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What causes excessive sleepiness?

It is normal for people to feel sleepy from time to time, particularly after a long day. However, excessive sleepiness can be disruptive and make it difficult for a person to go about their normal daily activities.Some of the more common causes of excessive sleepiness include not sleeping long enough and having poor quality sleep.…

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What causes excessive sleepiness?
It is normal for people to feel sleepy from time to time, particularly after a long day. However, excessive sleepiness can be disruptive and make it difficult for a person to go about their normal daily activities.

Some of the more common causes of excessive sleepiness include not sleeping long enough and having poor quality sleep.

In some cases, excessive sleepiness may be due to a sleep disorder or another underlying health condition.

Read on to learn about the various causes of excessive sleepiness, along with their symptoms and treatment options.

Causes

a man experiencing Excessive sleepiness

Excessive sleepiness can disrupt a person’s daily activities.

Excessive sleepiness can be difficult to quantify, as it may mean different things to different people.

In general, it is a feeling of fatigue or sleepiness that lasts throughout the day or for many days.

Excessive sleepiness is a relatively common issue. A 2019 study in Nature Communications notes that 10–20% of people deal with excessive sleepiness to some degree.

There are several possible causes of excessive sleepiness, each of which has different treatments.

Sleep deprivation

Sleep deprivation occurs when a person does not get enough sleep. The American Academy of Sleep Medicine (AASM) note that adults need between 7 and 8 hours of sleep each night to feel alert and well-rested the following day.

However, according to the AASM, about 20% of adults fail to get enough sleep.

A person who does not get enough sleep during the night is likely to experience excessive sleepiness the next day. People who regularly fail to get enough sleep may feel constantly tired.

Some common causes of sleep deprivation include:

  • excessive or inconsistent work hours
  • personal obligations
  • an underlying medical condition

Underlying medical causes require their own specific treatments. In most other cases, simple lifestyle changes can usually improve the duration and quality of a person’s sleep.

Insomnia

Insomnia is a sleep condition in which people have difficulty sleeping. People who have insomnia tend to feel excessively sleepy but are unable to fall or stay asleep.

People may experience insomnia in different ways. Some common symptoms include:

  • being unable to get to sleep
  • waking continually throughout the night
  • waking very early in the morning and being unable to fall back to sleep

Insomnia can be difficult to diagnose. The Centers for Disease Control and Prevention (CDC) note that doctors generally only diagnose insomnia by ruling out other potential sleep disorders.

Treatment

Treatment for insomnia may involve a combination of therapies. Examples include:

  • sedative-hypnotic medications
  • antidepressants
  • behavioral techniques to promote regular sleep

Obstructive sleep apnea

Sleep apnea is a disorder in which a person temporarily stops breathing during sleep. It is a relatively common cause of excessive daytime sleepiness.

There are two types of sleep apnea:

  • Obstructive sleep apnea (OSA): OSA occurs when the soft tissues in the back of the throat collapse, blocking the airflow.
  • Central sleep apnea (CSA): CSA occurs when the brain fails to signal to the respiratory muscles to breathe.

Some people experience mixed sleep apnea, which is a combination of OSA and CSA.

Episodes of sleep apnea may occur dozens or even hundreds of times in a single night. As a result, they can greatly disturb a person’s sleep cycle.

Common symptoms of sleep apnea include very loud snoring and gasping for air throughout the night.

During an episode of sleep apnea, a person’s body becomes temporarily starved of oxygen. This lack of oxygen may lead to other issues, such as an irregular heartbeat. Over time, this can lead to serious chronic conditions, such as high blood pressure and heart disease.

Sleep apnea commonly occurs when a person is overweight. When this is the case, weight loss will be the first recommended treatment.

Treatment

Two common treatments for sleep apnea include:

  • Positive airway pressure devices: These devices consist of a machine that attaches to a mask, which the person wears over their face. The machine supplies pressurized air into a person’s throat while they sleep. The air prevents the throat from collapsing.
  • Oral appliances: These are similar to a mouthguard or orthodontic appliance. The devices hold the lower jaw forward slightly during sleep. This positioning prevents the soft tissues in the back of the throat from collapsing and blocking the airways.

Restless legs syndrome

Restless legs syndrome (RLS) refers to an uncontrollable urge to move the legs when they are at rest. The condition usually also causes uncomfortable sensations in the legs.

RLS may occur during both wakefulness and sleep. People who experience RLS when awake may have difficulty getting to sleep.

If RLS happens during sleep, it may cause a person’s legs to spasm or jerk repeatedly throughout the night. While this may not be enough to wake the person, it can prevent them from reaching the stages of deep, restful sleep. As a result, the person may feel sluggish and tired the following day.

Some scientists believe that RLS is due to abnormalities in the neurotransmitter dopamine, which plays a role in controlling muscle movements.

Treatment

Certain lifestyle changes may be beneficial for people with milder cases of RLS. These include:

People with more severe cases of RLS may need medication to regulate the levels of dopamine and iron in the body.

Narcolepsy

Narcolepsy is a neurological condition that causes a person to fall asleep suddenly and at inappropriate times.

People with narcolepsy usually experience extreme and persistent sleepiness throughout the day. Most people with this condition will also have one or more of the following symptoms:

Treatment

Treatment usually involves stimulant medications, which help the person stay awake. Antidepressant medications may help control hallucinations and episodes of sleep paralysis.

Doctors may also recommend that people take a few good naps throughout the day, as this can improve narcolepsy symptoms.

Depression

Depression may contribute to sleep issues, including excessive daytime sleepiness, as well as oversleeping, or sleep that is not restful. Likewise, sleep issues may contribute to symptoms of depression.

General fatigue and daytime tiredness are common among people with depression. Other symptoms of depression include:

  • feelings of sadness
  • feelings of hopelessness or despair
  • feelings of anxiety
  • difficulty concentrating
  • difficulty remembering details

Treatment

therapist in counseling session talking with patient

Psychotherapy may help treat depression.

Treatment for depression may involve drug therapy, psychotherapy, or a combination of the two.

Several different types of antidepressant medication are available. A person can talk to their doctor about which medication would be most appropriate for them.

Common psychotherapies for depression include cognitive behavioral therapy (CBT) and interpersonal therapy. According to the Anxiety and Depression Association of America, these therapies appear to be particularly effective in treating depression.

Certain medications

In some cases, daytime sleepiness may be a side effect of a particular medication, such as:

It is important to discuss the side effects of any medication with a doctor. If side effects such as sleepiness are too difficult to deal with, the doctor may recommend a change in medication or dosage.

Symptoms

Excessive sleepiness is not a disorder in itself but a symptom of insufficient sleep or an underlying health condition.

People who experience excessive sleepiness may notice the following:

  • fatigue
  • mental fog
  • inability to focus
  • grogginess
  • sluggishness

Excessive sleepiness may also cause:

  • difficulty waking up or getting out of bed in the morning
  • feeling sluggish and unmotivated throughout the day
  • napping frequently throughout the day
  • falling asleep at inappropriate times, such as while driving or during meals
  • lapses in attention
  • loss of appetite
  • difficulty remembering events throughout the day
  • difficulty concentrating
  • irritation
  • poor performance in work or school activities

A person may experience additional symptoms if their excessive sleepiness is the result of an underlying health condition.

Diagnosis

Correctly diagnosing the underlying cause of excessive sleepiness is important for establishing the best treatment.

During the diagnostic procedure, a doctor may ask questions about a person’s lifestyle habits and any medications that they are taking. The doctor may also ask questions relating to mental health.

In some cases, a doctor may order the following diagnostic tests:

  • A sleep study called a polysomnography: This test records a person’s brain waves, oxygen levels, and body movements during sleep to assess their sleep cycle.
  • Electroencephalogram: This noninvasive test records electrical activity in the brain.

General treatment for excessive sleepiness

senior man running in the park

Regular exercise might help people get a better night’s sleep.

The specific treatment for excessive sleepiness will depend entirely on the cause.

Most healthcare professionals will not want to prescribe highly addictive drugs to assist with sleep, and people who receive a prescription for sleep medications should not take them every day.

However, some general lifestyle changes may help people get a better night’s sleep. These include:

  • eating a healthful, balanced diet
  • limiting caffeine and alcohol intake
  • exercising regularly
  • creating a relaxing sleep environment
  • taking a warm bath before bedtime
  • keeping a consistent sleep schedule

Summary

Excessive sleepiness is normal after a night of poor or insufficient sleep. However, persistent sleepiness could be a symptom of a sleep disorder or some other underlying health condition.

Anyone who regularly experiences excessive sleepiness should visit their doctor for a diagnosis. Treating the underlying cause can improve sleep quality, and it may reduce the risk of other complications.

Many treatment plans incorporate simple lifestyle changes that can help improve sleep quality.

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Stressed Students, Bridesmaids Drama, And More: An Advice Column From A Total Amateur

Hi! A while ago I asked the BuzzFeed Community to tell me a problem they’re having, so that I — a person with absolutely zero professional qualifications to help anyone — could give them advice. So, here are the results! NBC 1. “Dear Andy,I have NO idea where I should go to school… I’m applying…

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Stressed Students, Bridesmaids Drama, And More: An Advice Column From A Total Amateur

Hi! A while ago I asked the BuzzFeed Community to tell me a problem they’re having, so that I — a person with absolutely zero professional qualifications to help anyone — could give them advice. So, here are the results!


NBC

1.

“Dear Andy,

I have NO idea where I should go to school… I’m applying to 12 schools, 10 on the west coast and two in BC. I’m a high achieving student (I’m in five AP classes, president of two clubs, volunteering and a job, etc.) and I don’t want to go somewhere that’s all about the pressure, but I still want a high quality education. I’m so lost, help!”

—The Overwhelmed Student

Dear Overwhelmed,

You posted this just to dunk on all of us academically, didn’t you?

Kidding. In all seriousness, you can get a very good education at a bunch of different schools. And when you’re done, you’ll have a degree that probably nobody will ever verify! In my completely amateur opinion, the only reason people think the “Ivy League” schools are better is because a lot of wealthy, well-connected people go there (and have gone there), and therefore when you graduate from one, you’re more likely to get in at some fancy law firm or whatever because of your connections. So if you aren’t planning on being like, IDK, the CFO of Waystar Royco or something, just pick the school that you really want to go to. Where are you going to be happy living? Is one of the schools in a city you already want to move to and/or the city that has jobs in your future profession? Is it important for you to be close to home? How many Wendy’s are there on campus, and do they carry Spicy Nuggets? These are the questions you should be asking.

Oh, wait, actually…forget all that. Go to the school that will cost the least when you factor in tuition, room & board, and any scholarships you might get. Student loans are a curse and you want as little of them as possible. In the end, you might not even end up doing the thing you studied in college. Wanna know what degree I have? A BFA in Theater Performance. An acting degree. And now here I am, writing for a website. You’ll be fine.

—Andy

2.

“Dear Andy,

I got married this summer, and I decided to choose only family to be my bridesmaids. For me this included three female cousins and my (now) sister-in-law. My husband, on the other hand, decided to do a mix of family as well as friends from high school for his groomsmen. I had no problem with this at all.

I had a few friends who I knew would expect to be bridesmaids, so I made it clear to them from the very beginning that I would be choosing family only as to not have a huge wedding party, but I told them they were not any less important to me and that I still wanted them to be involved in the wedding as much as they felt comfortable with. Most of the friends I had this conversation with were very understanding, however one straight up told me that she was disappointed (this was two years before the wedding).

Now it’s been a few months since I got married and this friend (a friend from childhood) started talking about the wedding. She told me she felt left out of the wedding since she wasn’t part of the wedding party. It particularly bothered her that my husband included friends and I didn’t. She then proceeded to tell me that it was difficult for her to be there the day of my wedding because of these feelings. AT MY WEDDING. She also included the fact that she didn’t want to upset me and that it doesn’t change our friendship. But if that is the case then why say anything in the first place? I’ve already said one too many times the reason for my bridesmaid choices and how important she is to me regardless. And she says she understands. I just wish she would let it go. Ever since this conversation I feel like I’ve been seeing her in a whole new light.

I do care about her feelings, but I stick by my decision and I don’t regret anything. I feel like I’ve done everything I can to make her feel better.”

—The Besieged Bride

[TL;DR: Bride had only family as bridesmaids, groom had some friends in the mix, bride’s childhood friend felt left out and complained about it a few months after the wedding.]

Dear Besieged,

Question one: How drunk was your friend when she brought this up to you? If she was like, a 6 or more out of 10, I say let’s give it a pass and hope she got it out of her system.

Question two: Has your friend had a wedding of her own yet? If yes, then she should’ve understood the situation, because wedding planning is a special kind of hell and inevitably you have to make difficult decisions like this one that might hurt people’s feelings. So if you’ve planned your own wedding, you know the deal and you’re able to say to yourself, “It’s their wedding, I’m just going to be supportive and have fun.” If she hasn’t gotten married yet, she’ll realize later that it was totally inappropriate to complain about this to you. Hopefully.

—Andy

3.

“Dear Andy,

I have been taking so many of the relationship quizzes on BuzzFeed but they all say I’m single. The major problem is I have an S.O. Is she just faking or am I?? Help me!! Is my girlfriend not actually mine or are we real?”

—The Quizzical Quiz-Taker

Dear Quizzical,

You’re not real. This is all a simulation.

—Andy (or am I?)

4.

“Dear Andy,

I’m not sure where to live. I live in Milwaukee, WI, right now. Moved here three years ago for school, but that fell through because Milwaukee is friggin expensive. My family wants me to move back to the other side of the state, towards Minneapolis/St. Paul. What should I do?”

—Meandering the Midwest

Dear Midwest,

Get the fuck out of there, it’s so cold! Listen, I used to live in Michigan, and it was depressing because it was grey and miserable nine months out of the year. Now I live in Southern California, it’s sunny and beautiful and my vitamin D levels are through the roof. Migrate south, seriously.

But if you HAVE to stay, I will say that everybody who lives in Minneapolis seems to LOVE Minneapolis for some reason.

—Andy

5.

“Dear Andy,

My problem is that I struggle with feeling attractive. I started taking birth control when my boyfriend and I started dating (six years ago). I started gaining the weight right after. I’m now a size 12 and my boyfriend is a slender guy. I haven’t felt attractive in the last year. I gained so much weight at one point I was a size 16. I’m back to a 12 and trying to lose weight again. I don’t feel sexy or beautiful in any way. I prefer to keep my shirt on during sex now. I don’t know why my boyfriend still finds me attractive. I have a tummy, I have rolls when I sit down, I just don’t know what he sees anymore. Any advice you could give me would be much appreciated.”

—Struggling With Size

Dear Struggling,

First off, don’t worry about your boyfriend. Clearly he finds you attractive, and when you actually care about someone, the size tags on their clothes don’t matter to you at all. Appreciate that fact and find some security there.

Now, consider the possibility that if your boyfriend finds you attractive at any size, you can too! It’s not easy. It requires shedding every bit of toxic influence that the media and our society overall has thrown at you for your entire life. That takes time and work.

But if you are worried about your physical health at all, consult a doctor. There are many different types of birth control and like 40 different pills, and everyone reacts to each one differently. It can take time to find the right one, and not every doctor is going to be helpful about it. Advocate for yourself if you’re unhappy with your medication. You may have done all of this already and I’m just sitting here mansplaining BC to you, but if so at least you can cross that off your Mansplaining Bingo Card.

—Andy

That’s it for this week. But if you’re having a problem that you need advice about, let me know! It could be anything: petty arguments that you need a judge to decide who was right and who was wrong, help making life decisions, relationship issues — I’m your completely unqualified man. Email imho@buzzfeed.com (for total anonymity) or leave a comment here!

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Doctors Can Already Refuse To Prescribe The Pill. The Religious Discrimination Bill Could Make That Easier.

The Australian government is pushing ahead with its proposed religious discrimination laws, and doctors and lawyers are concerned the legislation could allow practitioners to deny or delay medical care when it comes to reproductive health.But as signs in GP’s offices provided to BuzzFeed News show, doctors are already refusing reproductive healthcare under the current guidelines,…

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Doctors Can Already Refuse To Prescribe The Pill. The Religious Discrimination Bill Could Make That Easier.

The Australian government is pushing ahead with its proposed religious discrimination laws, and doctors and lawyers are concerned the legislation could allow practitioners to deny or delay medical care when it comes to reproductive health.

But as signs in GP’s offices provided to BuzzFeed News show, doctors are already refusing reproductive healthcare under the current guidelines, before a patient has even walked into an appointment.

Laura — who asked to use a pseudonym to protect her privacy — saw this sign in the waiting room for her GP’s office in Sydney’s north. It makes clear the doctor will not prescribe any kind of contraception or referrals for sterilisation or in-vitro fertilisation.

“I just felt really angry that you can basically say ‘I’m not interested in seeing women aged between 15 or 16 and 50’, and that a bulk billing doctor receiving Commonwealth funding refuses to see certain people,” she told BuzzFeed News. “It is within the law to go to the doctor and ask for contraception so I don’t feel like it should be the right of the doctor to refuse it.”

Laura said it was “really alienating” and she was shocked that the sign was allowed under current guidelines.

“It seems to contravene a woman’s right to access healthcare and it sends a really negative message to young women who might be sitting in the waiting room,” she said.

The doctor can be booked online and Laura worries that some patients might not see this sign and then be refused care.

A Melbourne midwife saw this sign in her GP’s surgery making clear the doctor would not give referrals for abortion and featuring the Badge of the Immaculate Heart of Mary, a Catholic devotional article.

The sign itself does not breach Victorian law, nor professional guidelines governing abortion, as a termination has not yet been requested by — and therefore hasn’t been denied to — the patient. If a patient was to request a termination, the law dictates that they must be referred to someone who will provide it.

“According to the legislation, a patient who requests an abortion must be referred to another practitioner — we expect this law to be upheld by all clinicians,” a Victorian Department of Health and Human Services spokesperson told BuzzFeed News.

Chair of the Australian Medical Association Ethics and Medico-Legal Committee, Dr Chris Moy, said the religious discrimination bill was, to some degree, “a solution searching for a problem”.

“With respect to abortion every [jurisdiction] pretty much allows people to conscientiously object,” Moy told BuzzFeed News. “Most people accept at this moment in time that there can be conscientious objection, but the biggest controversies have always been about your obligations after that and the impact of a delay in treatment should be considered by doctors.”


Australian Government

Religious Discrimination Bill explanatory notes.

The association’s position statement on conscientious objection for any treatment says the impact of a delay in treatment, and whether it might constitute a significant

impediment, should be considered by a doctor if they conscientiously object: “For example, termination of pregnancy services are time critical.”

Moy said doctors need to consider not only their own needs but those of the wider community.

“We as doctors have a right to conscientious objection if we have deeply held beliefs but we cannot walk away from patients and we owe a responsibility to patients in urgent situations,” he said.

Equality Australia chief executive and lawyer Anna Brown said the government’s religious discrimination bill gives additional rights to health professionals who wish to refuse treatment to patients based on personal religious beliefs.

She said it makes it difficult for any health organisation — hospitals, pharmacies, clinics — to enforce standards requiring medical staff to provide “judgement-free treatment, or even treatment at all, regardless of any personal religious views”.

“Because you will not be able to ask current or prospective employees about their religious objections, employers will not — and cannot — know whether someone is willing to do the job until it’s too late,” she said.

“[If the bill passes] a health centre cannot ask its GP whether he objects to prescribing the pill before a patient seeking access books in for an appointment. This will make it very difficult for hospitals, clinics and practices to take steps to ensure continuity of care for their patients.”


Australian Government

Religious Discrimination Bill explanatory notes.

Brown said the bill would “expressly authorise adverse impacts on patient health” to accomodate the religious objections of a health professional, which could have serious implications for patients, particularly those outside major cities.

“If a pharmacist in a small town refuses to dispense a script, how far should the nearest pharmacy be, and how much should it cost to get there, before the law will protect the patient?” she said. “This law doesn’t provide an answer.”

Brown predicted the law would allow “religious judgement” to interfere with the relationship between health professionals and patients.

“Patients will have less protection if a health worker makes certain discriminatory statements during a consultation on the basis of their religious belief,” she said. “For example, women may lose existing discrimination protections if they are told they should ‘pray for forgiveness’ for having sex outside of marriage, falling pregnant outside of wedlock, or sleeping with other women.”

A spokesperson for the Medical Board of Australia told BuzzFeed News that its code states doctors have the right to “not provide or directly participate in treatments if they conscientiously object”.

“However, they must inform patients and colleagues, and not impede patients’ access to treatment,” the spokesperson said.

The code is “not a substitute” for the law.

“If there is any conflict between the code and the law, the law takes precedence,” the spokesperson said. “Anyone who has concerns about the actions of a registered health practitioner, such as a medical practitioner, is encouraged to report this to AHPRA so the concerns can be investigated.”

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Vijay Roach said the college’s response to the bill is consistent with its position on conscientious objection, the right of patients to access health care and the duty of a medical practitioner to ensure that a woman can access the health care she needs.

“RANZCOG respects the personal position of all of our members, and recognises the right to conscientious objection in relation to provision of certain aspects of healthcare,” Roach told BuzzFeed News.

“However, the college emphasises that health practitioners owe a duty of care and must refer the patient to other health practitioners or health services where a woman is able to receive the health care she needs.”

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The Sick Refugees Held In Island Camps Have Become A Defining Political Issue For Australia

The health of the hundreds of asylum seekers and refugees held on island nations in the Pacific has become a defining political issue for Australia. World Vision / PR IMAGE A Sri Lankan asylum seeker looks out to sea on Manus Island in 2017. More than seven years have passed since Australia reopened its offshore…

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The Sick Refugees Held In Island Camps Have Become A Defining Political Issue For Australia

The health of the hundreds of asylum seekers and refugees held on island nations in the Pacific has become a defining political issue for Australia.


World Vision / PR IMAGE

A Sri Lankan asylum seeker looks out to sea on Manus Island in 2017.

More than seven years have passed since Australia reopened its offshore detention centre on the Pacific island of Nauru. There, and in Papua New Guinea, refugees and asylum seekers were sent to wait in limbo for years, the human collateral of a harsh policy. Many got sick, both physically and mentally.

Fast forward to today. The government desperately wants to repeal the “medevac” law, which, by giving doctors a greater say, makes it easier for the hundreds still in island detention to access medical treatment in Australia.

The issue has become a defining one, and debate on the medevac repeal is likely to feature in Australia’s final political sitting week of 2019.

But how did we get here?

When Kevin Rudd unseated Julia Gillard to return as prime minister in 2013, he made a surprise announcement: nobody who came to Australia by boat in the future would ever be settled in Australia.


Australian Government

Gillard, who led a centre-left government, had reopened detention centres on Nauru and Papua New Guinea’s Manus Island for offshore processing in 2012, as thousands of people tried to make it to Australia by boat. But Rudd’s ban on ever being re-settled in Australia was new.

The policy was justified as an attempt to discourage people from taking the treacherous boat journey to Australia and halt the people smuggling trade in its tracks.

When the conservative Coalition won the election in September 2013, they doubled down on Rudd’s pledge and introduced Operation Sovereign Borders — a military-led operation that includes intercepting boats before they arrive in Australian waters and turning them back to where they came from.

The numbers of potential refugees in the detention centres on Nauru and Manus Island escalated, starting from Rudd’s declaration.


Eoin Blackwell / AAPIMAGE

Asylum seekers at the Manus Island detention centre in 2014.

By June 2014, there were more than 2,500 asylum seekers in offshore detention: 1,198 men on Manus Island, and 1,268 people on Nauru — including women and children.

24-year-old Iranian asylum seeker Hamid Khazaei, who was held on Manus Island, died from a leg infection in September 2014.


Refugee Action Coalition / PR IMAGE

After Khazaei contracted the leg infection, he developed flu-like symptoms. After three days, the Australian government approved his transfer to Port Moresby. He had a series of cardiac arrests. He was transferred to Brisbane, Australia, but he died a week later. A coroner would later find that Khazaei could have lived if he had received appropriate medical care when his condition first deteriorated. He found that Khazaei would have survived if he had been evacuated to Australia for medical treatment earlier.


Darren England / AAPIMAGE

Khazaei was the third man to die in offshore detention. Earlier in 2014, Reza Berati was murdered by security guards at the Manus Island regional processing centre, and Sayed Ibrahim Hussein drowned.

Meanwhile the number of people needing medical treatment for serious and complex complex in Australia was escalating. But in mid-2015, the government put on the brakes, deciding transfers to Australia should become “increasingly rare”.


Supplied.

In 2013, 92 people were transferred to Australia. The following year that number went up to 362. The first half of 2015 saw similarly high numbers of transfers.

But in May 2015, after a review of the number and purpose of medical transfers, the government decided they should become “increasingly rare”. According to a directive issued by immigration department secretary Michael Pezzullo, a patient would need to be in a “life and death” situation, or one “involving the risk of life-time injury or disability”, to come to Australia. He said he expected at least half the asylum-seekers temporarily in Australia for medical treatment to be returned within a month.

Previously, family members of a patient were automatically transferred with them. After the review, the immigration department would decide on a case-by-case basis.

The review also led the government to invest in more medical facilities and expertise on Nauru and Manus.

A failed legal challenge to offshore detention saw people take to the streets for the Let Them Stay campaign at the start of 2016.


Carol Cho / AAPIMAGE

A Let Them Stay rally in Sydney in February 2016.

On Feb. 3, 2016 the High Court rejected a claim from a refugee that Australia’s system of offshore detention was illegal.

In the wake of the case, refugee advocates launched the Let Them Stay campaign, demanding that 267 people in Australia for medical treatment (including 37 babies and more than 50 children) not be sent back to Nauru and Manus Island. The campaign achieved widespread support, with churches offering to provide sanctuary, and the 267 people were able to stay in Australia.


Paul Miller / AAPIMAGE

Demonstrators in Sydney in February 2016.

While the government largely stopped returning people to offshore detention, transfer numbers dropped dramatically.


Supplied: Department of Home Affairs.

In the calendar year 2016, just 73 people came to Australia from offshore detention. The number fell to 37 in 2017.

Although it is not government policy to keep sick refugees from offshore detention in Australia, since the Let Them Stay campaign very few people have been returned, even if they are not granted a visa. The last person went back to Nauru voluntarily in April 2018.

In the middle of 2016, two more refugees aged in their 20s died.


Dave Hunt / AAPIMAGE

A vigil for Omid Masoumali outside the inquest into his death in February 2019.

Omid Masoumali, 26, set himself on fire on Nauru on April 29, 2016. More than 24 hours later, he was flown to Brisbane, where he died several days later. Just two weeks later, Rakib Khan died at 26 from a suspected overdose.

A groundbreaking case in May 2016 laid the foundations for a legal campaign to get sick refugees to Australia.


Paul Miller / AAPIMAGE

The National Justice Project’s George Newhouse, who represented the woman.

A young woman refugee who became pregnant after a sexual assault on Nauru, and wanted an abortion, brought the case in the Federal Court. The Australian government wanted to take her to Papua New Guinea for the abortion, but the court found she could not receive a safe or legal termination there. The government gave evidence that they did not bring her to Australia because her case was not “exceptional” enough to comply with their strict policy.

In a landmark ruling, Justice Mordecai Bromberg found that the Australian government had a duty of care to the people it holds offshore.

In November 2016, the United States agreed to resettle refugees from Nauru and Manus Island.


Saul Loeb / Getty Images

Prime minister Malcolm Turnbull and president Donald Trump meet in the Oval Office in February 2018.

After a famously heated phone call, US president Donald Trump agreed to continue the arrangement, which prime minister Malcolm Turnbull had negotiated with the Obama administration. The first refugees left for the US in September 2017.

In the face of the “unique and complex” medical problems facing refugees on Nauru and Manus Island, the government convened a taskforce of bureaucrats to decide who would come to Australia.


Mick Tsikas / AAPIMAGE

Home affairs department secretary Michael Pezzullo.

The transitory persons committee, established in mid-2016, sat without a doctor among its members for nine months. Meeting records obtained by BuzzFeed News showed the committee discussed the department’s reputation and the likelihood of litigation when considering what to recommend. Until the medevac law, the secretive committee was the forum where transfer decisions were made.

The memo setting up the transitory persons committee noted that the government continued to see “unique and complex” cases, involving a combination of physical health, mental health and child protection issues. It said the committee’s purpose was to consider the “medical, legal, diplomatic, policy and financial implications” of medical transfers to Australia.

After reading the minutes, a former doctor on Nauru, Nick Martin, told BuzzFeed News: “They’re coming at it from the position of, what can we do to keep this person out of Australia? That a dangerous point to start off from.”

Taiwan and Australia secretly reached a deal in September 2017, allowing sick refugees to receive high-quality care for complex medical conditions — without being brought to Australia.


Solomon203 / Wikimedia

The first transfers happened in January 2018. At least 33 people have gone from Nauru to Taiwan for treatment, but many have refused to go.

Between August 2016 and November 2017, five more detainees died. Four had been held on Manus Island, and one on Nauru.

Building on the May 2016 decision, a flood of cases seeking medical transfers from offshore detention hit the Federal Court throughout 2018.


Refugee Action Coalition / PR IMAGE

A group of men protest in the Manus Island detention centre in November 2017.

Some of the cases were brought on behalf of children on Nauru suffering from serious psychiatric problems.

All up, lawyers brought 48 court cases between December 2017 and February 2019 to have clients transferred for treatment. They won every case.

Lawyers who fought the cases have said the government routinely ignored requests to evacuate desperately ill refugees, forcing lawyers to front court on weekends and in the middle of the night.

In the midst of the legal onslaught, the Department of Home Affairs formalised its hardline policy: nobody would come to Australia unless there were “exceptional” circumstances.


Supplied: Department of Home Affairs.

The policy, from June 2018, stated that transfer requests would only be considered if a patient had a “critical and complex” medical condition that would result in their death or “permanent, significant disability” if they were not transferred to Australia.

The transitory persons committee would later discuss whether there was “room for compassion” in the policy.

A health crisis was building. Evidence grew that the environment of offshore detention not only made it more difficult to access medical treatment, but was causing health problems in the first place.


Danny Casey / AAPIMAGE

MSF doctors addressing the media in Sydney in October 2018.

By mid-2018, health contractor International Health and Medical Services had started regularly reporting that the environment on Nauru was a factor causing ill health among refugees and asylum seekers.

International medical charity Médecins Sans Frontières agreed. “Living under a policy of indefinite processing creates a perpetual state of despair, making it impossible for asylum seekers and refugees to recover,” said the organisation’s Australian president in December 2018. After spending 11 months working on Nauru, MSF was expelled by the Nauruan government. MSF described the mental health situation on Nauru as “disastrous”.

“In fact the mental health situation and suffering is amongst the most severe that MSF has seen around the world, including in projects providing care for victims of torture,” president Stewart Condon said.

In mid-2018, two more asylum seekers died.

Children on Nauru developed Resignation Syndrome, a rare psychological illness where they withdrew from the world.


Mike Leyral / Getty Images

A 12-year-old Iranian refugee girl, who had attempted to self-immolate with petrol, on Nauru in September 2018.

BuzzFeed News reported, and MSF later confirmed, that a number of children held on Nauru had developed the condition, which doctors liken to “going into hibernation”. Children with the condition withdraw from the world, cease eating, drinking, speaking, and using the toilet, and fall into a seemingly comatose state.

Revelations in the media and the courts meant the Kids Off Nauru campaign gathered pace in the last months of 2018.


News Corp

The front page of the Sunday Telegraph on October 28, 2018.


Tracey Nearmy / Getty Images

A billboard outside parliament in November 2018.

This is big. Page 2 of today’s @dailytelegraph, which is a Murdoch newspaper. #KidsOffNauru

This is big. Page 2 of today’s @dailytelegraph, which is a Murdoch newspaper. #KidsOffNauru

Meanwhile in Canberra, home affairs minister Peter Dutton launched a leadership challenge against prime minister Malcolm Turnbull.


Sam Mooy / AAPIMAGE

Dutton announcing his challenge on August 23, 2018.

Dutton was unsuccessful in the first spill, but over the course of a chaotic parliamentary week, Turnbull lost the numbers and resigned as leader.

A second spill saw Scott Morrison emerge victorious and be sworn in as prime minister in August 2018.

During her campaign, Phelps had spoken out about the treatment of refugees in offshore detention.

Her victory, together with the resignation of MP Julia Banks from the Liberal party because of her disgust with the leadership spill, left the Coalition with less than half of the seats in the lower house of parliament.

In February 2019, Phelps and the combined forces of Labor, the Greens and other independents succeeded in getting the medevac law through parliament.


Lukas Coch / AAPIMAGE

It was the first time a government had lost a substantive vote on the floor of the House of Representatives in 78 years. The government stridently opposed the changes, which gave doctors a greater role in deciding who would be transferred. The government claimed it would lead to a flood of people smuggler boats making a dangerous sea voyage to Australia.

The first people transferred under medevac came to Australia on March 29, after the law commenced at the start of March.

Meanwhile, the health crisis in detention was worsening. In the first three months of 2019, 43 detainees were admitted to Nauru’s Regional Processing Centre Medical Centre (RPCMC), for stays between 1 and 44 days. The majority of admissions were for mental health treatment and some of the 43 were admitted more than once, with 73 admissions in total. There were 359 detainees in total on Nauru at the end of March.

Although the minority government could not repeal medevac, it fought the law in the courts, but lost in the Federal Court and the Full Federal Court. It has also tried to argue the courts cannot order refugees to be transferred from offshore, but was unsuccessful in the Full Federal Court. It wants to appeal the judgment in the High Court.

In February 2019, the last four children left Nauru, boarding a plane for settlement in the US.


Lukas Coch / AAPIMAGE

A woman and her daughter protest in Canberra in November 2018.

The Morrison government was returned in the May election, this time with a majority.


Tracey Nearmy / Getty Images

Morrison’s victory speech.

But that election also brought back Tasmanian senator Jacqui Lambie.


Tracey Nearmy / Getty Images

Lambie returns to parliament in July 2019.

With its newfound parliamentary majority, the government passed a bill to repeal medevac through the lower house in July. But it needs Lambie’s vote to secure a victory in the Senate before it is passed into law and medevac is gone.

Meanwhile, medevac has continued to operate.


Mick Tsikas / AAPIMAGE

Doctors call for medevac to be saved, at parliament house this week.

Under the first six months of the medevac regime, 127 people were approved to come to Australia. Since medevac became law, there have been no deaths in offshore detention. The independent panel which reviews government vetos of medical transfers has agreed with the government most of the time.

With one week left for the government get it done before the end of the year, all eyes are on Jacqui Lambie. She’s said she’ll vote to repeal medevac, on one condition…


Lukas Coch / AAPIMAGE

…but has refused to reveal the condition, citing national security. Nine newspapers reported that she wants the government to secure third-country resettlement for the people remaining on Nauru and Manus, perhaps by taking up New Zealand’s offer.

What happens next? We’ll find out this week.

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