Daytime Tiredness Keeping You Up At Night?

Feeling tired but unable to sleep is a common issue that affects many people. This phenomenon can be attributed to a complex interplay of physiological and psychological factors. Understanding the underlying causes is essential for finding effective solutions to improve sleep quality and overall well-being. Here are some key reasons why you might be unable to sleep despite being tired throughout the day.

Circadian rhythm disturbances

Circadian rhythm disorders, also known as sleep-wake cycle disorders, occur when your body's internal clock, which tells you when it's time to sleep or wake, is out of sync with your environment. This internal clock, called the circadian clock, cycles about every 24 hours, and these repeating 24-hour cycles are called the circadian rhythm.

Your body tries to align your sleep-wake cycle with cues from the environment, such as light and darkness, your eating patterns, and your physical activity. When your sleep-wake cycle is out of sync with these environmental cues, you may experience difficulty sleeping, and the quality of your sleep may be poor. Disruptions in your sleep patterns can be temporary, caused by factors such as your sleep habits, job, or travel. They can also be long-term, caused by ageing, your genes, or a medical condition.

There are several types of circadian rhythm disorders, including advanced or delayed sleep-wake phase disorder, irregular or non-24-hour sleep-wake rhythm disorder, and shift work or jet lag disorder.

Advanced sleep-wake phase disorder (ASWPD) can make it very difficult to stay awake in the early evening, resulting in you waking up too early in the morning. This can interfere with your daily responsibilities and commitments. Delayed sleep-wake phase disorder (DSWPD) is one of the most common circadian rhythm disorders. With DSWPD, you may fall asleep later than you would like and then find it challenging to wake up on time the next morning. This can lead to getting too little sleep and subsequent daytime tiredness or anxiety.

Irregular sleep-wake rhythm disorder (ISWRD) involves having several short periods of sleep and wakefulness throughout the day and night. You may be unable to sleep at night and end up taking multiple naps during the day due to excessive sleepiness. Non-24-hour sleep-wake rhythm disorder occurs when your sleep-wake rhythm is not in sync with the 24-hour day. As a result, your sleep times may gradually become more delayed, and you may find yourself going to sleep much later than the usual nighttime hours.

Shift work disorder affects those who work during the night or on rotating schedules. Due to your work schedule, you may not be able to get uninterrupted quality sleep when your body needs it. This can cause insomnia, extreme tiredness, and sleepiness while working at night.

Circadian rhythm disorders can be treated with external stimulus therapies, such as bright light therapy or chronotherapy, a behavioural technique where bedtime is gradually adjusted to achieve the desired bedtime. Bright light therapy aims to reset the patient's circadian rhythm to a desired pattern.

Poor sleep hygiene

Signs of poor sleep hygiene include having trouble falling asleep, experiencing frequent sleep disturbances, and feeling sleepy during the day. An overall lack of consistency in the amount and quality of sleep can also be symptomatic of poor sleep hygiene.

Optimise your sleep schedule

• Maintain a fixed wake-up time: Try to wake up at the same time every day, even on weekends. A fluctuating schedule disrupts your body's sleep rhythm.
• Prioritise sleep: Avoid skipping sleep to work, study, socialise, or exercise. Calculate a target bedtime based on your wake-up time and prepare for bed around that time each night.
• Make gradual adjustments: If you want to change your sleep times, do so gradually, in small steps, to give your body time to adjust to a new schedule.
• Limit naps: While naps can be energising, they can also disrupt your night-time sleep. Keep naps short and in the early afternoon.

Follow a nightly routine

• Keep your routine consistent: Following the same steps each night, such as putting on pyjamas and brushing your teeth, reinforces the idea that it is bedtime.
• Wind down for 30 minutes: Engage in activities that calm you, such as soft music, light stretching, reading, or relaxation exercises.
• Dim the lights: Bright lights hinder melatonin production, a hormone that facilitates sleep.
• Unplug from electronics: Blue light from devices decreases melatonin production, so avoid screens for 30-60 minutes before bed.
• Try relaxation techniques: Focus on relaxation rather than sleep. Techniques like meditation, mindfulness, and paced breathing can help you unwind.
• Get up if you can't sleep: If you haven't fallen asleep after 20 minutes, get up and do something calming in low light, like reading or stretching, before trying again.

Cultivate healthy daily habits

• Get daylight exposure: Sunlight is a key driver of circadian rhythms, which encourage quality sleep.
• Exercise regularly: This makes it easier to sleep and has other health benefits.
• Don't smoke: Nicotine disrupts sleep.
• Reduce alcohol consumption: While alcohol may make you sleepy, it can disrupt sleep later in the night.
• Cut down on caffeine: Caffeine is a stimulant that can keep you wired, so avoid it in the afternoon and evening.
• Avoid late dinners: Eating late, especially heavy or spicy meals, can disrupt sleep as your body is still digesting. Keep any pre-bed snacks light.
• Restrict in-bed activity: Only use your bed for sleep and sex to build a mental association between bed and sleep.

Optimise your bedroom

• Comfortable mattress and pillow: Your sleeping surface is critical for comfort and pain-free sleep.
• Use comfortable bedding: Sheets and blankets are the first things you touch when you get into bed, so choose ones that suit your preferences.
• Set a cool temperature: A cooler temperature (around 65°F or 18.3°C) is ideal for sleep.
• 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 bothersome sounds.
• Try calming scents: Light smells like lavender may induce a calmer state of mind and help create a positive space for sleep.

Environmental factors

• Noise and Light Pollution: Unwanted noise, such as a snoring partner, a baby's cries, noisy neighbours, or external sounds like traffic or alarms, can interrupt your sleep. Similarly, excessive light exposure, whether from bright streetlights or electronic devices like phones and TVs, can disrupt your sleep by suppressing melatonin production and altering your circadian rhythm.
• Temperature and Comfort: An uncomfortable sleeping environment, whether too hot or too cold, can affect your sleep quality. Ensuring a cool, dark, and quiet bedroom can improve sleep.
• Air Quality: Air pollution, including vehicular traffic noise and ambient air pollution, can contribute to sleep disorders like sleep apnea and insomnia. Proximity to busy roads or areas with high air pollution can increase your exposure to these pollutants, disrupting sleep.
• Social Cohesion and Safety: The social environment of your neighbourhood can impact your sleep. Living in areas with high social cohesion, safety concerns, violence, or disorder may be associated with reduced sleep duration and increased daytime sleepiness.
• Physical Neighbourhood Features: The physical characteristics of your neighbourhood, such as walkability, green spaces, and recreational facilities, can also influence your sleep. For example, living in areas with more destinations and higher population density can promote walking, which is beneficial for health, but may also increase exposure to noise, traffic, and light pollution, disrupting sleep.
• Diet: What you eat and drink before bed can impact your sleep. Consuming large meals, excessive fluids, caffeine, or alcohol close to bedtime can cause discomfort and increase the likelihood of sleep disruptions.

Medical conditions

There are a number of medical conditions that can cause tiredness during the day and sleep disturbances at night.

Sleep Disorders

Sleep disorders are a common cause of tiredness during the day. These include:

• Sleep apnea: A disorder that causes you to stop breathing temporarily while asleep, leading to feelings of exhaustion.
• Restless legs syndrome (RLS): This disorder leads to feelings of fogginess and can cause insomnia.
• Insomnia: A condition characterised by difficulty falling or staying asleep.
• Narcolepsy: A disorder that causes extreme sleepiness during the day and may lead to sudden sleep.
• REM sleep behaviour disorder: This disorder involves acting out dreams through talking, walking or swinging your arms while asleep.
• Idiopathic hypersomnia: A sleep disorder characterised by excessive nighttime sleeping and daytime napping.

Environmental Factors

Environmental factors such as a snoring partner, a noisy neighbourhood, or an uncomfortable mattress can also disrupt sleep and lead to tiredness during the day. Additionally, consuming caffeine or alcohol close to bedtime can negatively impact sleep quality.

Various medical conditions can contribute to tiredness and sleep disturbances. These include:

• Hypothyroidism (underactive thyroid): This condition slows down the metabolism and can lead to constant fatigue.
• Chronic kidney disease
• Chronic obstructive pulmonary disease (COPD)
• Multiple sclerosis (MS)
• Rheumatoid arthritis (RA)
• Fibromyalgia: A condition characterised by chronic fatigue, deep muscle pain, painful tender points, sleep problems, anxiety, and depression.
• Anemia: A blood condition that can lead to constant tiredness and is often associated with heavy menstrual cycles, uterine fibroids, or uterine polyps.
• Heart disease
• Lung disease
• Viral or bacterial infections
• Cancer
• Depression and anxiety: Mental health conditions that can impact sleep quality and contribute to tiredness.
• Chronic fatigue syndrome: A separate condition from fibromyalgia but with a shared symptom of severe fatigue.

Dietary Factors

Dietary factors can also play a role in tiredness and sleep disturbances. Nutrient deficiencies, such as a lack of riboflavin (vitamin B2), pantothenic acid (vitamin B5), or pyridoxine (vitamin B6), can lead to exhaustion. Additionally, diets high in ultra-processed foods, added sugars, and saturated fats can impair energy levels and sleep quality.

Mental health conditions

Anxiety can also lead to increased arousal and alertness, which can delay sleep. Sleep disturbance is a diagnostic symptom for some anxiety disorders, which are common risk factors for insomnia. Constant feelings of exhaustion may also be a sign of anemia, and a full eight hours of sleep may not be enough to feel rested if you have an iron deficiency.

Other mental health conditions that can cause fatigue include bipolar disorder and premenstrual dysphoric disorder.

Frequently asked questions