Sleep, fatigue and energy. Tiredness is a symptom, not a diagnosis, and in most people it has a cause that can be found with a careful history, a few well-chosen tests and, when it is needed, a sleep study.
in bed each night for two weeks impaired attention as much as up to two nights without sleep.
adults aged 30 to 69 worldwide are estimated to have some degree of sleep apnoea.
faster to fall asleep, on average, after cognitive behavioural therapy for insomnia.
Deep sleep, when the body does most of its physical repair, sits in the first half of the night. REM sleep, which supports memory and mood, sits in the second half. Cut the last hour or two and you lose a big share of your REM sleep. Many people who are in bed for eight hours are asleep for six and a half. In one study, people allowed six hours a night for two weeks were as impaired as after two nights with no sleep, and barely noticed it. Afternoon coffee and evening drinks both quietly break up sleep, and a wearable is useful for spotting trends over weeks rather than judging a single night.
The common physical causes are low iron (which causes fatigue well before it shows up as anaemia), thyroid problems, blood sugar problems, low testosterone in men and perimenopause in women. Each needs careful interpretation. A borderline thyroid result, for example, often is not the answer, and low testosterone is frequently a result of poor sleep rather than the cause of it. Stress, long hours, alcohol to wind down and a training load that has crept up without enough recovery all play a part too, and so do mood and anxiety.
In sleep apnoea the airway narrows or closes during sleep, breathing stops, and the brain briefly wakes to reopen it, sometimes dozens of times an hour without you remembering. The clues are loud snoring, pauses in breathing a partner notices, waking unrefreshed, morning headaches and getting up at night to pass urine. Women are more likely to notice poor sleep, fatigue and low mood than snoring, so it is easily missed. A questionnaire or a smart ring cannot diagnose it. A sleep study can, often at home, and there are several treatment options your doctor can talk you through.
A 47-year-old man sleeps seven and a half hours, trains five times a week and is exhausted by 3pm. His resting heart rate has crept up, his partner says he snores, his testosterone is borderline and his fasting glucose is at the top of normal. Looked at separately, each result invites a different fix. Looked at together, they point to one likely cause, and the right first step is a sleep study rather than a prescription.
A good assessment starts with your story: how you fall asleep and wake, how sleepy you are in the day, what you drink and when, how hard you train and how well you fuel it, your mood, your medicines and supplements, and what your partner has noticed. A one to two week sleep diary or your wearable data turns that into a pattern. From there, a focused set of blood tests and, where the history suggests it, a sleep study. If the answer turns out to be insomnia, the most effective first treatment is a structured therapy called CBT-I rather than a tablet. Anyone who has fallen asleep, or nearly, while driving should stop driving until they have been assessed.
At My Performance Doctor, your doctor reads them together and keeps watching the trend after the first appointment, rather than treating each result in isolation. If you are tired despite doing the right things, a call with Robyn is the place to start.
This article is general information and is not a substitute for individual medical advice. From the doctors at My Performance Doctor.