Do you wake up unrefreshed, reach straight for the coffee and constantly fight against falling asleep during the day? Perhaps you ask yourself, ‘why am I tired all the time?’ While it’s normal to have a dip in energy in the afternoon, it is not normal to be overwhelmed by a need to sleep and simply feel tired all the time. This is particularly important when fatigue interferes with normal activities, such as eating or driving.
Tiredness, fatigue and excessive daytime sleepiness will often need a careful history and examination by your local doctor to determine the cause. These can include lifestyle factors, medical disorders and sleep disorders that can affect both sleep quantity and quality.
Sleep quality and quantity.
Sleep quality and quantity are both important to feel refreshed. In the previous article on insomnia, I already mentioned things that can interfere with sleep such as caffeine and alcohol. In addition to avoiding these factors, a dark, quiet bedroom is best to prevent sleep quality being adversely affected by too much light and noise. Remember that sleep quality will suffer with too high a room temperature, so particularly in summer keep the bedroom cool, if you can.
Lifestyle factors.
In the 24-hour culture we live in, it is common to be very committed, including raising children, working full time, being available after hours and taking on extra activities. Hence the quantity of sleep may be the first to be sacrificed to fit it all in. In this case, it becomes important to know yourself. If you were to sleep uninterrupted, how much sleep do you really need in order to wake refreshed and not struggle through the day, tired and exhausted? Check to see if you are cutting this amount of time out of your sleep, so that you can take on extra activities. Most adults require between 7-9 hours of sleep per night. Less sleep can also occur in the setting of shift-work, as long shifts will often shorten the amount of time available for sleep as well as make it more difficult to sleep at times we are usually awake.
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Depression and feeling tired all the time.
Depression itself, which we will explore further in an upcoming article, can also lead you to feel tired all the time. This can be coupled with the lack of motivation and interruption to sleep, particularly waking early in the morning and being unable to go back to sleep. Depression partners with things like irritability and loss of enjoyment in normal activities, as well as feelings of hopelessness and isolation. If these feelings occur in the setting of insomnia, for longer than two weeks, always discuss them with your family doctor. The stigma around mental health is really being reduced now, and these conversations are always better to have than to remain suffering in silence.
Obstructive sleep apnoea syndrome.
Daytime sleepiness that affects the ability to stay awake while driving or operating equipment is always a concern. In obstructive sleep apnoea, the airway collapses during sleep and the resulting decrease in available oxygen, causes the brain to attempt to wake the person multiple times to restart their breathing. This results in an interrupted and lighter sleep pattern and excessive sleepiness during the day. Untreated, obstructive sleep apnoea syndrome can increase pressure on the heart, with increased risk of heart attacks and stroke. It is also associated with a higher risk of road accidents. The good news is that if sleep apnoea is detected and treated correctly, there is an increased quality of life for those affected. Risks for sleep apnoea include excess weight, large tongue, large neck circumference and snoring. Alcohol will often worsen the symptoms.
Other medical disorders that contribute to feeling tired all the time:
1. Restless legs syndrome.
Restless legs syndrome is an abnormal crawling sensation in the legs only relieved by moving them, which is often worse at night. On occasion this coincides with having an iron deficiency and can also be treated with medication.
2. Teeth grinding and sinus problems.
Other problems that interrupt sleep can be, having very bad allergies, hay-fever or grinding the teeth excessively during sleep (bruxism). Bruxism may be detected during routine dental check-up. It can result in jaw pain and headaches that will contribute to the feeling of being unrefreshed in the mornings.
3. Chronic pain.
Quality of sleep is also potentially impacted by chronic pain that could cause tossing and turning in bed, for example due to arthritis or other painful conditions.
4. Overnight urination needs.
Diabetes or prostate issues can lead to getting up to urinate multiple times overnight which will also interrupt sleep. These should be carefully excluded and managed together with your doctor so that you can achieve good quality sleep.
In the absence of any of these medical or sleep disorders, simple measures include not napping during the day so that you sleep well at night and going to bed when you are tired. Don’t sacrifice sleep for everything else. If you do feel tired all the time and wake unrefreshed, always get checked out with your trusted family doctor.
Author of this article:
Dr Tammra Warby is a General Practitioner with a PhD in Virology. She has worked in emergency medicine and general practice in chronic disease management including diabetes, paediatrics, mental health, preventative medicine, skin cancer checks and surgery. Tammra works at Foxwell Medical, and can be followed on Twitter.
