If Work Makes You Crash, It May Not Be ‘Stress’

Falling asleep while working is often blamed on stress or burnout. But if you frequently find your head nodding off at your desk, the real culprit might be a medical issue rather than just a heavy workload. In this article, we’ll explore common—and less common—causes of unexpected daytime sleepiness, how to tell if it’s more than stress, and steps you can take to feel more alert and healthy.

Why Dismissing It as “Just Stress” Can Be Risky

Stress can certainly sap your energy. But when fatigue crosses the line into uncontrollable drowsiness during meetings, while driving, or as you type, it may signal:

• A treatable health condition
• A medication side effect
• A combination of multiple factors

Ignoring repeated “crashes” can delay diagnosis and treatment of potentially serious problems.

Common Medical Causes of Falling Asleep at Work

1. Sleep Disorders

Even if you log eight hours in bed, poor sleep quality can leave you exhausted.

• Obstructive sleep apnea: Interrupted breathing leads to fragmented sleep and daytime fatigue.
• Narcolepsy: A neurological disorder causing sudden sleep attacks and muscle weakness.
• Restless legs syndrome: Uncomfortable leg sensations make it hard to stay asleep, reducing overall rest.

2. Anemia and Nutrient Deficiencies

Oxygen transport depends on healthy red blood cells and key vitamins.

• Iron-deficiency anemia: Low iron means less oxygen in your bloodstream, causing weakness and sleepiness.
• Vitamin B12 deficiency: Impairs nerve function and red blood cell production, often leading to fatigue.

3. Thyroid Disorders

An underactive thyroid (hypothyroidism) slows metabolism, leading to persistent tiredness, weight gain, and sensitivity to cold.

4. Diabetes and Blood Sugar Swings

High or low blood sugar can cause:

• Feelings of exhaustion
• Blurred thinking
• Sudden urges to nap

5. Medication Side Effects

Many prescriptions list drowsiness as a side effect:

• Antihistamines (for allergies)
• Some blood pressure drugs
• Certain antidepressants

6. Mental Health Conditions

Depression and anxiety don’t always present with anxiety or sadness. They can manifest as:

• Overwhelming fatigue
• Lack of motivation
• Difficulty concentrating

Less Obvious Culprits: Liver-Related Fatigue

Your liver plays a key role in energy metabolism and detoxification. When liver function declines, you may experience:

• Persistent tiredness
• Difficulty concentrating
• “Foggy” thinking
• Mood changes

Hepatic Encephalopathy

In chronic liver disease, toxins can build up in the blood and reach the brain, causing:

• Mild confusion or forgetfulness
• Sleep–wake cycle disturbances (e.g., excessive daytime sleepiness)
• In severe cases, drowsiness so profound it resembles coma

(European Association for the Study of the Liver, 2018; Vilstrup et al., 2014)

Portal Hypertension and Fatigue

Advanced liver scarring (cirrhosis) can raise pressure in the portal vein, leading to fluid buildup and poor nutrient absorption. This can worsen overall energy levels. Non-invasive tools like transient elastography help assess risk (Berzigotti et al., 2013).

Distinguishing Stress from a Medical Issue

Stress-related fatigue often comes with irritability, racing thoughts, and muscle tension. In contrast, medical fatigue tends to be:

• Unrelieved by rest or weekends off
• Accompanied by other symptoms (e.g., shortness of breath, leg tingling, mood changes)
• Progressive rather than fluctuating strictly with workload

Keep a simple diary for 1–2 weeks, noting:

• Sleep and wake times
• Energy peaks and crashes
• Associated symptoms (headache, bloating, leg discomfort)
• Any new medications or changes in routine

This record helps your doctor identify patterns and narrow down causes.

What You Can Do Right Now

1. Improve Sleep Hygiene

   • Stick to a consistent sleep schedule.
   • Create a dark, cool bedroom environment.
   • Limit screens and caffeine before bedtime.

2. Review Your Medications

   • Ask your pharmacist or doctor if drowsiness is a known side effect.
   • Explore alternatives or dose adjustments.

3. Optimize Nutrition

   • Incorporate iron-rich foods (leafy greens, lean meats) and vitamin B12 sources (eggs, dairy).
   • Balance carbohydrates with protein to stabilize blood sugar.

4. Manage Underlying Conditions

   • If you have diabetes, aim for steady glucose levels.
   • Monitor thyroid function with your physician.

5. Screen Symptoms Online

   • You might consider doing a free, online symptom check for to get started on possible causes.

When to Seek Medical Help

Contact your doctor promptly if you experience:

• Sudden, severe daytime sleepiness that interferes with daily activities
• Episodes of falling asleep while driving or operating machinery
• Signs of liver disease (yellowing of eyes/skin, abdominal swelling)
• New or worsening neurological symptoms (confusion, difficulty speaking)
• Persistent mood changes or thoughts of self-harm

Any of these could signal a life-threatening emergency or a treatable condition needing medical care.

Talking to Your Doctor

Bring your symptom diary, medication list, and any relevant test results. Together, you can:

• Order blood tests (CBC, liver panels, thyroid function, iron studies)
• Refer you to a sleep specialist for a sleep study or apnea screening
• Evaluate liver health using non-invasive tests like transient elastography
• Adjust or change medications that may be contributing to fatigue

Takeaway

Falling asleep while working is more than an annoying habit—it can be a red flag for a range of health issues, from common nutrient deficiencies to serious liver conditions such as hepatic encephalopathy. Don’t chalk it up to “just stress.” Track your symptoms, improve sleep and nutrition, and reach out for professional evaluation. For persistent or worsening fatigue, always speak to a doctor to rule out life-threatening or chronic conditions. Early diagnosis and treatment can restore your energy, focus, and quality of life.