You know that it’s vital to get between 7-8 hours of sleep (or possibly more) nightly. You might even advise your patients to do the same. Additionally, you may have cultivated a healthy sleep routine. Why then are you, or your patients, always tired? You won’t need to tattoo the words “always tired” on your face because your caffeine consumption, bags under your eyes, and struggle to stay awake during all-hands meetings speak for themselves. Here’s what could be amiss. Poor sleep quality Seven to 8 hours of sleep are useless if those hours are of poor quality. This could be why you’re always tired. Maybe you have a partner who snores, or a pet who needs to be on top of you in order to feel secure in the night. If you’re waking up repeatedly, you might not be getting the restorative sleep that you need. While sleep researchers are just beginning to scratch the surface of what these sleep stages do, it appears we might need REM sleep for memory consolidation and deeper, slow brain wave sleep for tissue repair. These sleep stages take place in cycles. Disruptions to the cycles might thwart the restorative effects of sleep. Stress Is there any disease state that isn’t worsened by or connected to stress? Well, we know excessive fatigue is. Circumstances have improved for us humans over millennia. While most of us don’t have to scan the savanna for lions, we still have the same fight-flight-freeze response that helped our ancestors survive predatory beasts. It’s the same system that kicks in when your hardcase CMO casts his predatory gaze your way. It’s not a life-or-death situation, but try reasoning with your amygdala. Every time this or other stressful situations arise, your amygdala pumps out epinephrine and norepinephrine depending on perceived needs. That can get pretty taxing and could be why you’re always tired. Disrupted circadian rhythm This is a common one for any physician doing shift work. Sleep-regulating hormones and neurons respond in part to sunlight exposure. If you’re sleeping during the day and working at night, you’re not receiving typical amounts of natural light. This, in turn, might be disrupting normal sleep-regulating hormone secretion. Also, studies have shown that exposure to the blue light emitted from electronic devices is disruptive to sleep. Spending evening hours glued to your smartphone or laptop could be sabotaging your circadian rhythm. Over-reliance on carbohydrates The American diet is very carb-heavy, and in some ways it creates a vicious cycle. Fast-burning carbs provide use with quick hits of energy, prompting spikes in insulin to transfer glucose into our cells. We get a short energetic lift, and a precipitous crash follows that leaves us craving more carbs. The cycle repeats itself. Slower-digesting macronutrients, such as fats and proteins, provide more stable sources of energy. Sedentary lifestyle It seems like a paradox that we need to expend energy in order to feel energized, but that is indeed the case. Chronic fatigue syndrome, one of the diseases du jour, appears to be linked to sedentary living. A Disability and Rehabilitation literature review showed that people with CFS tended to be less active and have less isometric muscle strength. This, of course, prompts a chicken or egg question, but regardless, it’s food for thought. A Cochrane Library study makes it clear: CFS patients who exercise feel less fatigued. Over-reliance on caffeine Newtonian physics, specifically the third law, tells us that for every action there is an equal but opposite reaction. The principle is true for how energy drinks affect the body. You’re tired. You reach for some coffee. You get a buzz. Then, the caffeine wears off and you feel more tired than before. This is called rebound fatigue. A study in Appetite shows that energy drinks will yield modest improvements in alertness and cognitive abilities. However, a literature review published in Innovations in Clinical Neuroscience shows that energy-drink consumers experienced increased daytime sleepiness the day after. What goes up must come down. TL;DR Here’s why you’re outwardly healthy but are always tired: You might be getting enough sleep, but your sleep is of poor quality. Stress and fight-or-flight hormones might be overtaxing your mind and body. Blue light or shift work might be disrupting your circadian rhythm. You’re too reliant on carbs for energy Sedentary living has resulted in depleted energy levels. You’re too reliant on caffeine for short bursts of energy and are experiencing rebound fatigue. Source
