Feeling tired? Do others tell you to just get over it?

Why am I so tired?Feeling tired is pretty common. In fact, recent research has shown that around 15% of the population report feeling tired. In people of working age there is a relationship between hours of work, and feeling tired, but people who don’t work can also feel tired, so work hours are not the only cause of tiredness.  For people who are very significantly affected by tiredness it can be frustrating. Most people feel tired at some point and they will give advice to people such as, “just get more sleep” or “look after yourself” when in fact the tiredness may be a manifestation of an underlying sleep disorder or other medical problem.

What’s making me feel tired?

There are many things that can contribute to feeling tired. Sometimes it is a problem with sleep itself, either not enough sleep or a sleep disorder. However, sleep itself only accounts for part of what makes us tired.  Interestingly, a lot of people I see with sleep problems feel that if only their sleep problems were resolved they would not have any tiredness at all and their energy levels would be normal.  However, a lot of other factors impact on our energy levels and tiredness such as:

  • Fitness
  • Nutrition
  • Weight
  • Chronic medical problems
  • Medications
  • Depression or anxiety

I often see people who are focused on improving their sleep but not paying attention to these other factors.  There is increasing research showing that addressing these other factors can reduce the impact of tiredness and the degree of tiredness symptoms even if people have ongoing sleep problems.

Tiredness or sleepiness? They not the same.

Why am I so tired?An important concept with tiredness is to try to differentiate the feeling of tiredness from sleepiness.  There is obviously a lot of overlap between these two things but think of sleepiness as heavy eyelids or the head nodding or a feeling of about to fall asleep.  That’s different from tiredness where you may feel as you’re lacking energy or motivation or feel that you can’t do anything more.  Differentiating these two symptoms is important because they have different causes and different treatments.  In general, people with sleepiness, that is falling asleep uncontrollably, need to make sure they’re getting enough sleep each night, and if they are, need to discuss their symptoms with their health professional. If causes for sleepiness aren’t obvious, referral to sleep physician should be considered to look for sleep disorders that may be contributing to symptoms of sleepiness. Whereas tiredness is less likely to be due to a sleep disorder, and more likely to be a part of other medical conditions. Lifestyle factors can also contribute to people feeling tired.

How does a sleep physician assess people who are feeling tired?

My general approach in assessing people with tiredness is to not focus just on sleep but look at other factors such as lifestyle, physical and mental health problems and medications that people may be taking.  If after looking at all these factors there are ongoing symptoms of tiredness I will usually do a sleep study to look at sleep quality and exclude other sleep disorders such as a problem with breathing during sleep (sleep apnea) or movements during sleep such as periodic limb movements. Other conditions such as circadian rhythm disorders or hypersomnias such as narcolepsy or idiopathic hypersomnia can also cause sleepiness.

What can be done to reduce tiredness?

To help to optimise energy levels and reduce the impact of sleepiness it is important to focus on a broad approach:

  • Lifestyle factors: How we live day to day and approach life has a significant impact on our energy levels.  Taking this broader or more wellness-based approach to managing energy levels is one of the key things that often people have not addressed and can make a significant difference to peoples’ symptoms.
  • Ensure physical and mental health are good:  As we get older, many of us accumulate other medical conditions that can impact on our energy levels.  Ensuring these are well controlled and not affecting us significantly is important in feeling our best.
  • Thinking and behaviour around sleep: Once people begin to feel tired they can start to think about sleep differently and behave differently around sleep.  People can spend too much time in bed or become anxious that they are not getting enough sleep as they see sleep as the cause of their tiredness.  This can evolve into an anxiety about sleep or becoming obsessed with sleep. It’s important to recognise this and work on it, usually with a health professional such as a sleep physician or psychologist experienced in managing sleep problems.
  • Check for sleep disorders: This generally involves seeing a specialist in sleep such as a sleep physician and having a clinical assessment of symptoms and then a sleep study to look at what might be happening during sleep. Note: Not all sleep studies are the same. Some home-based sleep studies are simpler and set up to screen only for sleep apnea.  However, if tiredness is your predominant symptom and it is not clear what is causing tiredness, a more comprehensive sleep study such as a hospital or laboratory-based sleep study that measures sleep patterns in more detail is what is needed together with a clinical assessment by a sleep physician.

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