“I’m waking up tired.” “I need an afternoon nap.” "Why am I tired all the time? I sleep all the time and it never seems to be enough!" “I’m just dragging, all day, every day.” Do any of these complaints sound familiar to you? Even if you’re going to bed early every night, you’re waking up exhausted. Perhaps you’re feeling like you never slept at all.
If you’re fatigued all day in spite of how many hours of shuteye you got, you may have an undiagnosed sleep disorder that’s fragmenting your sleep — interrupting it in such a way that you don’t progress properly through all the phases of sleep.
Sleep Quality vs. Sleep Quantity
Most of us think how much sleep we get is the most important factor in our health. How much sleep do we need? According to the National Sleep Foundation, most adults need 7 to 8 hours.
Knowing this, perhaps you go to bed at 10 P.M. and set your alarm to wake you at 6:15 A.M. You conk out within a few minutes. Eight hours later, you find yourself slapping groggily at the alarm. “It’s not enough sleep,” you moan. “I want to go back to bed. . . just 15 minutes more.”
But you did what the experts told you to do: you slept for 8 hours. You made that time a priority. Why are you waking up so sleepy?
The answer may have something to do with sleep quality, rather than quantity. It’s possible something is disrupting your sleep, preventing you from experiencing all five phases throughout the night.
During the night we pass through five sleep phases (1, 2, 3, 4, and REM) in order, completing a full cycle every 90 to 110 minutes. As the evening goes on, the amount of time we spend in REM sleep lengthens. By morning, we “taper off” from deep sleep completely, spending most of our remaining sleep time in phases 1, 2, and REM. Then we awaken.
If your sleep repeats like this for 7 hours or more, you’ll probably wake up feeling rested. If anything disrupts these sleep cycles, breaking you out of a stage prematurely or causing you to skip a stage altogether, your sleep quality suffers. Your sleep is inadequate; you’ll wake up tired and foggy-headed, and probably fairly grumpy, to boot.
Why does this happen? An undiagnosed sleep disorder could be to blame.
6 Sleep Disorders That May Cause You To Feel Tired All The Time
- Obstructive Sleep Apnea (OSA). If the tissues of the upper airway (throat) collapse during sleep, your airway can become blocked, preventing the lungs from properly getting and using oxygen and expelling CO2. This can lead to decreased blood oxygen levels, increased waste gasses in the body, high blood pressure, stress on the heart, and higher levels of stress chemicals. You may wake up frequently in the night, gasping for breath. These awakenings fragment your sleep, making it nearly impossible to pass through all five phases during a typical cycle. Though many OSA sufferers snore, not all do. Chronic daytime sleepiness is often the primary symptom that sends people to the doctor.
- Narcolepsy. This neurological sleep disorder is classified as a form of “hypersomnia,” which means people who have it are in a state of near constant sleepiness. Narcoleptics lack normal sleep-wake cycles. Due to the lack of a neurotransmitter called orexin (or hypocretin), a classic narcoleptic may fall asleep instantly at inappropriate times — even in the middle of talking or laughing. People with this sleep disorder also struggle to wake up feeling rested after an entire night’s sleep.
- Restless Leg Syndrome (RLS) or Periodic Limb Movements Disorder (PLMD). Restless Leg Syndrome is a waking movement disorder that can affect any body part, not just legs. It tends to happen at night when you’re trying to fall asleep: a creepy-crawly or achy sensation fills you with the urge to stretch or move around. Similar to this, Periodic Leg Movements are a sleeping movement disorder, typified by involuntary limb movement that can disturb sleep and sometimes awaken the sleeper.
- Insomnia. This common sleep disorder is typified by the inability to fall asleep (onset insomnia) or stay asleep (maintenance insomnia). Though both can rob you of valuable sleep hours, the latter is more likely to disrupt your sleep cycles. Many people with maintenance insomnia complain of the classic 3:00 A.M. awakening, where they’re suddenly alert and unable to go back to sleep, regardless of what time they went to bed.
- Idiopathic Hypersomnia. This somewhat uncommon sleep disorder is a form of chronic daytime sleepiness that stays with a person, even if she’s slept for 10 solid hours. It’s a somewhat mysterious central nervous system disorder with several possible causes. On the surface, IH looks similar to narcolepsy and can therefore only be verified with a sleep study.
- Bruxism is a movement disorder in which a sleeper grinds her teeth or forcefully clenches her jaw. In addition to cracking the teeth and wearing away enamel, bruxism can disrupt normal sleep by causing headaches, jaw pain, and neck and shoulder pain.
These are six disorders that could be fragmenting your sleep. However, your chronic tiredness could be due to other issues like a circadian rhythm disorder, illness, allergies, environmental factors (like noise or temperature), or poor sleep hygiene.
Restless disruptions from your bed partner can also be problematic. Is your spouse a snorer? Does he kick you in the night? Does she talk or walk in her sleep? Or maybe she turns the light on, flushes the toilet, or tosses and turns violently, making the bed shake.
You may be totally healthy and fine. But if you’re sharing a bed, another person’s undiagnosed sleep disorder could be what’s keeping you from getting restful, high-quality sleep.
Other Possible Reasons You’re Tired
Of course, sleep disorders aren’t the only possible explanation. You could be exhausted for a variety of other reasons. For example:
- You’re sacrificing sleep willingly. Sometimes we postpone sleep to stay up studying or to watch a late-night TV program. Unfortunately, if your wake time doesn’t shift to accommodate for this later-than-usual bedtime, you could be short-changing yourself. On the flip side, you could be setting your alarm to wake up early: to train for a marathon, to go to the gym, or to enjoy a few peaceful moments to yourself before the kids wake up. If you didn’t go to bed earlier to compensate, you’re losing that extra hour or two of sleep.
- You’re under stress. Stress is a huge sleep stealer. Feeling tense about work, family, or the nightly news can affect the quality of your sleep. In turn, sleep deprivation can leave you feeling sluggish, irritable, and depressed. The cycle continues.
- You have poor sleep hygiene. So many different factors affect how well we sleep at night: the consistency of bedtime and wake times, the brightness of the bedroom, the noise level, the temperature, the distractions we can see from the bed, the presence of children or pets, and even the smell. Practicing consistent sleep hygiene helps to eliminate distractions and anxiety. Better sleep hygiene promotes better sleep quality.
- You’re adjusting to shift work or jet lag. Making a dramatic shift to your sleep-wake schedule is a recipe for tiredness. You can and will adjust to a new sleep schedule, but it takes time.
- You have an underlying health or hormonal issue. Excessive daytime sleepiness isn’t always due to a movement disorder or sleep disorder. For example, your sluggishness could be caused by anemia, infection, or the flu. But if your sleepiness is due to fragmented sleep, the disruptions could be caused by menopause (hot flashes), diabetes (nighttime insulin fluctuations), prostate problems (getting up to urinate), or other health issues.
- You’re taking medications or consuming caffeine. Be sure to read labels on medicines carefully; some “non-drowsy” over-the-counter allergy meds contain stimulants that can keep you awake. Certain prescription medications (including birth control pills) can also cause sleep disturbances. Coffee, energy drinks, cigarettes and nicotine patches, vaping, alcohol, and recreational drugs can also fragment your sleep, reducing its quality.
The bottom line: if you’re tired all the time, you can try making lifestyle changes. Go to bed earlier, improve your sleep hygiene, eat healthy, read the labels on your medication carefully, and de-stress with exercise.
If these changes don’t help, it’s time to talk to a physician. A doctor’s exam can rule out underlying health conditions. A referral for a sleep study can tell you whether you have a sleep disorder that requires special treatment.
Remember: quality of sleep is just as important as quantity. If you’re not proceeding through your five phases of sleep, your sleep quality will be poor, no matter how many hours you spend in bed.
If you suspect that your sleep quality is compromised, try taking steps to improve your sleep hygiene. If that doesn’t work, a physical and a sleep study can help to identify what’s disrupting your sleep — and what you can do to fix it.