CHAPTER 12: Tiredness (Fatigue) and Sleep Problems

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CHAPTER 12: Tiredness (Fatigue) and Sleep Problems

About 5-15 percent of the general population have problems with tiredness/fatigue and sleep. Among people who have chronic (long term) illnesses or who are in fair or poor health the percentage of reporting problems with tiredness or sleep is about twice as great.

Common Cause of Tiredness and Fatigue

For many persons the words "tiredness" or "fatigue" mean both a lack of energy and the inability to complete usual activities. Not getting enough sleep or having fitful sleep is a common reason for being tired and fatigued.

In addition to sleep problems, there are other causes of tiredness and fatigue:

Low red blood cells (anemia). An easily treatable cause for anemia is a lack of iron in the diet.
Side effects of many medications, such as antihistamines (like Benadryl), blood pressure and "heart" pills, and most antidepressants and tranquilizers.
Not being physically active. As an example, when healthy people are forced to be in bed for a week, they can lose a large amount of their ability to completed their usual activities. People who have illness often "slow down" and this can actually make them feel sicker. Feeling sicker makes them "slow down" more. Eventually, they lose their ability to be active and they are always tired/fatigued.

The good news is that in well done studies of chronic tiredness and fatigue, 7 of 10 persons benefit from 12 weeks of regular exercise. (See "Exercise and Eating Well").

Sleep problems

Few things in life are as pleasant as a good night's sleep.The amount of sleep each person needs is different, but the typical range is between seven and eight hours a night. Your needs are fairly constant through adulthood. Later, aging reduces the length of sleep you can expect at any one time. With increasing age, many persons wake up several times each night.

Understanding Sleep as You Age

The normal sleep cycle consists of two different kinds of sleep--REM (Rapid Eye Movement or dreaming sleep) and non-REM (quiet sleep). Everyone has about four to five cycles of REM and non-REM sleep a night. As you get older, the amount of time spent in the deepest stages of non-REM sleep decreases. This may explain why older persons are thought of as light sleepers. In the elderly, about 3/10 have trouble falling asleep and about 5/10 have trouble staying asleep.

Medicines and Sleep

"Fluid pills" (diuretics) and some medicines to improve breathing can disturb your sleep. If you have followed the suggestions in the "Managing " section and still have trouble sleeping, please talk to a nurse or doctor. Your doctor may be able to adjust your medications and help you have a better night's sleep.

Managing Sleep Problems

Scientific studies of methods to improve sleep show that the following suggestions will actually improve sleep for about two out of every three people who have sleep problems.

A General Approach

FIRST: SET UP A ROUTINE

Go to bed only when sleepy. There is no need to sleep eight hours every night and there is no benefit from staying in bed when you cannot sleep. Staying in bed more than five hours a night is of no value if you are not sleeping.
Use your bedroom only for sleeping. (For safety your bedroom area should have a smoke alarm, a lamp that's easy to turn on, and a telephone by your bedside).
After turning off the light, give yourself about 20 minutes to fall asleep. If you are still awake or if you lose your drowsiness, get up and go into another room until you feel sleepy again.
Follow a regular schedule. Get up at the same time. Don't have one schedule for the work week and one for the weekend. A regular routine at bedtime, like reading a book or taking a warm bath, will tell your body it's time to sleep. Write down what you are doing each day. See if you are pushing yourself too hard.
Avoid daytime naps. If you take daytime naps, you are likely to stay awake at night. If you must nap, take a short nap before 3 PM. If you usually feel so tired during the day that you fall asleep without planning to nap -- please talk to a doctor.
Try to exercise regularly. Brisk walking four times a week improves sleep. Moderate exercise several hours before bedtime will also help you sleep.

SECOND: AVOID KNOWN AWAKENERS

Be aware of what you eat and drink. Avoid drinking caffeinated (coffee, cola) beverages late in the day. As a stimulant, caffeine can keep you awake.
Don't drink alcohol to help you sleep. Drinking even small amounts of alcohol can make it harder to stay asleep.
Smoking is not only dangerous (starting a fire by falling asleep with a lit cigarette), but nicotine is a stimulant and will keep you awake.

THIRD: TRY THESE "TRICKS" IF YOU STILL HAVE DIFFICULTY SLEEPING.

Try not to worry about your sleep. Some persons find that playing mental games is helpful. For example, think black - a black cat on a black velvet pillow on a black corduroy sofa, etc.; or tell yourself its five minutes before you have to get up and you're just trying to get a few extra winks.
A warm bath with a small drink of warm milk or herb tea may help.
Several studies show that exposure to very bright light for one hour during the morning will help sleep by resetting "REM" patterns closer to normal.
Keep a diary of your sleep for a week. This will help you and your doctor decide on the best treatment for you. For example, if you have trouble staying asleep, you may limit your sleep time to 5 hours. Then gradually over a week, increase sleep time by 30 minutes a night until you wake up feeling rested. Don't spend more time in bed than that.

Medications

All sleep medicines have side effects when used for a long period of time. Most sleep medicines you can buy without a prescription usually contain antihistamines. These medicines can make you drowsy and more likely to have accidents the next day. Kava, valerian and melatonin may also be available without a prescription.

Prescription sleep medicines are more effective than non-prescription medicines. However, they are also more likely to be habit forming and may build up in your body. The effects of sleep medications do not last when the pills are stopped.

Non-Medicine Treatments for Special Situations

Best Treatment for restless legs and leg cramps: stand two feet away from a wall and lean forward against it keeping your feet flat to the floor. Hold and repeat. Clonazepam and drugs for Parkinson's disease may help restless legs. These medications must be prescribed by a physician.
Treatments for snoring included weight loss if needed, no alcohol at dinner, and devises such as chin straps, and nose vents. Sleeping on the side (place a tennis ball on the back of the pajamas) may also help.
Treatments for sleep apnea include devices to be worn at night (trouble some), continuous air pressure using a device through the nose (bothersome), and even surgery (50% effective). The cheapest and safest first approach is to reduce weight when necessary and avoid alcohol.
Your doctor may recommend that you visit a sleep clinic. Sleep clinics may be used used to make diagnoses and recommend treatments for persons who have sleep apnea or severe sleeping problems not responding to any of the above described approaches.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.

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