Q: I am a 23 years old married female, working for a multinational company. My office hours are from 12:30 pm to 9:30 pm. My problem is that even if I sleep for 10 hours, I feel sleepy the entire day. I reach home after work at 10:45 pm and sleep thereafter. Even if I force myself to get up early the next morning, I get severe headache. I also have dark circles under my eyes. What should I do?

A:Several underlying disorders/disturbances could lead to difficulty waking up early in the morning. These could include i) Disorders which disrupt the quality of sleep (Sleep Apnoea, Insomnia, Parasomnias); ii) Disorders which primarily are associated with excessive need for sleep and daytime sleepiness (Narcolepsy, Idiopathic Hypersomnia); and iii) Disorders related to disturbances in normal sleep cycle called as Circadian Rythm Sleep Disorders. Other than primary sleep disorders, disorders which are commonly associated with symptoms of difficulty waking up in the morning and increased sleep duration/24 hours are mood and anxiety disorders (major depression & anxiety disorders).

If symptoms of excessive sleep duration (10hr./day) & delayed wake up time started a year ago and were associated with weight gain, two major disorders that need to be ruled out are Sleep Apnea and Narcolepsy. I do not have any data from Indian Subcontinent to quote in order to estimate the chances, however, in general Sleep Apnea is less likely in younger women and the prevalence of Narcolepsy is low (0.5-1%), therefore I suspect the chances of these disorders are less likely in your case. An important disorders that definitely needs to be ruled out in your case would be underlying persistent mood/anxiety disturbances OR ongoing chronic stress. Chronic stress can also lead to weight gain.

Beyond these, a disorder of normal sleep cycle called as Delayed Sleep Phase Syndrome (type of Circadian Rythm Sleep Disorder) in which a person goes to bed late (2-4AM) and wakes up late in the morning (10A-12) and feels unrested and tired if woken up early is also a possibility. However, this disorder starts during teenage years and gets worse with time.

In your case, to begin with I would suggest to honestly and consciously assess your own stress level by yourselves. It is often difficult to objectively assess our own stress but one can always make an attempt. If you believe that your stress overtime has increased, try to figure out healthy ways to deal with it. Some of the healthy ways that may be helpful for you are i) ability to talk and express it to your friends/relatives whoever you can trust with such information and have the time to listen to you. ii) Exercise - particularly aerobic exercise (running, jogging, treadmill) - even a minimal 15-30 minutes will help. iii) Setting up a routine wakeup time. iv) Give yourselves time to interact with close family members. And v) give yourself time to relax. If you try these and do not find them to be helpful OR if you feel that the stress level has not changed much, I suggest that you get evaluated by a physician who specializes in sleep disorders for a comprehensive evaluation. Evaluation of sleep disorders may require an overnight sleep study (polysomnography) and a comprehensive evaluation.