Friday, April 14, 2017

Why Can’t I Stay Awake?

Written by  Dr. Eva Hersh, MD

Dear Dr. Eva,

I have always had problems staying awake in movies and boring classes. Over the past few years this has gotten worse to the point that I am falling asleep at work, especially in meetings. What can I do about this problem? I don’t like coffee or tea.

I. Doze

Dear I. Doze,

Most of my answer is not directly about daytime sleepiness, because most daytime sleepiness is caused by problems at night: either not getting enough sleep or not getting good quality sleep.

There are many different causes of drowsiness. I will list a series of suggestions for addressing this problem, beginning with simple and free / low-cost suggestions then continuing to complex and expensive approaches. For many people, more than one of these suggestions apply.

Sleep hygiene

Do you reserve enough time for sleep? Most adults need at least seven-and-a-half hours of sleep nightly. Most working age Americans don’t get nearly that much. I know this sounds obvious, but think about it-how often do you spend eight or more hours a night in a dark room with your eyes closed? If you haven’t been setting aside enough time to sleep, make an effort to go to bed earlier and/or get up later.

The room you sleep in may not be quiet enough. Turn off the TV and radio. If you are used to falling asleep with those sounds, this may take time to get used to, but your brain will quiet down and rest better without the extra stimulation.t

It is smart to turn off your mobile phone and actually leave it in another room. The cell phone is a major distractor from sleep. If you have a land line phone extension in the bedroom, turn the ringer off.

The room may not be dark enough. Blinds or drapes that block out all or most of the light will help you sleep more deeply and keep you from waking earlier than you need to.

Most people know that caffeine can interfere with sleep by keeping the brain too alert. Many do not realize that alcohol also interferes with sleep, but in a different way. Alcohol makes people sleepy but it also interferes with the brain’s ability to enter the deep Rapid Eye Movement or REM stage of sleep, the dreaming stage which is necessary for restful sleep.

Are you losing sleep because of pain, restless legs, shortness of breath, or other physical problems? If so, work with your physician or nurse practitioner to pinpoint the cause and treat it.

Could you be depressed? People who are depressed often sleep poorly. Waking up too early is the most common sleep problem in depressIon. Depression can usually be successfully treated. If you think you might be depressed, please see a primary care or a mental health provider.

Please follow these recommendations for several weeks. If daytime sleepiness continues to be a problem, try these suggestions:

• Avoid eating for at least two hours before situations in which you are likely to get drowsy. After eating, blood flow is shifted to the digestive tract and away from the brain, leading to drowsiness.

• Try over-the-counter 200 mg caffeine tablets. Take one pill 20 to 30 minutes before the sleep-inducing event. If needed, you can take a second pill after an hour.

• If you are able to affect them, consider changing the conditions in rooms/situations where you get drowsy. Can you open a window? Lower the thermostat? Open the blinds? Suggest a mid-meeting bathroom break?

• Consider standing up when you feel sleepy. This may attract attention, but falling asleep attracts more negative attention.

If these suggestions aren’t helpful, and if you have medical insurance (because this is an expensive test), ask your primary care doctor or nurse practitioner for a referral to get a sleep study.

A sleep study is an overnight test done in a sleep lab. This test can diagnose sleep apnea, restless legs, and other sleep disorders. Treatment depends on the results of the test and can include wearing a nighttime mask to improve breathing or taking prescription medication.



Dear Dr. Eva,

My husband sometimes falls asleep driving. He has already had two accidents because of this. Each time he acts as if it’s just a fluke and won’t happen again. Other than refuse to get in the car with him, what can I do?


Dear ND,

Sleepiness severe enough to cause a person to fall asleep while driving is a medical emergency. Your husband should not drive until this is addressed. Assuming that you have a driver’s license, you should do the driving. What’s at stake is not just your life and his life, but also the life of whoever else is involved in the next potentially fatal accident.

If this seems extreme to you, consider this: a person who has had seizures is barred from driving until they have gone without a seizure for six straight months. Falling asleep while driving is every bit as life-threatening as having a seizure while driving.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


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