Healthy Living

What Are the Causes and Treatment of Somnolence?

What Are the Causes and Treatment of Somnolence?

What is somnolence?

Somnolence is the medical term used when a person is close to falling asleep or is in a state of sleepiness. In such case, the person is not able to resist the urge of sleeping or dozing off. A person taking many psychiatric medications for bipolar disorder or any other mental illness can be affected by somnolence. Many nonpsychiatric medications can also cause sleepiness. Hence, people who are on certain medications are strongly advised not to drive and operate heavy equipment to avoid accidents. Since the urge to sleep is so strong, a person may fall asleep in the middle of activities despite trying very hard to stay awake. Many other terms are used to describe this state of sleepiness. They include lethargic, insensible, drowsy, and just sleepy. It is estimated that almost 20 percent of the overall population may be affected by daytime sleepiness.

Somnolence comes from the Latin word somnus, which means "sleep". Basically, somnolence means sleepiness or drowsiness. However, somnolence may also mean the need for excess sleep or a chronic condition of constant tiredness. Many people may experience excessive sleepiness or constantly feel tired. Even after a nap, they do not feel better. Excessive sleepiness could be due to a variety of causes. To determine its underlying cause, it is highly recommended that you see a doctor since excessive sleepiness or the constant feeling of tiredness could be related to a sleeping disorder or a serious medical condition. The doctor may prescribe some medications to combat drowsiness.

Understanding Somnolence

When a person has a strong desire to sleep, somnolence occurs. As a part of the circadian rhythm, drowsiness at bedtime is a natural occurrence. However, excessive sleepiness throughout the day is a sign of a sleep disorder.

Similar terms to somnolence:

  • Hypersomnia - It is a condition in which the person experiences persistent and uncontrollable drowsiness and prolonged daytime sleepiness. The period of time the person is in deeper sleep is longer. During the day, the person finds it difficult to stay awake.
  • Somnambulism - It means sleepwalking. It is a sleep condition, wherein a person performs certain activities such as sitting up in the bed or walking while asleep. In the early stages of sleep, the person experiences symptoms of hypersomnia or may show excessive daytime sleepiness. The person is moving around but is not completely aware of the surroundings. This state exists between sleeping and wakefulness.

Causes of Somnolence

Many reasons could cause somnolence, but not all reasons are related to medications or health. Not getting enough sleep is one of the most common causes of somnolence. Studies have shown that if people's sleep rhythm is interfered by their different working shifts, then there are more chances of accidents or making mistakes. 

According to research, shift workers are at a higher risk of developing diabetes and heart disease. Some medical conditions may also be possible causes of somnolence. These conditions include chronic pain, diabetes, low thyroid function, and other conditions that may cause excessive sleepiness.

Sleep apnea is a specific disorder related to sleep. Sleep apnea is a condition in which a person who is asleep stops breathing for a short period of time. This sleep disorder can cause somnolence to some people. Hence, an evaluation from a sleep medicine specialist will help determine the exact cause of the problem.

For people without sleep disorders, being somnolent is a natural biological process. The body needs to sleep every night to recharge and repair cells. Consult a doctor if you excessively feel tired during the day or if you are unsure what causes your sleepiness. In order to determine the exact cause, the physician may run a series of different tests but even they may have a hard time hence before you finally fix one solution it is necessary that you look for and try for various other solutions. Some causes of somnolence have been listed below:

Some causes of somnolence are listed below:

1. Sleeping Disorders

Many sleeping disorders such as insomnia, sleep apnea, sleepwalking, excessive snoring, and narcolepsy could be responsible for somnolence. Doctors may probably suggest cognitive behavioral therapy, sleeping aids or even medications if they are able to determine that the underlying problem is a sleeping disorder.

2. Medical Conditions

A number of medical problems can make a person feel drowsy. Moreover, somnolence could be caused by certain medications. Certain cancer treatments such as chemotherapy can cause this problem. Diabetes, chronic pain, an underactive thyroid gland, and anemia may also cause somnolence. Stress, anxiety, depression, and boredom could alternatively cause somnolence. If a particular medical treatment is causing the problem, then the doctor may try other treatment options.

3. Medications

People taking certain medications such as antihistamines, steroids, sedatives, tranquilizers, and even sleeping pills may experience excessive sleepiness. To combat drowsiness, your doctor may change your medicine and put you on a different medication. Certain bipolar medications cause also cause somnolence. People taking medications for bipolar disorder and other mental health conditions are at risk of developing somnolence.

  • Antidepressants - Sleepiness is one of the side effects of antidepressants. Some antidepressants may also cause insomnia. Selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine), serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine), and older tricyclic antidepressants can cause sleepiness.
  • Benzodiazepines - These are anxiolytic or anti-anxiety drugs. Severe somnolence can be caused by taking these drugs, which include Xanax (alprazolam) and Valium (diazepam). It has been found that in some cases, taking caffeine along with benzodiazepines can help fight off sleepiness. Anticonvulsant and antipsychotic medications are also known to cause drowsiness.
  • Lithium - Many people who take lithium for bipolar disorder report sleepiness. The common side effects of lithium medications are sleepiness and tiredness. 

Each person is differently affected by bipolar medications. Consult your doctor about dose adjustments if you feel that a single drug or a combination of drugs is causing somnolence.

4. Hormones

Hormones can cause drowsiness in women, especially during pregnancy, after childbirth, and during menstrual cycles. A person with an underactive thyroid may also want to take more daytime naps and would want to sleep more.

5. Diseases

A number of health conditions can urge the body to sleep more. These conditions include chronic diseases such as stroke, autoimmune disease, diabetes, and an underactive thyroid.

6. Depression

Fatigue and low energy levels are felt by people who are depressed. Such people also have a strong desire to sleep. Some people in the state of depression may experience insomnia while others tend to oversleep or sleep the whole day.

7. Biological Clock

Drowsiness can also be experienced by people who have a circadian rhythm (body clock) disorder.

Treatment for Somnolence

Addressing the underlying cause is the best way to treat somnolence. The person should make changes to his or her sleeping habits, routine, schedule, sleeping environment, and sleep management.

  • If the person is diagnosed with some sleeping disorder, then some specific treatments can be applied. For instance, in the case of sleep apnea, the most effective treatment is by using a continuous positive airway pressure (CPAP) machine.
  • In some cases, medications may help too. People using CPAP for sleep apnea but still feel drowsy may be prescribed some medications to keep them alert. For people with narcolepsy, medications may be prescribed. These medications will keep them awake and productive throughout the day. Sometimes, shift workers do not benefit from only adjusting their sleep habits or by rotating sleep schedules. Medications may be effective for shift workers, who during working hours, feel sleepy.

Drugs That Promote Wakefulness

Modafinil and armodafinil are two drugs that promote wakefulness. The actions of certain chemicals in the brain are changed by these medications. They have a monoaminergic effect on the brain. Certain stimulants such as methylphenidate may also be effective.

To determine which medication is right for you, it is important to closely work with your doctor to monitor your progress. However, the treatment plan depends on your medical history, unique situation, sleep habits, and schedule.

Somnolence treatment usually depends on its cause. If behavior and lifestyle are the causes, then getting plenty of rest and getting rid of distractions can be the effective solutions.

Safety and Drug Interactions

A number of different options are available for the treatment of excessive sleepiness. However, it is important to note that a healthy sleep cannot be replaced by medications. It should be known that other forms of treatment such as medical and behavioral therapies can be complemented or supplemented by medications.

For people with narcolepsy, stimulants are often prescribed such as methylphenidate. They make the person more alert by stimulating the central nervous system. However, some side effects are associated with this medication. They include an increase in one's blood pressure, tremors, irritability, and insomnia. Always follow your doctor’s instructions when taking medications.

Modafinil and armodafinil are non-amphetamine drugs that can increase a person's alertness. Some side effects associated with these drugs are headaches, nervousness, dizziness, upset stomach, back pain, diarrhea, difficulty sleeping, nausea, and nasal congestion. Some less common but serious side effects include trouble breathing, rashes, fever, abnormal heart rhythm, and chest pain. Inform your doctor about the side effects that you are experiencing regardless of the type of medications you are taking.

Another important stimulant that people usually take for excessive sleepiness is caffeine since it increases mental alertness. However, caffeine does not work enough for an average mildly sleepy person.

If a person experiences excessive sleepiness due to insomnia, then another option could be sleep-promoting medications such as zolpidem or eszopiclone, which are benzodiazepine-receptor agonists. Some side effects associated with these drugs are stomach pain, dizziness, headache, constipation, and unsteady walking.

A medication usually prescribed for narcolepsy is sodium oxybate. It improves the symptoms of excessive sleepiness and improves the quality of sleep in a person with a sleep disorder. Some side effects associated with it are back pain, stomach upset, sweating, dizziness, headache, and bedwetting. 

Inform your doctor about any psychological issues that you are experiencing such as depression, psychosis, anxiety, history of depression, personality disorders, and physical issues such as kidney, liver, or heart problems. Let your doctor know if you are pregnant or breastfeeding. Keep a list of all the medications or supplements you are taking. It is also recommended to give your doctor a complete picture of your mental and physical state as well.

The doctor will decide the dose and timing accordingly. These medications are supposed to increase the level of alertness and wakefulness. However, you should still refrain from engaging in activities that require mental alertness such as driving or operating machinery.

Ways to Combat Somnolence

  • Make it a point to sleep and wake up at the same time everyday. To reset the internal body clock, develop a routine.
  • Sleep for an extra few hours at night. Adding 1-2 hours of extra sleep at night may reduce excessive daytime sleepiness.
  • To develop better sleeping patterns, make sure that you use the bed only for sleeping. Spend time on the bed only when you want to sleep. Avoid eating, writing, watching TV, or working on your laptop while lying on the bed.
  • Do some exercises as early as possible during the day to give you energy. Try to do exercises early in the day and after 7 pm.

Key Takeaways

  • When a person has a strong desire to sleep, somnolence occurs. As a part of the circadian rhythm, drowsiness at bedtime is a natural occurrence. However, excessive sleepiness throughout the day is a sign of a sleep disorder.
  • Somnolence itself can be a symptom rather than a disorder. Treatment depends on the underlying cause.
  • Modafinil and armodafinil are non-amphetamine drugs that can increase a person's alertness.