Ask The Expert: Can Exercise Help with Excessive Sleepiness?

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Monday, February 25, 2013

This "Ask The Expert" is courtesy of Barbara Phillips, MD, MSPH, FCCP. 

Exercise of any sort has generally been shown to improve daytime sleepiness. This is true for just about every population that has been studied, from healthy teens who took up running (1) to inactive people who began pilates (2).  In understanding how exercise can result in such a positive effect on sleepiness, it’s helpful to take a look at the most common causes  of sleepiness. 

Among the most frequent causes of sleepiness and fatigue in the population are depression, obesity, diabetes, smoking, and inadequate sleep at night (3).    Exercise helps with the first three of these.  For example, physical activity has been shown to help depression in some studies (4).  Physical activity is also an important part of  most effective weight loss programs. Working out may also help with glucose control in diabetes (5).  So part of the beneficial effect of exercise on sleepiness may result from its positive effects on some of the common causes of sleepiness. 

Another part of the story is that many conditions associated with sleepiness (including obesity, diabetes, short sleep duration and even sleep apnea) are associated with increased levels of substances known as inflammatory markers (6).  (There are many of these, including C-reactive protein, tissue necrosis factors, and interleukins). These substances circulate in the blood and may cause sleepiness.  Exercise has been shown to reduce levels of these agents (5), which may explain part of its effect on sleepiness.  (By the way, these inflammatory markers are also associated with cardiovascular disease; part of the mechanism by which exercise reduces the risk of heart disease may be by reducing the circulating levels of inflammatory markers). 

We probably don’t know the whole story yet, but what we do know is compelling: exercise can help with excessive sleepiness. 

1. Kalak N, 3. Gerber M, Kirov R, Mikoteit T, Yordanova J, Pühse U, Holsboer-Trachsler E, Brand S Daily morning running for 3 weeks improved sleep and psychological functioning in healthy adolescents compared with controls.J Adolesc Health. 2012 Dec;51(6):615-22.

2. Leopoldino AA, Avelar NC, Passos GB Jr, Santana NÁ Jr, Teixeira VP Jr, de Lima VP, de Melo Vitorino DF. Effect of Pilates on sleep quality and quality of life of sedentary population.J Bodyw Mov Ther. 2013 Jan;17(1):5-10.

3. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A (2005) Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab 90:4510–4515.

4.Herring MP, Puetz TW, O'Connor PJ, Dishman RK. Arch Intern Med. 2012 Jan 23;172(2):101-11. doi: 10.1001/archinternmed.2011.696.

5,Petersen AM, Pedersen BK (2005) The anti-inflammatory effect of exercise. J Appl Physiol 98(4):1154–1162

6. Miller MA. Association of inflammatory markers with cardiovascular risk and sleepiness.J Clin Sleep Med. 2011 Oct 15;7(5 Suppl):S31-3. doi: 10.5664/JCSM.1356.