Q I feel exhausted all the time, not just sleepy but exhausted. I can tell the difference between my sleepiness and my exhaustion. Someone told me it was because I did not get enough Stage 3 and 4 sleep, and if I don't get enough, how can I get more?

A Your "exhaustion" sounds like it prevents accomplishing much during the day even if you have slept a normal amount. This can be due to many different problems, such as poor quality sleep or a condition that exhausts you even if your sleep is relatively OK. People with narcolepsy have a greater risk of breathing poorly during sleep. This sets off the body's alarms to make the person awaken briefly dozens or scores or even hundreds of times during the night, without their remembering it. The alarms go off because these episodes deprive the brain of adequate oxygen. Often, but not always, people who suffer disordered breathing during sleep feel awful upon awakening. This is not typical of narcolepsy, in which people often feel best at the beginning of the day. Stages 3 and 4 sleep, together known as "deep sleep," were once thought to be what really refreshes a person. But newer research suggests that REM sleep may refresh just as much as deep sleep. The total time you sleep or the solidarity of your sleep may be as important as any particular stage of sleep.

In addition to narcolepsy, you may suffer chronic fatigue syndrome, which can represent leftovers from a virus infection, other medical conditions, depression or drug side-effects. So many Americans sleep less than they need, that sleep deprivation has become a fatiguing national epidemic. Your problem is worth a careful investigation. Only after the likely cause for your exhaustion has been discovered can the treatments most likely to relieve it be prescribed.

by Quentin Regestein, M.D., Boston, MA

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