Sleep-Deprived But Not Tired: What's The Reason?

Feeling tired but unable to fall asleep can be frustrating and impact your daily life. There are many reasons why you might be experiencing this, such as an irregular sleep schedule, high cortisol levels due to stress, or poor sleep hygiene.

Your body's internal clock, or circadian rhythm, plays a crucial role in regulating sleep. An inconsistent sleep schedule can disrupt this rhythm, making it difficult to fall asleep at night and leaving you tired during the day.

Stress and anxiety can also impact your sleep. When you're stressed, your body may produce high levels of the hormone cortisol, which can keep you alert and make it hard to relax. Additionally, screens, caffeine, alcohol, and late meals can interfere with your sleep, and certain sleep disorders or medical conditions may be the root cause.

If you're struggling with sleep, consider improving your sleep hygiene by reducing screen time before bed, limiting caffeine and alcohol intake, and maintaining a consistent sleep schedule. If issues persist, consult a healthcare professional for guidance.

Circadian rhythm disorders

There are six types of circadian rhythm sleep disorders:

• Delayed sleep-wake phase disorder: People with this condition go to sleep and wake up much later than normal, often interfering with work or school.
• Advanced sleep-wake phase disorder: This is when a person goes to sleep and wakes up much earlier than normal, struggling to stay awake in the early evening.
• Irregular sleep-wake rhythm disorder: This disorder is characterised by a chaotic sleep schedule that lacks a clear pattern. People with this condition experience several short periods of sleep and wakefulness throughout the day and night.
• Non-24-hour sleep-wake rhythm disorder: This disorder occurs when a person's circadian rhythm extends beyond the regular 24-hour cycle, resulting in bedtimes and wake-up times shifting later each day.
• Shift work sleep disorder: This affects people who work night shifts or rotating schedules, leading to disrupted sleep and extreme tiredness.
• Jet lag: Jet lag occurs when travelling across multiple time zones, causing a person's circadian rhythm to temporarily fall out of sync with the new time zone.

If you suspect you have a circadian rhythm disorder, it is important to consult a doctor for diagnosis and treatment. Treatment options may include bright light exposure, maintaining a regular sleep-wake schedule, melatonin supplements, caffeine or other stimulants, light avoidance, strategic napping, and safety practices to prevent accidents during periods of excessive sleepiness.

Sleep apnea

Symptoms

The symptoms of sleep apnea mainly occur while you sleep:

• Breathing stopping and starting
• Making gasping, snorting, or choking noises

During the day, you may also experience the following:

• Difficulty concentrating
• Headaches when you wake up
• Extreme fatigue

Diagnosis

Treatment

Other treatments for sleep apnea include:

• A mandibular advancement device, similar to a gum shield, that holds your airways open while you sleep
• Surgery to improve breathing, such as removing large tonsils

Restless leg syndrome

RLS causes sleep problems due to the difficulty it causes in getting to sleep. Severe daytime fatigue can also be a problem. The cause of RLS is unknown, but some cases are believed to be inherited, and others have been linked to nerve damage in the legs from diabetes, kidney problems, iron deficiency, certain medications, pregnancy, sleep disorders, and alcoholism.

The sensations of RLS occur when you lie down or sit for a prolonged period. This can cause a need to move the legs for temporary relief by stretching, bending, tossing and turning in bed, or getting up and pacing. Symptoms often worsen when lying down, especially when trying to fall asleep at night, and tend to be most uncomfortable late in the day and at night.

RLS is usually diagnosed based on signs and symptoms, a complete medical history, and a physical exam. There is currently no definitive test for RLS, but lab tests or a sleep study may be done. Treatment options include good sleep habits, stopping activities that worsen symptoms, giving up caffeine, alcohol, and tobacco, regular moderate exercise, a well-balanced diet, and treating underlying chronic conditions.

Insomnia

Symptoms of Insomnia

• Difficulty falling asleep
• Waking up in the middle of the night
• Waking up too early in the morning
• Feeling tired, unwell or sleepy
• Delayed responses
• Trouble remembering things
• Slowed thought processes, confusion or trouble concentrating
• Mood disruptions, especially anxiety, depression and irritability
• Other disruptions in work, social activities, hobbies or routine activities

Causes of Insomnia

The exact causes of insomnia are not fully understood, but it is believed that a variety of factors could contribute to the condition, including:

• Family history and genetics
• Brain activity differences
• Medical conditions, such as acid reflux or Parkinson's disease
• Mental health conditions, such as anxiety or depression
• Stressful or difficult life circumstances
• Life changes, such as jet lag, sleeping in an unfamiliar place or adjusting to a new work schedule
• Sleep habits, such as napping, caffeine consumption and sleep schedule

Treatment of Insomnia

There are several ways to treat insomnia, ranging from simple lifestyle changes to medications and mental health options. Some recommended treatments include:

• Developing and practicing good sleep habits
• Medications that help induce sleep, such as sedative or hypnotic drugs, mental health medications, herbs and supplements
• Cognitive behavioural therapy or relaxation techniques to reduce anxiety
• Bright light therapy
• Natural products, such as melatonin

Caffeine and alcohol consumption

Firstly, caffeine blocks adenosine receptors in the brain. Adenosine is a crucial chemical in the sleep-wake cycle, increasing when one is awake and decreasing during sleep. By blocking these receptors, caffeine prevents adenosine from causing sleepiness. However, once the body fully metabolizes the caffeine, adenosine molecules can bind to the receptors again, resulting in a sudden increase in sleepiness.

Secondly, regular caffeine consumers can develop a tolerance, leading to a need for higher doses to achieve the same stimulating effects. This increased tolerance can negatively impact sleep, creating a cycle of tiredness despite caffeine consumption. Additionally, caffeine intake close to bedtime can disrupt sleep, with studies suggesting that even consumption six hours before bedtime can affect sleep quality.

Furthermore, caffeine acts as a diuretic, increasing urine output and potentially leading to dehydration. Dehydration can cause fatigue and sluggishness, with cardiovascular effects such as increased heart rate and reduced blood pressure. This may further contribute to feelings of tiredness.

On the other hand, alcohol is known to disrupt sleep patterns and quality. While it may help individuals fall asleep initially, it often leads to disrupted sleep during the night. Alcohol can interfere with the body's natural sleep cycles, reducing restorative sleep and causing individuals to wake up tired, even after a full night's rest.

Additionally, alcohol can exacerbate existing sleep disorders, such as sleep apnea and snoring. It relaxes the muscles in the throat, which can block the airway and lead to snoring and breathing interruptions. This disruption can result in non-restorative sleep, leaving individuals feeling tired upon waking.

To improve sleep quality and reduce the impact of caffeine and alcohol consumption, it is recommended to limit caffeine intake to 400 milligrams per day and avoid consumption within six hours of bedtime. For alcohol, moderating intake and avoiding it close to bedtime can help minimize its disruptive effects on sleep.

Frequently asked questions