Fatigue is one of the most commonly voiced complaints in the medical setting and one of the most difficult to diagnose and treat. Possible causes of fatigue are legion and include insomnia, sleep apnea, anemia, low ferritin (iron), abnormal thyroid function, post-viral chronic fatigue (Epstein-Barr virus), depression, anxiety and other medical issues which occur less frequently. For the physician, it can be difficult task to sort out which of these potential issues is the real cause of fatigue and how to best help a patient.
Common things being common, the most common cause of fatigue is poor quality sleep. So let’s start with insomnia. The easy part about diagnosing insomnia is that most patients know they have it and are happy to share their challenges around sleep.
Fatigue from chronic sleep restriction refers to the Type A individual who are unwilling to allow themselves the luxury of getting the required seven to eight hours of sleep a night. They sever their electronic link to the world at midnight and are up again a 4 a.m. to start their fitness program. Some people thrive on this program, most don’t … for long.
Sleep disruption includes complaints about getting to sleep, maintaining sleep or waking inappropriately early. Insomnia can be short term, less than three months, or long term, which includes ongoing or episodic periods of insomnia. Short-term insomnia is usually caused by stress such as grief or major challenges in the work situation while chronic insomnia is more of a medical challenge.
One survey suggested that up to 69% of patients suffer from insomnia with 50% of patients suffering short-term insomnia and 19% suffering from long-term insomnia. Another study suggested the incidence of chronic insomnia resulting in decreased daytime performance may be as high as 10% of the population. Women appear to suffer from insomnia more frequently than men.
As insomnia compromises the quality of life and daytime performance, it should be assessed in a medical setting and treated. Options for treatment include from cognitive behavioural therapy, sleep hygiene strategies and short-term use of sleep medication. Most patients are appropriately reluctant to take sleep medication on a long-term basis; but that shouldn’t stop you from trying the other approaches including the use of sleep medication on a short-term basis to adjust your sleep cycle.Good sleep requires a healthy sleep/wake cycle
Sleep apnea is the elephant in your bed; most persons with sleep apnea don’t know they have it. Some individuals are fortunate to have a bed partner that can report snoring and/or periods of “non-breathing” (apnea). The others are left to wonder why they feel fatigued in the morning, wake with a headache, feel like sleeping after lunch or fall asleep in front of the television. Elevated blood pressure is often the first objective sign of sleep apnea. Fatigue should not be ignored as sleep apnea significantly increases the risk of heart disease, stroke and sudden death from cardiac arrhythmias.
Obstructive sleep apnea (OSA) is measured by the apnea-hypopnea index, the number of episodes per hour when breathing is obstructed. Using AHI> 15 events per hour (moderate to severe) sleep apnea, the prevalence of OSA is 15 % in men and 5% in women. However, the prevalence rises significantly with weight. In the obese male population (BMI > 30), the prevalence of OSA rises to > 50%.
The definitive test is a sleep study in a sleep lab. But the word on the street is that sleep labs can be noisy and it’s difficult to sleep when wired up with multiple recording leads. Some patients even dismiss the diagnosis of sleep apnea as they claim they didn’t sleep although the sleep recording shows otherwise. A new option is a home sleep study in the comfort of your own bed.
As sleep apnea may be related to sleeping on your back, strategies to sleep on your side or stomach can eliminate sleep apnea. Dental appliances are becoming a popular option for managing sleep apnea. The tried and true treatment is still CPAP (Continuous Positive Airway Pressure) though it can be challenging to learn to sleep with a mask on your face. But some patients are ecstatic when they experience a completely restful and refreshing sleep which they hadn’t experienced since childhood.
Fatigue is an important measure of your health; don’t ignore it. Find a physician who is willing to take the time to find out why you are experiencing fatigue and the right option to treat it.
Sleep is a required refresh for your brain.
Read MoreDr. David Caspari, Senior Medical Consultant, and Dr. Alain Sotto, Director, Year-Round Care, discuss how to remove the obstacles keeping you from your best sleep.
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