More than a few times per month, I have patients comment that they think others perceive them as being lazy. Whether they like to "sleep in" or have trouble getting up in the mornings, or if they’re prone to taking naps in the afternoon, their sleepiness often elicits other’s perception of them as being lazy or unproductive. Add to this a saying from Proverbs: "Laziness brings on deep sleep, and the shiftless man goes hungry." Given that this type of work ethic runs deep in our modern day culture, it’s difficult to avoid being called lazy if you’re not the first one in the office and the last one to leave.  

However, laziness may have less to do with sleep than it does with how well one is breathing while they’re sleeping. Without assessing the latter, it would be wrong to assume the former. 

Sleepy or Sleep Deprived? 

Typically, most self professed "lazy" people don’t look forward to waking up in the morning. On more than one occasion, patients have complained that they "curse the mornings" when they have to get up. Often it takes multiple cups of coffee, or vigorous exercise, before they feel even somewhat functional. Naps are also a requisite for most of these people and almost all of them crash at night, completely exhausted by the time they get to bed. In the morning, they never feel refreshed—always feeling like they’ve slept only for a few hours.  

The other common misperception people have about other sleepy people is that they must have trouble sleeping or that they have insomnia. However, what many supposed "lazy" people suffer from is not usually due to insomnia—they can fall asleep just fine. In fact, many of these people fall asleep too easily. The difference is, these people just can’t wake up once they do fall asleep.  

So, if these people are not sleep deprived, sleeping more than their peers, why do these people seem so tired and "lazy" all the time? The true answer lies in how well they’re breathing while they’re sleeping. 

To Breathe Or Not To Breathe 

Many supposed "lazy" people that I see in my practice often have a sleep breathing problem called Upper Airway Resistance Syndrome (or UARS for short). This often occurs to those who have a smaller than average airway opening, or a bigger than average tongue to jaw size ratio. And for those who suffer from UARS, this is the primary reason why they’re not getting the deep and restful sleep that they truly need and desperately desire.  

It’s taken for granted that all humans have rigid, open windpipes that allow air to pass easily from the nose through the lungs. What’s unique about the human upper airway, however, is that due to our unique ability to talk, our voice boxes are much lower down, underneath the tongue, which forces the tongue to rotate backwards. This is fine when you’re awake, but when you’re on your back, the tongue and voice box falls back partially due to gravity. Furthermore, when you go into deep sleep, your throat and tongue muscles relax, then with a bit of deep inspiration, the tongue falls back completely to occlude the 1-2 mm airway space behind the tongue. 

If you have UARS, a number of different scenarios can occur: the tongue falls back, and you can wake up after a few seconds, with you panting, in a sweat, your heart racing, and in a state of panic. Or you wake up from deep to light sleep only, never realizing that your sleep was disturbed.  

Also, if you stop breathing for 10 seconds or longer, and then wake up, then you just had an apnea or a "loss of breath" due to an obstructed airway. Five or more apneas per hour is in the range of having obstructive sleep apnea. But even if you stop breathing 20-30 times every hour, each lasting anywhere from 1-9 seconds, you’ll be told you don’t have any apneas, so therefore there’s nothing clinically wrong with you.  

This is the major conundrum many UARS patients find themselves in. Although they’re not found to have a clinically diagnosable problem, they still suffer from the same level of fatigue and exhaustion that many OSA patients experience. This may be why so many UARS patients are often mistaken for being lazy and not properly treated as someone who suffers from a sleep breathing problem. 

Fighting While Sleeping 

Another physiologic phenomenon that many UARS patients experience is that they’re constantly under a low grade state of stress or anxiety.Whether or not they feel this way while they’re awake, while they’re sleeping, their bodies are in a constant mode of "fight or flight." Both hormonally and neurologically, having UARS can put your body under enormous stress. Since you’re never able to reach a deep level of sleep, and stay in a sustained state of light sleep, your entire nervous system goes en guarde, and becomes hypersensitive. Even your emotions and senses are heightened, including your hearing, vision, taste, and smell. Simultaneously, you are exhausted all the time. 

Also, in this constant state of readiness, blood is taken away from your gastrointestinal system, your reproductive organs, your skin or your hands and feet. This may be why so many people with UARS have cold hands or feet or suffer from a rash of gastrointestinal problems. 

Laziness May Be a Virtue 

But there is one positive side to all of this. Contrary to popular belief, I see many people with UARS who self proclaim themselves as being lazy, compensate for their chronic fatigue and lack of energy by becoming overachievers, being highly productive and creative in everything they do, going non-stop during the day, but crashing at night. They’re also much more attuned to their bodies, being proactive about their health, and taking care of whatever illnesses they have before they become huge problems. 

However, there are those who can’t sustain this high energy lifestyle especially as they get older and they start gaining weight. What happens for many of these patients is that they now progress into a more severe form of sleep breathing problem like OSA. 

So the next time you think you’re lazy or think that others perceive you this way, the way you feel and act may actually be due to chronic deep sleep deprivation and not a personality defect. Something else to sleep on.