13 - Waking fatigued
A good night sleep is essential, but not enough, to prevent fatigue. One of the most common reasons (10-20% of reasons) women go to see their doctor or naturopath is because they feel fatigued, and a good night sleep doesn’t seem to be enough. In my twenties (a while back now!) I went through a period of years feeling fatigued. In a way I have that to thank for my love of naturopathy, as it was in looking for answers that I first discovered naturopathy and fell in love with it as I finally began to feel better. I have more energy now than I did then, which is pretty remarkable given that I now work, have a young child and am in my late forties! Fatigue might feel like a vague symptom, but it should never be ignored. Here are some possible reasons why you might be feeling like you were hit by a bus, even after a good night’s sleep, and steps you can take to deal with it.
Sleep apnea
Sleep apnea is a sleep disorder where breathing is interrupted during sleep. This reduces oxygen supply to the body and brain, leading to waking up feeling unrefreshed, tired and even sometimes headaches and dry mouth on waking.
Many people have heard of obstructive sleep apnea, which is a risk for those with considerable extra weight or for those who carry their extra weight on the neck. This causes an obstruction, making the body work harder to open airways to bring in enough air during the night.
However, sleep apnea is not just due to having a larger weight – another form called central sleep apnea can be caused by the brain simply not telling the muscles to breathe, usually in those with severe illnesses affecting the brain stem.
If you carry extra weight generally, or around your neck, have been told you snore, wake up with a headache, or have high blood pressure it’s worth asking your doctor about sleep apnea.
Cortisol dysregulation and excessive stress
Cortisol is one of the stress hormones secreted by our adrenal glands. When we’re healthy it helps to give us our “get up and go” – with a rise in cortisol shortly after waking in the morning helping us get going with our day. However, like anything, our adrenals can become fatigued and dysregulated, particularly after long periods of excessive stress. Disrupted daily rhythms caused by shift work can also disrupt our cortisol. When cortisol is depleted or just not following the correct cycle, we can wake up feeling like we don’t have the energy to get out of bed.
Iron or B12 anaemia
Iron and vitamin B12 help in the formation of red blood cells, which carry oxygen around the body, including to the brain. Understandably, if this system isn’t working optimally, it’s easy to feel out of breath and exhausted after the slightest exertion, and even tired when we wake up. It’s really important to get proper testing done to see if this is the cause though, rather than just taking iron tablets, as too much iron can be harmful or even dangerous. Anaemia can lead to paleness, including pale gums and inside of eyelids, shortness of breath and feeling weak generally. It’s more likely in women who have heavy periods, digestive disorders, unmanaged celiac disease or who have a vegetarian or vegan diet.
Lack of nutrients in the diet
Have you heard of mitochondria? They are the tiny units in our cells which convert our food into energy. Most of us know we get energy from our foods such as carbohydrates, proteins and fats. But did you know that this happens over a series of chemical reactions, each of which require different nutrients to occur? Some of the nutrients that help create the reactions which produce energy are CoQ10, B vitamins, carnitine and magnesium. This indicates a healthy, nutritious diet plus good digestion and absorption are necessary to fuel our body to produce the energy it requires. It’s difficult to measure this level of nutrition at the GP – chat to a nutritionist or naturopath if you’d like to know more. If you’re waking up fatigued and flagging in energy through the day, take a look at the quality of your diet.
Thyroid dysfunction
Even before lowered thyroid function crosses the line to officially be a diagnosed condition, it can produce symptoms of fatigue, brain fog and mood changes. It often accompanies a difficulty in losing weight. Initial blood tests can miss this at the beginning stages so it’s worth seeing a naturopath or nutritionist in addition to having a good check up with your doctor to really get to the bottom of it. It’s worth having this checked if you can relate to the symptoms of weight gain and fatigue, feeling cold and particularly if there have been autoimmune or thyroid conditions in your extended family it is worth having your thyroid checked out.
Blood sugar dysregulation
Sometimes it’s frustrating the way our culture talks about health in such on and off terms, and blood sugar dysregulation is one of them. We think of people as having diabetes or normal blood sugar – but for many people they are in between. We can go a long time eating a high carbohydrate diet, over eating and having spikes in blood sugar followed by over zealous attempts by insulin to get our levels under control, causing a drop and crash. This often looks like feeling tired mid afternoon after lunch, craving sugar and carbohydrates and general fatigue and feeling our of control around food. If your fatigue looks like this, simple blood tests and a chat with your health practitioner can determine how well your blood sugar is managed. Having diabetes in the family, autoimmune issues personally or in the family, a habit of eating lots of carbohydrates, large meals or snacking can indicate blood sugar regulation is worth getting checked.
Side effects of medication
Medications can be necessary to treat illness, and have a definite place in our health tools. And it’s important to understand that any medication – even natural ones – may carry side effects such as fatigue. If fatigue has developed since beginning a new medication, or if you take medications long term this is worth considering. Some medications change our neurotransmitter production, others create gradual depletions of the nutrients needed to create energy, or block chemical pathways that are part of energy production. It’s helpful having a chat with your pharmacist the next time you get a script filled, to understand if any symptoms you may be having could be a side effect of anything you are taking.
What do I do now?
If the above illustrates to you how multi layered fatigue is, then I’m glad. It can seem like such a simple or casual complaint but can be really hard to unravel and address without guidance. If you are experiencing ongoing fatigue, start here:
Book an extended appointment with your doctor and ask for a full work up and blood tests for common fatigue markers such as blood sugar, nutrients and thyroid function
Look at obvious causes of fatigue in your diet such as sugar intake, meals based around carbohydrates such as bread or pasta or lack of vegetables indicating inadequate nutrient intake
Go into a pharmacy and talk with the pharmacists about the medications you are on and if you need to be aware of any side effects or interactions
Book an appointment with a nutritionist or naturopath to discuss your lifestyle and diet and how these may be impacting your levels of fatigue
Don’t assume there’s nothing you can do. There is a cause for your fatigue and there are steps you can take to address it
If you are fatigued you have my empathy and thoughts. It can feel so relentless and frustrating to drag ourselves through each day, lacking the energy we so wish to put into the people and things we love. Above all, please don’t resign yourself to feeling this way. Small steps you put into place each day can begin to turn the tide and build momentum to a whole new level of vitality. I hope that you, too, look back and say “I have so much more energy now than I did back then”. If you’d like some help getting there, book in a free discovery call here.
References
Arredondo, E., Udeani, G., Panahi, L., Taweesedt, P., & Surani, S. (2021, September 9). Obstructive sleep apnea in adults: what primary care physicians need to know. Retrieved from Cureus: http://doi.org/10.7759/cureus.17843
Asp, K. (2017, September 18). Obstructive vs. cnetral sleep apnea: key differences and treatment options. Retrieved from American Association of Sleep Technology: https://www.aastweb.org/blog/obstructive-vs.-central-sleep-apnea-key-differences-and-treatment-options#:~:text=Two%20main%20types%20of%20sleep,a%20lack%20of%20respiratory%20movements.
Bhadra, P., & Deb, A. (2020, April). A review on nutritional anemia. Retrieved from Indian Journal of Natural Sciences: https://www.researchgate.net/profile/Preetha-Bhadra-2/publication/342216517_A_Review_on_Nutritional_Anemia/links/5f64797b458515b7cf3c102a/A-Review-on-Nutritional-Anemia.pdf
Biondi, B., Cappola, A., & Cooper, D. (2019). Subclinical hypothyroidism. Retrieved from Journal of the American Medical Association: http://doi.org/10.1001/jama.2019.9052
Celano, C., Freudenreich, O., Fernandez-Robles, C., Stern, T., Caro, M., & Huffman, J. (2022, April 1). Depressogenic effects of medications: a review. Retrieved from Dialogues in Clinical Neuroscience: https://doi.org/10.31887/DCNS.2011.13.1/ccelano
Hamilton, D. (2021, May). Nutraceutical support of mitochondrial function associated with reduction of long-term fatigue and inflammation. Retrieved from Alternative Therapies: http://www.alternative-therapies.com/abstracts/pdf/24042.pdf
Jones, C., & Gwenin, C. (2020, December 19). Cortisol level dysregulation and its prevalence - is it nature's alarm clock? Retrieved from The Physiological Society: https://doi.org/10.14814/phy2.14644
Maisel, P., Baum, E., & Donner-Banzhoff, N. (2021, August 23). Fatigue as the chief complaint. Retrieved from Detsches Arzteblatt International: https://doi.org/10.3238%2Farztebl.m2021.0192