Help me stay awake.
May 21, 2013 12:57 PM   Subscribe

I don't think I'm narcoleptic, but I fall asleep all the time.

I'm 25. Since junior high, I have fallen asleep in classes, lectures, and meetings, but only if I'm not doing anything else. This is so, so embarrassing at work, and I need to fix this for my job as well as for impending grad school.

My various coping strategies over the years have included sudoku, crosswords, and the internet. Things that don't work include taking notes (I will fall asleep writing), doodling or other engaging activities with pen and paper, and active listening; I promise you, I have tried these over and over and over. I try very, very hard to listen and to stay engaged.

I am not bored or usually even tired when I fall asleep. I just fade out. If I am expected to listen to a lecture or meeting, I will just start slipping into sleep. This afternoon, at a weekly department meeting, I was out for a good forty minutes of it. It is not subtle. I do not know when I am starting to sleep, either; I was taking minutes during the meeting but still drowsed off. I often fall asleep during movies and plays, even though I love these events. I have, on occasion, fallen asleep sitting up at my desk while working if I am just editing a document or something non-engaging.

I've always been good at school and a hard worker, so I haven't been in big trouble for this yet. My hypothesis is that my brain just needs to be doing something, and it can't just sit there and be quiet. If I can't mentally grab on to something, my brain seems to just take that as, "well, I'm not doing much anyway, so I'll take full advantage of this rest time."

Health stuff: I take an SSRI and thyroid medicine. I work out 3-5 days a week. I eat tons of fruits and vegetables, lean protein and fat. (I've eliminated a lot of sugar from my diet, because I've noticed that I crash during the day if I eat it.) I sleep at least seven hours a night. I wake up and go to bed at the same time almost every day, even weekends. I consume a cup of coffee every morning. (Caffeine will not keep me awake during these meetings, no matter how hard I try.) I don't drink a lot.

What is the deal, and how can I stop sleeping like this? Is this a doctor-worthy issue?
posted by quadrilaterals to Health & Fitness (24 answers total) 16 users marked this as a favorite
Response by poster: To add: I can certainly go a day or week without sleeping during the day. But put me in a lecture hall or a meeting room, and I'm out like a light no matter what. Also, I am so embarrassed.
posted by quadrilaterals at 12:58 PM on May 21, 2013

Best answer: Of course this is a doctor-worthy issue. This shouldn't be happening. It's very likely there's either something wrong with your sleep (e.g., you have apnea, so you aren't actually sleeping enough at night and your body is desperately trying to do something about it), or you do have narcolepsy (not all narcolepsy comes with cataplexy, which is that sudden falling asleep thing that is stereotypical narcolepsy, sometimes it's just how you describe it).

Definitely go see a doctor.
posted by brainmouse at 12:59 PM on May 21, 2013 [4 favorites]

Many folks swear by Provigil in the LEO-MIL community. Talk to your doctor.
posted by vonstadler at 1:02 PM on May 21, 2013

Is this a doctor-worthy issue?

Oh christ yes. You didn't mention it, but what if it happens while you're driving? Please see a doctor. This shouldn't be happening to you.
posted by phunniemee at 1:03 PM on May 21, 2013 [4 favorites]

Go go go. To a doctor, asap. This was happening to a colleague and the diagnosis was Fibromyalga. I do get sleepy myself from time to time, but I can feel it coming, force myself away, or contrive a way to get away for 20 min to cat nap, returning refreshed.
posted by tilde at 1:11 PM on May 21, 2013 [1 favorite]

This afternoon, at a weekly department meeting, I was out for a good forty minutes of it.

Yes, you should see a doctor.
posted by jetlagaddict at 1:15 PM on May 21, 2013

Best answer: I was exactly in your situation. I kept laughing because everything you wrote I could have written 6 years ago.

Here's what I did. I went to a sleep specialist neurologist and did a sleep study. You should too, to rule out sleep apnea and actual narcolepsy. If they don't rule those things out, they might give you a CPAP and/or prescribe you Provigil/Nuvigil.

I was prescribed Provigil and it did work. I would basically take a half dose in the morning and half dose at lunchtime and it was fine. But I didn't love the side effects (it gave me insomnia.) Even though he prescribed me, I don't ever really believe that I had narcolepsy- I never had any of the cataplexy or sympathetic nervous signs.

Anyway, I stopped taking Provigil a few years ago, and here's the secret. I simply needed 9 hours of sleep a night. Not like EVERY night, but basically, 7-8 hours is not enough for me. As I get older, I need a little bit less sleep, but definitely, try sleeping 9 hours a night. Some people need more sleep. Yeah, it's kind of annoying, but at least it's a solution.

But definitely go to a doctor to figure out other problems first. And then try sleeping more!
posted by thewumpusisdead at 1:19 PM on May 21, 2013 [1 favorite]

Yes, go to a doctor. I used to have a similar issue when I was going to college at night while working full-time. I would fall asleep during lectures no matter how interesting I found the subject matter, and I am sure it was due to the level of sleep deprivation I was subjecting myself to.

It rarely happens to me anymore, but I find that the times when I am sleepy during meetings or lectures directly correspond to the quality and quantity of sleep I have been getting. It is possible that you have sleep apnea or some other condition that is interfering with your sleep.

In the meantime, can you do things like chew gum or eat a hard candy during meetings? Stand up? Fidget? Those things all help me to stay alert, even if I am exhausted.
posted by bedhead at 1:19 PM on May 21, 2013

I had similar issues with overpowering sleepiness in similar situations. I had my abnormally large tonsils and uvula removed after it was discovered that I had sleep apnea and wasn't getting enough oxygen when I was sleeping. After I had my surgery, I no longer had the overpowering sleepiness problem. I don't know if this is because I was actually getting some real rest for the first time in my life or if it was because I was also maybe doing something while seated that made it hard for me to get the oxygen I needed.

A sleep study couldn't hurt!
posted by dottiechang at 1:20 PM on May 21, 2013

Do you ever drive in areas with boring, monotonous views? What happens? It could be dangerous and Yes, you should see a doctor.
posted by theora55 at 1:25 PM on May 21, 2013

I have narcolepsy. Had the same issues as you throughout my life along with other symptoms. It is doctor worthy especially since it's affecting various areas of your life.
Have you looked at the symptoms of sleep disorders such as narcolepsy and sleep apnea? Did you have this problem before taking your SSRI? Make an appointment with your doctor. Make sure they draw blood.
I sympathize; I know how frustrating it can be.
posted by KogeLiz at 1:27 PM on May 21, 2013 [1 favorite]

My insurance wouldn't cover Provigil without a narcolepsy diagnosis.
posted by The Underpants Monster at 1:28 PM on May 21, 2013

When did you last have your thyroid function checked?
posted by BenPens at 1:36 PM on May 21, 2013 [2 favorites]

Agreeing with thewumpusisdead-- you may just need more sleep each night.
posted by travertina at 1:44 PM on May 21, 2013

I used to be like this, and it turned out I have pretty substantial sleep apnea. I got a CPAP machine and everything changed. I thought everyone was that tired all the time and it was some character defect that made me fall asleep in meetings often enough it was a running joke with my coworkers. Nope! Now that I'm actually sleeping when I sleep, it's a whole new world.
posted by rmd1023 at 2:01 PM on May 21, 2013

Best answer: See a doctor. I had similar problems - could fall asleep standing up, at meetings, in class, during things I enjoyed, while driving, writing, talking. Caffeine and fixing my sleep schedule didn't help. My husband made me see a sleep doctor because he thought I had sleep apnea. I saw the sleep doctor who had me take a night-time and day-time sleep test. The night-time test showed that I didn't have sleep apnea. The day-time test showed that I wasn't kidding - I was falling asleep all the time.

My eventual diagnosis was idiopathic (no one knows why) day-time sleepiness which is a lame diagnosis but who cares. For whatever reason, the sleep that I get isn't restful sleep. I got a prescription for Nuvigil. For me, the biggest side effect is that I'm grouchy, so most recently, I started taking Provigil to see if that works differently. Recently I've been breaking them in half and taking a drug holiday on the weekends. That has been working for me.

BUT DUDE. The side effects aren't ideal but Nuvigil has seriously changed my life for the better. Before, I wasn't suicidal but I definitely started thinking to myself, what is the point of living if I'm too tired all the time to do things that I enjoy? Nuvigil isn't an amphetamine and it doesn't make me jumpy. It isn't magic. If I don't want to do my work, it doesn't make my work get done. And I have side effects. But like. I can't even. Any problem - side effects from medicine, work being boring, people being annoying - I can deal with it now because *I am awake.*

I had a wonderful moment of clarity a few months ago. It was a time of year when work was just insane and I was working like crazy. I thought to myself, I'm stressed out but I can do this. It was amazing to have that realization. Like, things aren't perfect but I am in a position to work on them. There isn't a light at the end of the tunnel - it turns out that I had a blindfold on this whole time. And it's not an amazing day - it's a little cloudy and maybe it will rain later but it's a lot nicer out than I thought it was.

You don't have to deal with this. See a doctor.
posted by kat518 at 2:34 PM on May 21, 2013

See a doctor, yes, but also take into account how much sleep you're getting and when. A friend had similar problems as you, went through a sleep study with no diagnosis, and took a week off work to experiment with sleep. Turns out his body needs a full 12 hours, which basically means he's in bed by 7 every night, or he spends the next day falling asleep randomly. Does this suck for him? Yeah, but way less than things did before.
posted by linettasky at 3:28 PM on May 21, 2013 [1 favorite]

I agree with everyone who is saying that you must see your doctor. I wanted to mention as well, though, are you taking your SSRI late in the day? It could be interfering with your sleep. Maybe you could try taking it earlier until you get in to see your doctor?
posted by kitcat at 4:13 PM on May 21, 2013

Please be screened for sleep apnea. Has anyone ever mentioned your being a loud snorer?
posted by St. Alia of the Bunnies at 7:14 PM on May 21, 2013

Response by poster: Thanks, all. I rarely drive (thrice a year?) and walk / take public transit everywhere; I do snore; my thyroid was checked recently; I do snore; and I take all of my pills as soon as I wake up. That said, I'll be in touch with my doctor. Like described above, it's a running joke about how I always fall asleep, and I've had people close to me be offended by my sleepiness (mistaking it for boredom). I guess that alone means it's worth a copay.
posted by quadrilaterals at 8:08 PM on May 21, 2013

Before you pursue all the excellent suggestions here, it might be worth making a project of getting 9-10 hours of sleep every night for a month and see if that changes anything.

When I was an undergraduate I would literally fall asleep writing notes in lectures (you can watch the line of writing getting messier and less on the line until it ends in a line - like in cartoons). Once I was a graduate student and I was getting a bit more sleep I still fell asleep in lectures occasionally, but I could control it using the strategies above (constant writing, having a mint in my mouth, drinking enough to be slightly needing the toilet work best for me). When I went back to being a graduate student again I had a different life and schedule and I never once fell asleep in lectures - I was the annoying perky one at the front asking difficult questions.

It's worth a go in addition to the other thoughts! 7 hours just isn't enough for a lot of people - the usual range is 6-10 hours of sleep needed per night.
posted by kadia_a at 11:08 PM on May 21, 2013

In addition to the excellent suggestions above, I would consider your SSRI. I took a few different ones and they all made me sleepy. Well except for Wellbutrin which made me kinda jittery. But anyhow I have a lot more energy now that I am not on one.
posted by radioamy at 7:02 AM on May 22, 2013

Response by poster: Follow-up: I'm getting a night sleep study and a day sleep study, but both doctors I've seen suspect I do have something going on. It might be idiopathic hypersomnia, it might be narcolepsy, but who cares - I can actually start getting treated and stay awake during things! Thanks, all.
posted by quadrilaterals at 1:27 PM on May 30, 2013 [2 favorites]

Yay! Glad there's progress happening. I hope the docs find something definitive and easily treatable. Good luck!
posted by rmd1023 at 7:20 AM on May 31, 2013

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