Did you know that if you type into Google, "why am I so......", that the first autofill option is the word "tired". This is really saying something about how common the experience of tiredness is, and how many people are concerned about their levels of tiredness.
Thinking about your experience with tiredness, which of the following do you think apply? Are there others not listed here?
Debilitating tiredness, that goes on week after week, on the other hand, may indicate an underlying issue that needs addressing. Tiredness can be a complicated beast and the reasons for chronic and debilitating tiredness are numerous. While the focus is on sleep in this post, it is important to emphasise that sleep is just one reason for tiredness. Often, tired patients that we see see are indeed sleeping poorly, but they have other factors at play (see list above) contributing to their daytime fatigue. There are (at least) three broad presentations of tiredness that we see at Sleep Matters:
Those that undervalue sleep: When poor sleep is a factor causing tiredness, it may be that the person isn't getting enough sleep because they live a very busy life, full of demands from work, family, hobbies etc. These people may be prone to burning the candle at both ends in order to fit everything in. Sleep may be seen as unproductive, wasteful time. Over time the lack of sleep catches up with them, leading to tiredness, reduced productivity, ill health, and or difficulties with mood. Stress can also be a large factor resulting in fatigue. Reliance on stimulants such as caffeine during the day, and sedatives such as alcohol or sleeping pills at night can become part of the picture (these are short term fixes that can make things worse in the longer term). For this grouping, stress management and coming to respect sleep as an important promoter of health is important.
Those that overvalue sleep: A second group of people we see also have poor sleep that leads to tiredness, but for them the reverse of the above is true. For these people sleep has a value close to diamonds and gold. They are trying everything they can to learn about sleep and how to get more of it. They may have rigid rituals around sleep, they may be examining their night's sleep on waking each morning, monitoring it with a fitness tracker, planning their day based on how well they slept, and planning their evening so that sleep-spoiling activities are avoided. The poor sleep is in control and is robbing the person of their life. Life becomes about i) how to get more sleep and ii) how to mange on inadequate sleep. This is Insomnia. It can feel like scraping through life and dreading bed time. The anxiety about poor sleep and tiredness is a major driver keeping the sleep disturbance going. Our aim is to assist people with insomnia to re-learn how to sleep and to trust that sound sleep is possible. This is balanced with assisting people to reduce anxiety about poor sleep and tiredness so that re-engagement with life can occur.
The case of excessive daytime sleepiness: The final grouping are those patients who sleep well, indeed they may sleep very well, up to 9 or more hours a night. But unfortunately, their daytime fatigue remains. Disorders of excessive daytime sleepiness (eg. hypersomnia and chronic fatigue) can actually be worsened by too much rest and sleep. When people become inactive for long periods (months or years), muscles can weaken, stamina and fitness reduce, mood and motivation can reduce, and anxiety about activity can result. Of course each case is unique, and care must be taken to identify and treat any underlying conditions, but as a general rule, for this group an important goal is to gently work towards sustainable increases in activity levels.
Do you feel you fit into one of these groups?