Question:
When I have to sit still for long periods I fall asleep. This can happen at the theatre, at the cinema or, most embarrassingly, during meetings at work. It's almost painful trying to keep myself awake, and I become dizzy and disoriented. I've had the problem for years - at university I dealt with it by avoiding lectures and reading at home instead. I'm a 23-year-old woman, only drink alcohol at the weekends, eat healthily and am not overweight. I usually have about eight hours' sleep, although I know I often sleepwalk and have very vivid dreams, so I'm not sure whether these could be connected. My GP tested me for diabetes and anaemia, but the tests came back negative. What can I do?
The sleep expert: Dr Neil Stanley
You may have narcolepsy. It causes sufferers to fall asleep at inappropriate times, and excessive daytime sleepiness is a classic sign. Sufferers often experience disturbed sleep at night, which may exacerbate dreams and sleepwalking, both of which you experience. Narcolepsy usually begins in adolescence, and although its cause is unknown, the current consensus is that it is genetic. As only one in 2,000 people have the condition, it probably wouldn't have occurred to your GP yet. Read up on it, and ask your doctor to refer you to a sleep clinic - there are a number of NHS clinics. Please don't worry if you are diagnosed positively - it can be treated with drugs that counter the signal to sleep, prescribed by the clinic or your doctor. In addition, continue to make a good night's sleep a priority - the usual common-sense advice, such as keeping your room dark and quiet, will help.
· Dr Neil Stanley is manager of the Clinical Research and Trials Unit at Norfolk and Norwich University Hospital
The GP: Dr Partick Milroy
Certain medical conditions need to be ruled out. I'm pleased you have been tested for anaemia, a common cause of fatigue in women of childbearing age (especially if you have heavy periods). Diabetes can be another cause, though you would probably have had other symptoms, such as needing to pass water more often. Rarer physical causes can include thyroid disease or malignancies - unlikely, but they should be excluded by further tests. After that, I feel your doctor must consider chronic fatigue syndrome [CFS], also known as ME. The causes aren't fully understood, but it's a chronic condition associated with bouts of extreme tiredness. Otherwise, your disturbed sleep could indicate depression if you have other symptoms such as low mood; and narcolepsy, a rare disorder associated with a fault in the brain mechanisms that control wakefulness and sleep, could also be looked at.
· Dr Patrick Milroy is a GP and senior partner at the Knoll Surgery in Frodsham, Cheshire
The Dietician: Azmina Govindji
Diet plays a key role in sustaining energy levels and can affect sleep, so yours may benefit from fine-tuning. Avoid sugar-rich foods such as cakes and biscuits, and have slow-burn carbohydrates to keep blood sugar steady - try porridge, granary bread, light pasta dishes and fruit and vegetables. If you want to have caffeinated drinks, three to four cups of filter coffee or six cups of tea or instant coffee daily are harmless, but strong coffee at night could keep you awake. In the evening, choose foods that improve sleep quality. The amino acid tryptophan, found in protein foods like poultry, dairy, meat and eggs, is needed for production of serotonin, which helps promote sleep. In the UK most of us eat enough protein - the key is to have it later in the day. Carbohydrates help your body use tryptophan, so a milky drink, which contains both protein and carbohydrates, could be just what the doctor ordered.
· Azmina Govindji is a registered dietician (govindjinutrition.com)
