Fatigue: Facts and Fiction

Tired? Irritable? Can’t concentrate?

Everyone experiences fatigue at some point, but according to sleep expert Shiraz Daud, MD, ongoing fatigue may indicate a more serious problem. “A major myth about fatigue is that it’s normal and just related to a busy lifestyle,” said Dr. Daud, a pulmonologist at Missouri Baptist Medical Center and fellowship-trained sleep medicine specialist. “In reality, fatigue can signal medical problems.”

It’s more than counting sheep.

“There are two types of fatigue: chronic fatigue, which lasts for months, and tem­porary fatigue, which is related to a spe­cific problem, such as the flu,” explained Dr. Daud. “Chronic fatigue is frequently caused by sleep apnea, but it should be evaluated as it could be a symptom of a serious condition, including cancer, dia­betes, thyroid issues, anemia or chronic fatigue syndrome.”

Individuals with sleep apnea stop breath­ing for short periods while sleeping. They typically have some degree of snoring and usually feel excessively tired during the day. Left untreated, sleep apnea can have cardiovascular side effects, such as high blood pressure, heart attack, stroke and heart failure,” said Dr. Daud.

Menopause myth.

According to Dr. Daud, sleep apnea often is discovered in women in their 50s and 60s. “What used to be chalked up to post-menopausal fatigue is often sleep apnea. While many patients with sleep apnea are overweight, I am seeing more and more individuals who aren’t.”

Try These Sleep Tips:

  • Maintain a regular bed and time schedule, including weekends.
  • Establish a relaxing bedtime routine, such as taking a hot bath, reading a book or listening to soothing music.
  • Create a sleep-conducive environ­ment that is dark, quiet, comfort­able and cool.
  • Sleep on a comfortable mattress and pillows.
  • Use your bedroom only for sleep.
  • Finish eating 2-3 hours before bedtime.
  • Exercise regularly. Complete your workout a few hours before bedtime.
  • Avoid caffeine, nico­tine and alcohol close to bedtime, as it can lead to poor sleep.

Treatment of sleep apnea varies depending on the type and severity. Weight loss or preventing the person from sleeping on their back often helps with mild sleep ap­nea. Other people may need special devices or surgery. Dr. Daud stresses that people with sleep apnea should never take seda­tives or sleeping pills, which can prevent them from awakening enough to breathe.

Understanding insomnia.

Because fatigue is such a universal symp­tom, understanding a person’s sleep and medical history are a large part of diag­nosing sleep apnea. Dr. Daud checks for symptoms of insomnia, and uses certain scales to judge how sleepy a patient is dur­ing the day. To fully understand a patient’s condition, an overnight study at a sleep lab remains the cornerstone of diagnosis.

Chronic insomnia is a complicated prob­lem. Most patients have a combination of sleep maintenance insomnia and sleep onset insomnia. Sleep onset insomnia is the inability to fall asleep in the desired time. “This patient tosses and turns, and becomes frustrated because they realize it’s getting later and they really need sleep,” Dr. Daud described. “It’s a per­petual cycle. As their frustration increases, they become more alert and it’s difficult to fall asleep when you’re alert.” Sleep maintenance insomnia patients fall asleep, but wake up every one-to-two hours and have difficulty falling back asleep.

Advice for the weary.

Dr. Daud does have advice for the person who has temporary fatigue due to staying up late. “We pay a sleep debt when we miss out on sleep. People who skip hours of sleep really ought to try to make it up to improve their overall health,” he recommends. 

Dr. Shiraz Daud is board-certified in pulmonary dis­ease, critical care and internal medicine. He received his medical degree from the University of Missouri-Kansas City, completed his internship at Univer­sity of Pittsburgh Medical Center, and completed a fellowship in pulmonary, critical care and sleep medi­cine at Washington University School of Medicine.

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