Exhaustion: The Only Way To Sleep

There are many reasons why you might not be able to sleep even though you feel tired. It could be due to your circadian rhythm being off, daytime napping, anxiety, or many other factors. For instance, if you have an irregular sleep schedule, this can disrupt your circadian rhythm or body clock, which thrives on consistency. Additionally, stress and anxiety can interfere with sleep, as they can induce a fight or flight response that makes it challenging to relax and fall asleep. Other factors such as caffeine consumption, blue light from electronic devices, sleep disorders like insomnia, and even diet can also play a role in sleep difficulties.

Circadian Rhythm Disorders

There are several types of Circadian Rhythm Disorders:

• Advanced Sleep-Wake Phase Disorder: Individuals with this disorder may find it challenging to stay awake in the early evening and wake up too early in the morning, interfering with daily responsibilities.
• Delayed Sleep-Wake Phase Disorder: This is one of the most common circadian rhythm disorders. Individuals tend to fall asleep later than desired and have difficulty waking up on time. It often leads to reduced sleep and daytime tiredness or anxiety.
• Irregular Sleep-Wake Rhythm Disorder: Individuals with this disorder may experience multiple short periods of sleep and wakefulness throughout the day and night, resulting in non-restorative sleep.
• Non-24-Hour Sleep-Wake Rhythm Disorder: This disorder occurs when an individual's sleep-wake cycle is not aligned with the standard 24-hour day. Sleep times may gradually become more delayed, and individuals may experience periods of insomnia and daytime sleepiness.
• Shift Work Disorder: This affects individuals who work night shifts or rotating schedules. They may struggle to obtain quality sleep due to their work schedule, leading to insomnia and extreme tiredness.

These disorders can be caused by various factors, including changes in routine, medications, time zone changes, aging, genetics, and medical conditions. Treatment options include external stimulus therapies, such as bright light therapy, and chronotherapy, which involves gradually adjusting bedtime to achieve the desired sleep schedule. Maintaining a consistent sleep schedule and improving sleep hygiene can also help prevent circadian rhythm disorders.

Sleep Disorders

Some people with sleep disorders may experience chronic fatigue, a lingering tiredness that is constant and limiting. They may wake up feeling unrefreshed, be unable to function at work, or be too exhausted to manage their daily affairs. Sleep disorders can also cause difficulty thinking, or "brain fog", making it hard to pay attention, remember things, or focus on detail-oriented tasks.

There are several factors that can contribute to sleep disorders, including other health conditions such as heart disease, lung disease, nerve disorders, and pain, as well as mental illnesses like depression and anxiety. Lifestyle factors can also play a role, such as consuming caffeine and alcohol, working night shifts, and aging.

To diagnose a sleep disorder, a healthcare provider will consider an individual's medical history, sleep history, and perform a physical exam. A sleep study, or polysomnogram, may also be conducted to monitor heart rate and electrical activity during sleep.

Treatments for sleep disorders vary depending on the specific disorder but may include good sleep habits, lifestyle changes, cognitive behavioral therapy, relaxation techniques, the use of a CPAP machine, bright light therapy, medication, and natural products such as melatonin.

If you are experiencing chronic fatigue or symptoms of a sleep disorder, it is important to consult a healthcare professional for proper diagnosis and treatment.

Stress and Anxiety

Anxiety can affect sleep in several ways. Cognitively, anxiety can lead to intrusive thoughts, doubts, or worries that interfere with the ability to fall asleep. Emotionally, anxiety can cause fear, uncertainty, and a sense of being trapped, making it challenging to relax and let go of worries. Physically, anxiety can manifest as sweaty palms, muscle tension, an increased heart rate, and an upset stomach, all of which can contribute to sleep difficulties.

Additionally, the relationship between sleep and anxiety is bidirectional. Poor sleep quality can increase the risk of developing an anxiety disorder. When individuals do not get sufficient restful sleep, they are more likely to experience stress and anxiety. This can further exacerbate sleep difficulties, creating a cycle that reinforces both conditions.

To manage stress and anxiety-related sleep difficulties, several strategies can be employed:

• Deep breathing exercises before bed can activate a calming response through the parasympathetic nervous system.
• Listening to relaxing music, affirmations, or guided meditations with nature sounds can help calm the mind and body.
• Reducing or eliminating substances such as alcohol, nicotine, and caffeine, which can affect anxiety levels and sleep quality.
• Avoiding heavy meals and spicy foods close to bedtime, as they may trigger nausea and stomach discomfort, especially if anxiety is already present.
• Establishing a relaxing bedtime routine, such as reading, journaling, or meditation, can help signal to the body that it's time to wind down and prepare for sleep.
• Practicing good sleep hygiene, including maintaining a consistent sleep schedule, limiting screen time before bed, and creating a comfortable sleep environment.
• Seeking professional help if at-home strategies are ineffective. A healthcare provider can recommend additional behavioural or lifestyle changes, such as cognitive-behavioural therapy, or discuss further treatment options, such as anti-anxiety medication.

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, making it harder to fall asleep when you want to.
• Lack of natural light exposure: Getting too little sunlight during the day and too much bright light in the evening can interfere with your body's production of melatonin, the hormone that regulates sleep.
• Screen time before bed: The blue light emitted by electronic devices suppresses melatonin production and increases alertness, making it harder to fall asleep.
• Stress and anxiety: High levels of stress or anxiety can make it difficult to relax and fall asleep.
• Caffeine, alcohol, and heavy meals close to bedtime: These substances can interfere with sleep by stimulating your body or disrupting your sleep later in the night.
• Uncomfortable sleep environment: A bedroom that is too bright, noisy, or warm can hinder your ability to fall asleep and stay asleep.
• Lack of a bedtime routine: Not having a consistent pre-sleep routine can make it harder for your body and mind to wind down and prepare for sleep.
• Medical conditions and sleep disorders: Conditions like insomnia, anxiety, and depression can contribute to poor sleep hygiene and make it difficult to fall asleep.

If you're experiencing sleep difficulties, it's important to evaluate your sleep hygiene practices and make changes where necessary. This may include sticking to a strict sleep schedule, improving your sleep environment, reducing screen time before bed, and managing stress and anxiety. If you continue to have trouble sleeping, it's a good idea to consult a healthcare professional for further guidance.

Medical Conditions

If you are tired all the time and do not know why, it could be a sign of a problem. Feeling tired can be caused by lifestyle factors such as stress, an unhealthy diet, and lack of exercise. However, if you are concerned that your tiredness is caused by a medical condition, you should consult a doctor.

There are several medical conditions that can cause tiredness and fatigue. These include:

• Iron deficiency anaemia
• Overactive thyroid (hyperthyroidism)
• Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS)
• Excessive daytime sleepiness (hypersomnia)
• Idiopathic hypersomnia
• EPIC dreaming

Iron deficiency anaemia can cause tiredness, as well as other symptoms such as noticeable heartbeats (heart palpitations), shortness of breath, and pale skin. An overactive thyroid can also result in tiredness, along with other symptoms such as weight loss, feeling nervous, anxious, and irritable, and muscle weakness. Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) is characterised by extreme fatigue that lasts for at least three months and makes it hard to carry out daily activities.

Excessive daytime sleepiness (hypersomnia) is a condition where people fall asleep repeatedly during the day, in addition to sleeping for long hours at night. Idiopathic hypersomnia is a type of hypersomnia where people sleep for long periods and wake up feeling confused or irritable, rather than refreshed. There is currently no known cause for idiopathic hypersomnia.

Finally, EPIC dreaming is a rare disorder characterised by endless and exhausting dreams, resulting in morning tiredness and chronic daytime fatigue. This disorder is more common in women, and there is currently no known cause or treatment.

Frequently asked questions