea. This problem is seriously affecting your life and something like apnea can cause long term damage. Your doctor is really remiss in not treating this more seriously and you definitely need to push for the study. At most it'll rule stuff out, then you can move onto other ideas for trying to figure it out (because this is not normal and it doesn't sound like just bad sleep hygiene given you get it even when you sleep lots and eat well and whatever).

And yeah, lots of people have already said exactly the same things as me. Because really, the sleep study and some more aggressive diagnosing by a doctor (possibly a different one that gets how much this is messing with your life) is what you need here, not to give up and crawl into bed forever.
posted by shelleycat at 10:58 AM on April 20, 2011

Response by poster: Thanks so much for the great answers and tips, guys.

I guess I'm feeling nervous about going to the doctor again or asking to do a sleep study because I assume they're going to say I should just make a lot of the lifestyle changes that are suggested here, that I certainly have not been doing well on: getting up earlier (to make/eat breakfast), going to sleep earlier, and working out. I feel like doing all those things will reduce my day to just... work and sleep and I really don't want that to happen.

ANYWAY. I need to try harder at those things. there are a lot of good ideas here. I've been taking my medication at night (psych's suggestion) and taking a vitamin D supplement occasionally.

I kind of always just chalked it up to "adjusting to not being in college." I sure do miss 10am classes, morning runs and dining hall breakfasts :)

I guess I'll call my dr's office and make an appointment.
posted by sarahj at 11:14 AM on April 20, 2011

What time of the day do you take your Celexa? If it's in the morning, that may be what's making you tired. I had a similar problem when I was on Lexapro, and my doc told me to take it at bedtime instead. It definitely helped to switch that.
posted by vickyverky at 11:14 AM on April 20, 2011

Best answer: I had severe life-wrecking fatigue when I was on Celexa. We tested all kinds of things, fixed my anemia, fixed my vit D deficiency, checked my thyroid, and so on. Nothing helped. Ultimately getting off the Celexa is what made my life worth living again. It is very hard to get medical types to take these kinds of side effects seriously (a friend who is a PA was told by a psychiatrist that "the only people who get side effects from Celexa are the ones who read about it on the internet."), and I was very frustrated that my doctor didn't think to consider med side effects during my two years of trying to get treated for the fatigue (I eventually figured it out myself from somebody's description of their Celexa-related fatigue on AskMe).
posted by not that girl at 11:40 AM on April 20, 2011 [2 favorites]

Best answer: Can I make a suggestion?

Write down what you want to discuss with your doctor. It's often hard to be in a medical exam room and feel empowered to ask your doctor to answer your questions (rather than just meekly answering hers). She's the one with the MD and the white coat, who are you to question her? But really, it's totally ok to push back and say, "Over the winter, I was going to hot yoga 3 or 4 times a week, and didn't notice any change in my energy level. Lately, I've been too tired to drag myself to yoga. I really think this is something else is going on. Can we talk about the medications I'm on?"

It's easier to push back in that way if you bring your own very specific questions and concerns to the visit (i.e., not just "I'm tired all the time--help!" but rather, "I get 8 hours of sleep per night at least, and I'm still exhausted. I'm falling asleep at work. I'm skipping showers just so I can sleep longer. Something is wrong. I would like to discuss my current medications, diet, schedule, and I would like to schedule either a sleep study or a consult with a sleep specialist.")
posted by Meg_Murry at 12:18 PM on April 20, 2011

Habitually skipping breakfast does not make a person sleepy for literally the entire day, especially after eight hours of sleep at night. It sounds like there's more going on here than the typical lifestyle recommendations can fix -- I like Meg_Murray's examples of how to explain this to your doc.
posted by desuetude at 1:30 PM on April 20, 2011

Best answer: Definitely try the lifestyle changes. I KNOW how hard it is to get out of bed in the morning. It's the hardest thing I do all day. But if I just stay in bed longer and hit the snooze for an hour, I feel much worse. Eat early in the day. By evening I'm just about out of allowable calories because I eat breakfast and lunch and have healthy snacks during the day. The body doesn't need much fuel to sleep on. And exercise is always good, but for me, appropriate diet habits are king.

That said, even on my crappiest days when I've been eating like sh*t and I've been snoozing every morning and skipping showers and all that kind of stuff, I'm still not actually falling asleep during the day. Which makes me worry that you have a health issue. You don't sound actually sleep deprived, unless you have a problem that's not allowing you to sleep well.

Good luck! Do talk to your supervisor and tell her how important your job is to you and that you're working as hard as you can on your sleeping problem. :)
posted by iguanapolitico at 2:53 PM on April 20, 2011

You don't need to quit, you need a medical evaluation by a specialist.

Fill out this Epworth Sleepiness Scale and ask your doctor for names of sleep specialists in your area. Our sleep specialists uses this scale for the initial screening of their patients.

nthing the idea of trying Provigil. You can ask your primary care doc if he can prescribe some until you can get a full evaluation (including a sleep study) done.

Personal opinion: in my experience there are some "not that excellent" sleep centers out there. Recommend you look for one associated with an academic hospital or large medical center.
posted by Meta-4 at 4:17 PM on April 20, 2011

Best answer: Chiming in with my personal experience. I used to crash every day at 3pm until I changed my diet to exclude carbs and sugar, even fruit sugar, during the day. Also, snacking on almonds and yogurt during the day has helped. No more crashing. Conclusion: the sugars and carbs were putting me to sleep.
posted by Lieber Frau at 4:46 PM on April 20, 2011 [1 favorite]

Best answer: Ps: consider seeing a nutritionist. That was the health professional who helped me the most.
posted by Lieber Frau at 4:48 PM on April 20, 2011

Best answer: I think everybody's got it well covered, just wanted to add: Not everybody needs 8 hours of sleep. My husband really only requires 7 hrs, but I don't feel good unless I've had *at least* 8.5 hrs, usually 9. Yeah, it cuts into my social life, but I don't feel good otherwise.
posted by Green Eyed Monster at 6:34 PM on April 20, 2011

If your doctor does start on the lifestyle changes just point out that, right now at least, you're so tired you literally can not make the changes. Because, yeah, all that stuff is really good but you're beyond the point where you can work on it and something more needs to be done first. Make sure you emphasise how this is affecting your quality of life, tell them your boss has noticed and you might get fired, make them take it more seriously. If they don't then find another doctor because, even if it does end up just being a lifestyle thing (and you've got a lot more to rule out before you can come to that conclusion), they should be able to support you to making those lifestyle changes even if it means some kind of short term medication while you sort it out.
posted by shelleycat at 12:21 AM on April 21, 2011

Best answer: I haven't read all the answers but: Give up caffeine. When I've had enough sleep, caffeine is fine. When I haven't had enough sleep, the post-caffeine crash is as good as a sleeping pill.

And maybe try getting another hour of sleep at night. 8 hours is only an average. I need 9. And believe me, you wouldn't think so, but that extra hour makes a big difference.
posted by IndigoRain at 2:17 AM on April 21, 2011 [1 favorite]

Response by poster: Thanks again guys, I have an appointment this afternoon and now I have some really constructive things to say and ask for! I really appreciated the specific phrases, advice, and your stories.

If anyone comes back and sees this - I'm wondering, is it normal to fall asleep at work ever when you don't get enough sleep the night before? I got about 6.5-7 hours last night, which I know isn't a lot, and I fell asleep a few times this morning (before 11). I relocated for a "toilet nap" (haha) only to nod off again once I got back to my desk.
I finally said "screw it" and got a large coffee before this morning's meeting (and saw your response too late, IndigoRain!) but does anyone else do this when they get only 6-7 hours of sleep? Or is falling asleep when I'm not supposed to at ANY time a problem? (I know, YANMD, YANMe)
posted by sarahj at 9:38 AM on April 21, 2011

It's certainly unusual. I'd mention it to your doctor, and let him tell you how "normal" it is. Six-to-seven hours of sleep isn't all that bad for most, actually; I was trying to get by on four hours sometimes, and still didn't actually fall asleep at my desk. If you got 6 hours and actually dozed off more than once within only a couple hours, I'd say that definitely bears mentioning.

...Okay, I really seriously am not a doctor, and I freely admit I'm talking out my ass -- but has anyone else in your family had attacks of falling asleep like that? Because that almost sounds like narcolepsy.
posted by EmpressCallipygos at 9:47 AM on April 21, 2011

Response by poster: Nobody else in my family does this that I know of, but I have a very small family and a few relatives I'm not in touch with, so I don't fully know medical histories really.

I've been thinking that it's the celexa, but I still felt this way when I had a few months "off" from it recently when I was switched to buproprion. hopefully I'll find out soon enough!
posted by sarahj at 10:03 AM on April 21, 2011

Response by poster: hooray, i have a sleep clinic appointment in 2 months! -_- this is gonna take longer than I thought. I'm going to look into getting an appointment with a nutritionist too. Thanks again everyone.
posted by sarahj at 12:55 PM on April 21, 2011

Not sure if it's been mentioned, but in addition to everything above, consider going on a brisk 10 minute walk in the middle of the day. My psychiatrist advised that for me when I was sleepy during the day. I've started taking long walks during my lunch breaks and I find that I'm much more alert in the afternoon. YMMV.
posted by lacedcoffee at 6:50 PM on April 21, 2011

sarahj, uncontrollably falling asleep on a regular basis is really not normal. And I say this as someone who does not always get enough sleep sometimes for a number of reasons. I do best with about 7 1/2 hours of sleep, but regularly get by on 6 1/2 without napping.

Most people, if they just didn't sleep great the night before, will feel tired or have a little trouble focusing the next day. I've had bouts of insomnia that have resulted in me nodding off for a moment. This sort of occasional sluggishness can be mitigated pretty well to taking a brisk walk, staying hydrated, taking extra care to eat enough, a cup of coffee, etc.

You sound like you're only alert for a few hours, tops? Get checked out for a sinus infection, too -- a lot of women in particular experience crushing fatigue and sinus pressure, but surprisingly little nose-blowing.
posted by desuetude at 10:18 PM on April 21, 2011

If anyone comes back and sees this - I'm wondering, is it normal to fall asleep at work ever when you don't get enough sleep the night before? I got about 6.5-7 hours last night, which I know isn't a lot, and I fell asleep a few times this morning (before 11).

No, it's not normal. 6.5-7 hours is actually pretty close to what most people get most nights, and most people do not fall asleep at work. This is why your coworkers are concerned about you. If you were falling asleep at work after 3 hours of sleep, perhaps. This is worth investigating with your doctor, or with a team of doctors.
posted by judith at 7:13 PM on April 25, 2011

Response by poster: Another update - I brought it up with my psych at my last appointment and she gave me long-acting Ritalin (?!!) as a short-term fix for this week. I took 20mg this morning and I feel energetic, social, awake, and generally WONDERFUL! Before I take it in the morning I'm my usually sluggy sleepy snooze-button self, and at the end of the day I'm the same, but during the work day this is fantastic. She wanted to see how I would respond to it first and is switching me off the celexa next week so I can see if that's been the issue all along.
posted by sarahj at 11:02 AM on April 27, 2011 [1 favorite]

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