Do You Have A Sleep Disorder Or Are You Just Tired?

Photographed by Michael Beckert.
Here's an unscientific yet totally indisputable fact: We are all really tired. If you were offered a nap at any point during the waking hours of the day, you'd be foolish not to take it — and it seems like everyone else is right there with you. But at what point should we actually be worried about our sleepiness?
Excessive daytime sleepiness (EDS) is a defining feature of most sleep disorders, and it basically means you're tired all the time. But before you jump straight to "IT ME," you should understand that EDS is not the same thing as feeling fatigued.
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Although fatigue can include sleepiness, it can also refer to a lack of motivation, the need to rest, and feeling worn down or winded, explains Scott Hollingshaus, MD, clinical instructor of sleep medicine at the University of Utah's Sleep Wake Center.
On the other hand, doctors define EDS as the "inability to stay awake and alert during the major waking episodes of the day," Dr. Hollinghaus says. This means you go through periods of having an "irrepressible need" to sleep, and accidental lapses into sleep or drowsiness while you're at work or driving, for example. But a person can be very tired and fatigued and not actually dozing off, Dr. Hollinghause says. Or you may not even be able to fall asleep if you do try to nap. So simply feeling like you want to sleep all the time isn't enough to count as EDS — you have to actually need to be sleeping at inappropriate times during the day to qualify.

People are used to being sleepy because everybody else is.

Scott Hollingshaus, MD
To assess just how tired you are, your doctor will first ask you some questions about how likely you would be to doze off in specific conditions, such as being stopped at a traffic light or lying down in the afternoon.
Then your doctor might send you to do a sleep study. After a night of monitored sleep in the lab, you'll be instructed to take five naps, one every two hours in order to help figure out how long it takes you to enter the REM cycle of sleep. People who don't have EDS take between 10 and 20 minutes to fall asleep. So if it takes you less than 10 minutes to drift off, that's a sign your sleepiness may be more serious.
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If doctors do confirm that you're dealing with a case of EDS, they'll try to figure out what's causing it. That could be a specific sleep disorder (such as narcolepsy or idiopathic hypersomnia), a medical condition (such as sleep apnea), or a medication (such as antihistamines or beta-blockers). These diagnoses take a while to figure out — sometimes years — because there are so many reasons why someone might feel tired.
But getting EDS treated requires you to go through the process of figuring out and dealing with whatever is causing it (e.g. a sleep disorder). From there, you and your doctor will create a plan to get your sleep back on track, Dr. Hollingshaus says. That might include sticking to a rigid sleep schedule, changing around your sleep-inducing medications, and/or taking stimulants to help keep you awake when you need to be.
Unfortunately, some of us are simply more likely to develop EDS than others. According to Dr. Hollingshaus, that's due to a few major factors that contribute to your specific level of sleepiness: how much and how well you sleep, your individual circadian rhythm, the drugs you take (legal and otherwise), and any other underlying health issues you have. The degree to which you can recover from the inevitable middle-of-the-night sleep disruptions also plays a role, Dr. Hollingshaus says. And whether or not you can actually get back to sleep after those 2 a.m. car alarms might be partly genetic.
"Sleepiness has kind of become part of American society," Dr. Hollingshaus says. "People are used to being sleepy because everybody else is." The issue is so severe that he suspects that many people with sleep disorders will go their whole lifetime without ever getting a proper diagnosis. So if you feel like you need to nap at all hours of the day and couldn't get through this article without wanting to doze off, chances are good that this should be a wake-up call (so to speak) to seriously think about your sleep habits. It's definitely worth a chat with your doctor — and, probably, a good nap.
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