Fighting Sleep: Understanding Your Body's Tiredness

Feeling tired but not wanting to sleep is a common experience, and there are several reasons why this might be the case. One reason could be poor sleep hygiene, which includes factors such as insufficient natural light exposure during the day, excessive screen time before bed, and consuming caffeine, alcohol, or a large meal too close to bedtime. Another reason could be a disruption in your circadian rhythm or body clock, which can occur due to an irregular sleep schedule. Additionally, underlying sleep disorders like insomnia, restless leg syndrome, or sleep apnea could be contributing factors. Hormonal changes, medical conditions such as anxiety and depression, and stress can also impact your sleep. To improve your sleep, it's recommended to maintain a consistent sleep schedule, improve sleep hygiene, and seek professional help if necessary.

Circadian rhythm issues

Your body tries to align your sleep-wake cycle with cues from the environment, such as when it gets light or dark outside, when you eat, and when you are physically active. When your sleep-wake cycle is out of sync with your environment, you may experience insomnia, have difficulty sleeping, and the quality of your sleep may be poor. Disruptions of your sleep-wake cycle that interfere with daily activities may mean that you have a circadian rhythm disorder.

Circadian rhythm disorders can be temporary and caused by your sleep habits, job, or travel. Or they can be long-term and caused by ageing, your genes, or a medical condition. You may have symptoms such as extreme daytime sleepiness, decreased alertness, and problems with memory and decision-making.

Causes of Circadian Rhythm Disorders

Circadian rhythm disorders can be caused by:

• Brain damage or disruptions in brain activity, including degenerative brain diseases, head injuries and infections that cause encephalitis.
• Vision impairments. The suprachiasmatic nucleus (SCN) in the brain, which controls the production of the sleep hormone melatonin, has a direct connection to your eyes. That’s why daylight is a key set point for our sleep-wake cycle.
• Travel. Jet lag is a key circadian rhythm disorder that happens when we travel faster than our bodies can adjust.
• Work. People who work night shifts or changing shifts may experience circadian rhythm disorders because of the change.

Treatment for Circadian Rhythm Disorders

Circadian rhythm disorders can be treated through:

• Adjusting your lighting.
• Taking supplemental melatonin or medications that work similarly, after talking with your healthcare provider.
• Adjusting sleep-related behaviours, such as setting and keeping a consistent sleep schedule, gradually moving your bedtime, making time to get enough sleep, and having a bedtime routine.
• Adjusting your meal times. Eating meals at later times can shift your circadian rhythm later, while eating breakfast upon waking and avoiding late dinners can help shift your circadian rhythm earlier.
• Limiting alcohol and caffeine intake.
• Avoiding exercise too late in the day.
• Reducing artificial light exposure, especially blue light, in the hours before bed.

Sleep disorders

Other common sleep disorders include:

• Sleep apnea: A breathing disorder characterised by pauses in breathing during sleep, often causing snoring or choking sounds.
• Restless leg syndrome (RLS): Involving a tingling or prickly sensation in the legs, along with a powerful urge to move them.
• Hypersomnia: Being unable to stay awake during the day, including narcolepsy, which causes extreme daytime sleepiness.
• Circadian rhythm disorders: Problems with the sleep-wake cycle, making it difficult to sleep and wake at the right times.
• Parasomnia: Unusual behaviours during sleep, such as walking, talking, or eating.

Consequences of sleep disorders can include fatigue, decreased energy, irritability, problems with focus and mood, and an increased risk of chronic health issues such as heart disease, diabetes, and obesity.

Treatment options depend on the specific disorder and may include good sleep habits, cognitive behavioural therapy, relaxation techniques, medical devices, light therapy, and medications.

Hormones

The thyroid gland plays an important role in hormone production, and issues with the thyroid can cause health issues, including tiredness and poor sleep. The hormones produced by your thyroid help control your metabolism. There are two primary conditions associated with thyroid function:

• Hypothyroidism (underactive thyroid) – The thyroid does not make enough of the hormones to control metabolism. Body processes slow down, causing symptoms like fatigue, depression, and memory problems.
• Hyperthyroidism (overactive thyroid) – The thyroid makes too much of the hormone to control metabolism. Body processes speed up, causing symptoms like anxiety, restlessness, and sleep problems.

Cortisol is often called the "stress hormone" because it is responsible for modulating the body's stress response, both long-term and daily. When the body is not functioning as it should, cortisol can spike at the wrong time, causing sleep difficulty, which leads to fatigue. Long-term stress can also affect the adrenal glands. When your adrenals are fatigued, your cortisol can become depleted, which leads to chronic fatigue.

Serotonin is a neurotransmitter that controls the sleep and waking cycle and helps keep us happy and energised. Serotonin levels can be maintained through a diet that includes foods containing tryptophan. Abnormal serotonin levels may also cause sleeping problems. Research has found a direct link between low serotonin levels, poor sleep, and depression. If we don't get proper sleep, our body might not produce enough serotonin, which can leave us feeling tired and low in mood the next day.

Oestrogen is the main sex hormone for women and plays a huge role in the female body as it promotes the growth and maintenance of female reproductive organs. Poor use of serotonin due to low levels of oestrogen may cause poor or disrupted sleep, thus making you more tired the next day. Menopausal women can suffer from low energy as a result of falling oestrogen levels.

Progesterone is also an important sex hormone. It is a crucial hormone in pregnancy as it prepares the body for labour. Progesterone is also a muscle relaxant and can aid the production of gamma-aminobutyric acid (GABA), which can promote sleep. Progesterone levels tend to be highest towards the end of your menstrual cycle, leading to increased GABA production. This may help you get better sleep, which can help boost your energy levels. However, at the beginning of your cycle, your progesterone levels decrease and produce less GABA, which may make you feel more tired and less energetic.

Testosterone is a sex hormone produced by both males and females; however, men produce more of this hormone than women. Testosterone plays a key role in the reproductive system for both sexes, and it also helps improve muscle and bone mass in males. From the age of 30, testosterone levels in males gradually decrease as a result of ageing. Research has linked low levels of testosterone to tiredness and sleep disturbance.

Medical conditions

Feeling tired but unable to sleep could be a result of various medical conditions. Here are some possible health-related reasons:

Sleep Disorders

Sleep disorders such as insomnia, sleep apnea, and restless leg syndrome can leave you feeling tired during the day and disrupt your sleep at night. Insomnia, characterised by difficulty falling or staying asleep, can be caused by stress, menopause, medical conditions, psychological factors, poor sleep environments, or excessive mental stimulation. Sleep apnea involves temporary pauses in breathing during sleep, leading to frequent awakenings. Restless leg syndrome causes an irresistible urge to move your legs due to uncomfortable sensations. These conditions can impact your sleep quality and leave you feeling exhausted.

Circadian Rhythm Disorders

Your internal body clock, or circadian rhythm, regulates your sleep-wake cycle. When this rhythm is disrupted, it can lead to feelings of fatigue and sleep disturbances. Delayed sleep phase disorder is one such condition, where individuals are unable to fall asleep at a typical time and experience difficulty maintaining a normal sleep schedule. This disorder is more prevalent in teenagers but can affect adults as well.

Mental Health Issues

Mental health conditions such as depression, anxiety, and ADHD can contribute to sleep disturbances and daytime fatigue. These issues can impact your mood, energy levels, and ability to handle stress. Addressing these underlying mental health concerns is crucial for improving sleep and overall well-being.

Chronic Conditions

Chronic health conditions, including Alzheimer's disease, chronic kidney disease, chronic obstructive pulmonary disease (COPD), multiple sclerosis (MS), rheumatoid arthritis (RA), and type 2 diabetes, can also affect sleep patterns and energy levels. Managing these conditions effectively is essential for optimising sleep and reducing fatigue.

Other Medical Conditions

Other medical issues, such as nutritional deficiencies, obesity, and shift work sleep disorder, can also play a role in feeling tired but unable to sleep. Nutritional deficiencies in specific vitamins and minerals can lead to fatigue, even if you're getting sufficient sleep. Obesity increases the risk of sleep apnea, contributing to daytime fatigue. Shift work that disrupts your natural sleep-wake cycle can result in sleep deprivation and fatigue.

Poor sleep hygiene

• Inconsistent sleep schedules: Going to bed and waking up at different times each day can disrupt your body's natural sleep-wake cycle.
• Use of stimulants: Consuming caffeine, nicotine, or alcohol, especially close to bedtime, can interfere with your sleep.
• Inadequate sleep environment: A bedroom that is too bright, noisy, or uncomfortable can make it difficult to fall asleep and stay asleep.
• Lack of relaxing bedtime routine: Engaging in stimulating activities or using electronic devices before bed can make it hard to wind down and fall asleep.
• Poor daily habits: Lack of physical activity, excessive screen time, and irregular eating habits can negatively affect your sleep.

To improve your sleep hygiene, consider the following:

• Stick to a consistent sleep schedule, even on weekends.
• Create a relaxing bedtime routine and avoid stimulating activities before bed.
• Optimize your bedroom environment by minimizing light and noise, and ensuring a comfortable temperature.
• Limit caffeine, nicotine, and alcohol consumption, especially close to bedtime.
• Incorporate physical activity and healthy eating habits into your daily routine.

Frequently asked questions