Waking Up Exhausted?
"All last night, I dreamt I was a car muffler and this morning, I woke up feeling exhausted!"
Admittedly, I love a good “bad” joke! But in all seriousness, there are plenty of people that wake up feeling exhausted and this can be a very frustrating experience!
So, what could be the cause of waking up exhausted each morning?
Are you really getting enough hours?
Well, the first (and easiest) to consider whether you’re truly getting enough hours of sleep. I see many an adolescent who tell me they get the “recommended” 7 hours of sleep each night and don’t understand why that isn’t enough. To their surprise, I share that the typical adolescent is thought to need 8-10 hours of sleep. So, I often recommend people first just take an honest account of their sleep time, if they are on the lower end of the recommended amount of sleep by age, try adding anywhere from 30-90 minutes for a week and see what happens.
Okay, let’s say you’re getting the hours, but still struggle - let’s move on to the other considerations.
If it’s not the hours of sleep that’s the problem, could it be the quality of sleep? Sleep quality can be affected by a whole host of factors.
Sleep Environment:
Temp: Ideally, a cool, dark, quiet environment to sleep in is recommended. How cool? Some say ~68 degree F (~20 degrees C). I say typically cool enough that you want to snuggle up with a light blanket. Light: Does it have to completely dark? In a word, no. Some people have anxiety in completely pitch black rooms, so a soft, dim nightlight is okay if it brings comfort.
Sound: What if it’s Quiet, a little TOO Quiet? For some a white noise machine or soft (not too catchy) music can help ease your mind or block disruptive ambient noise.
Okay, what if the problem isn’t the environment…
Sleep Disordered Breathing:
This term describes any trouble breathing when sleeping. It can include obstructive sleep apnea (which is often characterized by snoring, gasping while sleeping), central sleep apnea (characterized by pauses in breathing with oxygen drop or sleep disruption) or poor ventilation/gas exchange which can be seen with significant apnea or other conditions. An evaluation by a medical professional is needed to determine if you have sleep disordered breathing.
What are some signs that you may need to speak with your doctor/health care provider about this?
You wake up with a morning headache frequently
You wake up with a dry mouth or sore throat
You know (or have been told) you snore or pause/gasp when sleeping.
You are taking a medication that is known to reduce your drive to breathe (e.g. opioid medications)
You sweat when you sleep.
Periodic Limb movements: Periodic limb movements (PLMs) can be an isolated sleep problem or can be associated with another sleep problem like sleep apnea. In a nutshell, PLMs are recurrent, involuntary movements of the limbs during sleep, often involving the legs. They can disrupt sleep and may be associated with restless legs syndrome. Of note, PLMs and restless legs syndrome (RLS) are often related, but are actually different. Where RLS is characterized by an uncontrollable urge to move the legs, usually due to an uncomfortable sensation, especially during periods of inactivity or rest. RLS symptoms typically cause insomnia and keep patients awake. PLMs may wake you up, or decrease the restfulness of your sleep. It’s worth talking to a doctor (ideally a Sleep Doctor or Neurologist) to explore whether PLMs may be affecting your sleep quality. A sleep study can help diagnosis this condition.
Central Hypersomnia Disorder: There are some conditions that are characterized by excessive sleepiness, even in the absence of other primary sleep disorders. Idiopathic hypersomnia and narcolepsy are examples of these, and they both require a specialists to explore your symptoms and to consider appropriate testing and treatment.
Wait, am I Sleepy or am I Tired?
Great question! Often Sleepy and Tired and used interchangeably, but believe it or not they are slightly different. Sleepy means you are likely to fall asleep if given the chance. To feel tired or fatigued can be caused by all sorts of reasons, so considering your symptoms and talking them over with a healthcare professional is important to help sort it out.
Speaking with a healthcare professional who can help screen for causes of fatigue and/or sleepiness is helpful if you feel simple changes to your sleep habits isn’t enough. Conditions such as anemia, hypothyroid, vitamin deficiency, kidney/liver dysfunction, mood disorders can all cause feelings of exhaustion. Stress can also cause us to feel exhausted. Check out these tips to maximize your clinic visit.
If you have started to notice that you wake up exhausted, consider the ideas noted above. First see if simple changes can help, and if not, ask for help from your healthcare professional! Afterall, we are here to help!
Here’s to restorative sleep!
Sleep Well! Be Well!
Caroline Okorie, MD, MPH
