The Mystery Of My Endless Energy Reserves

Feeling tired is a common problem for many people, and there is no one-size-fits-all solution. While it might be tempting to blame a busy schedule or late nights, there could be a more serious underlying issue at play. For some, the problem could be a vitamin deficiency, while for others, it could be due to a sleep disorder, hormone imbalance, or even a medical condition such as anxiety or depression.

If you're tired all day but can't sleep at night, you may be experiencing insomnia, which is characterised by difficulty falling or staying asleep. This could be further exacerbated by poor sleep habits, such as excessive screen time or caffeine consumption close to bedtime. Additionally, certain medications and medical conditions can also interfere with sleep.

If you're struggling with tiredness, it's important to address the problem. Chronic insomnia has been linked to health issues such as obesity, high blood pressure, heart disease, diabetes, and depression.

Circadian rhythm

The circadian rhythm makes sure the body's processes perform optimally at different points during a 24-hour period. It tells your body when to sleep and when to wake up, and it also affects several other body processes, like hormones, digestion, and body temperature. The circadian rhythm is like an internal timekeeper for everything our bodies do in a 24-hour period.

The body's master clock is located in the brain and controls melatonin production. This hormone helps regulate sleep. During the day when it's light outside, melatonin levels remain low. Later in the day, as it grows darker, our bodies produce more melatonin, with levels peaking between 2 and 4 a.m. before falling again. Our bodies are best primed to fall asleep about 2 hours after melatonin levels start to rise.

Everybody has their own circadian rhythm, which, to some extent, is genetic. Maintaining your circadian rhythm is very important for your health. If you experience a circadian rhythm disruption and can't get an adequate amount of sleep, you may develop certain short-term and long-term health issues. Short-term disruptions may result in a delay in healing wounds, changes to your hormones, and fluctuations in your body temperature. Long-term disruptions can lead to health conditions in many different body systems, including the cardiovascular and gastrointestinal systems.

To reset your circadian rhythm, your body needs to follow a healthy 24-hour schedule. Try to stick to a daily routine, get some form of daily physical activity, and foster a restful sleep environment. Avoid caffeine, nicotine, and alcohol, especially in the evenings, and limit your screen time before bedtime, as the blue light can disrupt your ability to fall asleep.

Sleep disorders

Insomnia

Insomnia is characterised by difficulty falling or staying asleep, or experiencing non-restorative sleep, at least three nights a week for a duration of at least three months. It can be chronic or acute and may be a primary disorder or a symptom of another condition. Insomnia can manifest as trouble falling asleep, frequent awakenings during the night, or early morning awakenings. It is often treated with cognitive-behavioural therapy (CBT-I) and good sleep hygiene practices.

Delayed Sleep-Wake Phase Disorder

This disorder involves a misalignment between an individual's sleep-wake cycle and the external light-dark cycle. Those affected tend to have delayed sleep and wake timings, often falling asleep much later than what is considered normal and struggling to wake up in the morning. This disorder is relatively uncommon, affecting about 1% of adults.

Sleep Apnea

Sleep apnea is characterised by repeated pauses in breathing during sleep due to blocked airways. It can affect individuals of any size or gender and is not solely associated with obesity. Sleep apnea leads to disrupted sleep and excessive daytime sleepiness. Treatment options include lifestyle changes, oral appliances, or the use of a CPAP machine to maintain open airways during sleep.

Restless Legs Syndrome (RLS)

RLS causes uncomfortable sensations and an uncontrollable urge to move the legs, typically in the evening, making it difficult to fall asleep. It is associated with an increased risk of heart disease and depression, particularly in women. Treatment options include exercise, hot baths, leg massages, and medication to reduce symptoms.

Hormonal Influences

Fluctuating hormone levels can impact sleep by altering body temperature and anxiety levels, resulting in symptoms like hot flashes and night sweats. Good sleep hygiene practices, such as maintaining a cool and calm environment before bed, can help mitigate the impact of hormonal changes on sleep.

In addition to these specific disorders, other factors that can contribute to sleep disturbances include irregular sleep schedules, caffeine and alcohol consumption, large meals before bedtime, stress and anxiety, and poor sleep hygiene. Maintaining a consistent sleep schedule, limiting stimulating substances and activities before bed, and creating a relaxing bedtime routine can help improve sleep quality.

Hormones

Melatonin

The body's master clock, known as the suprachiasmatic nucleus (SCN), controls the production of melatonin, the hormone that helps regulate sleep. During the day, when it's light outside, melatonin levels remain low. As it gets darker, our bodies produce more melatonin, with levels typically peaking between 2 and 4 am. Our bodies are primed to fall asleep about two hours after melatonin levels start to rise. However, if your circadian rhythm is disrupted due to an irregular sleep schedule or other factors, you may miss this "Melatonin Window," making it difficult to fall asleep at night.

Cortisol

If you're feeling stressed or anxious before bed, it could be due to high levels of the hormone cortisol. This can prevent your body from winding down and drifting off, leaving you tired but unable to sleep. Cortisol can keep you in a state of alertness and heighten fight-or-flight responses, making it challenging to relax and fall asleep.

Menopause

For women going through menopause, hormonal changes can significantly impact sleep quality. Menopause is associated with night sweats and hot flashes, which can disrupt sleep and lead to daytime fatigue.

Thyroid Hormones

The thyroid gland produces hormones that help control how your body uses energy. When the thyroid gland is not functioning optimally, it can lead to fatigue. People with an underactive thyroid often experience tiredness due to sluggish cellular function and slower reflexes.

Other Medical Conditions

Hormonal imbalances associated with certain medical conditions can also contribute to sleep disturbances. For example, depression, which is linked to changes in serotonin levels, can affect sleep patterns and energy levels. Additionally, conditions like diabetes, congestive heart failure, and sleep apnea can impact sleep quality and contribute to daytime fatigue.

While hormones play a crucial role in sleep regulation, it's important to note that sleep hygiene, lifestyle factors, and other medical conditions can also influence your sleep. Maintaining a consistent sleep schedule, practising good sleep hygiene, and addressing any underlying health issues are essential steps in improving sleep quality and managing fatigue.

Medical conditions

There are several medical conditions that can cause insomnia or otherwise disrupt your sleep. Here are some of the most common ones:

Sleep Disorders

• Insomnia: Insomnia is a sleep disorder characterised by difficulty falling or staying asleep, even when you have the opportunity to sleep. It can manifest as trouble falling asleep at the start of the night, waking up in the middle of the night and struggling to fall back asleep, or waking up too early and being unable to fall back asleep. It can be chronic (lasting longer than three months) or acute (lasting less than three months).
• Sleep apnea: Sleep apnea is a condition where your airways close off during sleep, causing your body to wake you up to restart breathing. This can happen repeatedly throughout the night, disrupting your sleep. Sleep apnea is often associated with snoring, but not everyone who has sleep apnea snores, and not everyone who snores has sleep apnea. It can be caused by anatomical issues such as a narrow jaw or changes in muscle tone.
• Restless leg syndrome (RLS): RLS causes uncomfortable sensations in the legs and an uncontrollable urge to move them, typically in the evening, which disrupts sleep. It is often accompanied by a "creepy, crawly" feeling in the legs.

Mental Health Issues

• Depression: Depression is a common cause of sleep disturbances and is more prevalent in women than in men. People with depression may sleep more than usual, but their sleep is often non-restorative. Additionally, some antidepressants can interfere with sleep.
• Anxiety: Anxiety can also compromise sleep and is another common mental health issue that affects sleep. It can leave you feeling wired but tired at bedtime, with a racing mind that makes it difficult to fall asleep.
• Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is mentioned as a potential cause of sleep issues, but the source does not elaborate further.

Physical Health Issues

• Chronic illnesses: Conditions such as Alzheimer's disease, chronic kidney disease, chronic obstructive pulmonary disease (COPD), multiple sclerosis (MS), rheumatoid arthritis (RA), ulcerative colitis, bipolar disorder, type 2 diabetes, and geographic atrophy are mentioned as potential contributors to sleep disturbances.
• COVID-19 and long COVID: Sleep difficulties may be more prevalent in people with long COVID. Even in the short term, COVID-19 can cause sleep issues due to factors such as stress or an autoimmune response to the virus.
• Pain and physical discomfort: Arthritis aches and other types of pain can interfere with sleep. Poor sleep can also increase your sensitivity to pain, creating a cycle of disrupted sleep and increased pain.
• Hormonal imbalances: Fluctuating hormones can change your body temperature and anxiety levels and cause symptoms like hot flashes or night sweats, all of which can disrupt sleep.
• Nutritional deficiencies: Vitamin deficiencies, for example, can lead to feelings of tiredness and fatigue.

Sleep hygiene

Set a Strict Sleep Schedule

• Maintain a fixed wake-up time: Try to wake up at the same time every day, including weekends. This helps to normalise sleep as an essential part of your day and gets your body accustomed to a consistent sleep schedule.
• Prioritise sleep: Avoid sacrificing sleep for other activities like work, studying, socialising, or exercise. Calculate your target bedtime based on your fixed wake-up time and stick to it as much as possible.
• Make gradual adjustments: If you need to shift your sleep times, do it gradually. Adjust your sleep schedule by an hour or two each day until you reach your desired bedtime.
• Limit naps: Naps can disrupt your nighttime sleep. Keep them short, preferably in the early afternoon, to avoid affecting your nighttime sleep.

Follow a Nightly Routine

• Keep your routine consistent: Follow the same steps every night to reinforce the mental association between your routine and bedtime. This can include activities like putting on pyjamas, brushing your teeth, or reading.
• Wind down for 30 minutes: Engage in calming activities like soft music, light stretching, reading, or relaxation exercises to prepare your mind and body for sleep.
• Dim the lights: Bright lights hinder melatonin production, a hormone that facilitates sleep. Dim the lights or use low lighting during your bedtime routine.
• Unplug from electronics: Put away electronic devices like phones, tablets, and laptops at least 30 minutes before bedtime. These devices stimulate your mind and emit blue light, which suppresses melatonin production.
• Practice relaxation techniques: Instead of forcing yourself to fall asleep, focus on relaxation. Try meditation, mindfulness, paced breathing, or other techniques to calm your mind and body.
• Get up if you can't sleep: If you can't fall asleep within 20 minutes, get up and do something calming in low light, like stretching or reading. This helps reinforce the mental association between your bed and sleep.

Cultivate Healthy Daily Habits

• Get daylight exposure: Sunlight is a key driver of circadian rhythms, which regulate your sleep. Get natural light exposure during the day, especially in the morning, to promote better sleep at night.
• Be physically active: Regular exercise improves sleep quality and has additional health benefits. Just avoid intense exercise too close to bedtime, as it may energise you and make it harder to fall asleep.
• Avoid nicotine: Nicotine is a stimulant that disrupts sleep. If you smoke, consider quitting or reducing your consumption, especially closer to bedtime.
• Reduce alcohol consumption: While alcohol may make you sleepy, it can disrupt your sleep later in the night. Avoid drinking alcohol, especially within 3-4 hours of bedtime, for more restful sleep.
• Limit caffeine intake: Caffeine is a stimulant that can keep you wired, even when you want to rest. Avoid caffeine in the afternoon and evening, and finish your last caffeinated beverage at least 12 hours before bedtime.
• Eat dinner early: Eating late can disrupt your sleep schedule and cause digestive issues. Finish dinner at least 2-3 hours before bedtime, and opt for a light, healthy snack if you need to eat closer to bedtime.
• Restrict in-bed activities: Reserve your bed for sleep and sex. This helps strengthen the mental association between your bed and sleep, making it easier to fall asleep.

Optimise Your Bedroom

• Comfortable mattress and pillow: Choose a mattress and pillow that provide comfort and support to ensure pain-free sleep.
• Use comfortable bedding: Select sheets and blankets that match your preferences to create a cosy sleep environment.
• Set a cool temperature: Keep your bedroom on the cooler side, around 65°F (18.3°C). A slightly cooler temperature can help you fall asleep more easily.
• Block out light: Use heavy curtains or an eye mask to prevent light from interrupting your sleep.
• Drown out noise: Use earplugs, a white noise machine, or a fan to block out noise disturbances and create a quiet sleep environment.
• Try calming scents: Scents like lavender may induce a sense of calm and help create a relaxing atmosphere in your bedroom.

Frequently asked questions