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Why Am I So Tired? Chronicles of Fatigue Part 2: Sleep

In Part 1 of the Chronicles of Fatigue, we covered deficiencies, which was a big topic! This article I want to focus on just one underlying cause….one IMPORTANT underlying cause…poor sleep!

This seems obvious enough, but we often overlook the importance of our sleep. More specifically, I talk a lot about sleep quality vs sleep quantity. Maybe you are in bed for 7-8 hours, but did you maybe have a couple glasses of wine before? Did you wake up around 3am and toss and turn for a while? Do you snore and have been told are a restless sleeper? All these things can affect if we are truly getting the rest we need.

The goal is to get 7-9 hours of relatively uninterrupted sleep, consistently each night at the same or very similar intervals of time. And this is why:

~Sleep continuity: When our sleep is interrupted and we wake up throughout the night, our body is not able to go through the proper sleep cycles, from light, deep and REM sleep most importantly. This then leads to the fatigue, and even mild cognitive impairment, we feel the next day according to a 2015 study. Causes of sleep interruptions can be the wakings you are aware of, sleep apnea you may not be aware of, and drinking alcohol before bed. Having 1 drink for a women before bed can reduce sleep quality by 24% according to The Sleep Foundation!!

~Sleep consistency: Following our circadian rhythm in a consistent pattern is also crucial. When our eyes perceive dark, our body releases melatonin to get us sleepy and prepare for bed. The opposite happens when we see light in the AM, it wakes us up with cortisol (and the now low levels of melatonin). So when our bodies natural circadian rhythm is not followed, it can create less sleep quality. This can happen from staying up past our sleep cues, looking at screens up until bedtime, or in shift workers.

So is sleep part of the culprit for YOUR fatigue? Here's what to consider:

 ~Are you at risk?: Drinking alcohol and/or too much caffeine late in the day, not following natural circadian rhythm cues (staying up late, not getting sun exposure in the AM, looking at screens up until bedtime, shift worker), have been told you snore, are a restless sleeper or actually stop breathing for periods of time, waking frequently at night, getting less than 7 hours of uninterrupted sleep consistently each night, wake feeling unrested, low hormones - specifically progesterone.

~Testing: I recommend a sleep study if you have signs of apnea or you have ruled out other causes of fatigue and your sleep hygiene is on point. You can also monitor your sleep with an Oura ring or other smart watch. I will test for low Progesterone and their cortisol curve if this matches the patient's story and we know sleep is an issue.

Until we optimize our sleep, we will never know how much it is truly contributing to the fatigue! It’s amazing how many people say they sleep SO much better just from dimming lights and turning off screen for 30min before bedtime. Give it a try for a week and see what you notice :)

Part 2 is coming up next when we will discuss how mental stress can lead to fatigue…stay tuned!

Please reach out if you have any questions or would like to schedule a free 15min consult to see how this may relate to YOU. It’s all about individualized, holistic medicine in my book.

Dr. Jessie Miller



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