Tired all the time YANMD YANMP
February 26, 2022 11:25 AM Subscribe
For the last few years I am tired all the time.
I can easily lie or down after work, start to read (or not) and go to sleep for 1-2 hours after work (I work part time), four or five days a week. I've tried powering through all day and just felt sleepy and miserable. My thyroid levels (which keep changing but were checked in Nov) are right in the middle of things and my doc then told me to "stay the course". I take 264 mcg of levothyroxine (Synthroid) and 2.5 mcg of Liothyronine (cytomel) daily (the hypothyroid and to a lesser extent, the Hashimotos has been going on for many years). My old doc kept me on the non-generic label, which I didn't notice any difference either way. Not sure I can afford the name brand. He retired and I like my new doc. I take B complex, C and D daily. I use a CPAP which actually turned out to be the difference between night and day for me.
I like to be in bed at 10-10:30 but read till 11:30, occasionally 12. Working on all the sleep hygiene like, no screens for an hour before bed, cool room, etc. I have some Temazepam that I took all through the pandemic but am now weaning off (since January...1 day off, 1 on for a few days, 2 days off, 1 on...etc.) Sometimes I use valerian root which I used with success a few years back. It's not as much of a punch as a benzodiazepine, but it seems to do the trick.
I probably get 7-8 hours solid sleep a night. I feel better at 8.
Supplements, yoga, rituals, anything. I don't want to spend the rest of my life sleeping. I mean, a nice nap once in a while is one thing, but this has gone way beyond that.
I can easily lie or down after work, start to read (or not) and go to sleep for 1-2 hours after work (I work part time), four or five days a week. I've tried powering through all day and just felt sleepy and miserable. My thyroid levels (which keep changing but were checked in Nov) are right in the middle of things and my doc then told me to "stay the course". I take 264 mcg of levothyroxine (Synthroid) and 2.5 mcg of Liothyronine (cytomel) daily (the hypothyroid and to a lesser extent, the Hashimotos has been going on for many years). My old doc kept me on the non-generic label, which I didn't notice any difference either way. Not sure I can afford the name brand. He retired and I like my new doc. I take B complex, C and D daily. I use a CPAP which actually turned out to be the difference between night and day for me.
I like to be in bed at 10-10:30 but read till 11:30, occasionally 12. Working on all the sleep hygiene like, no screens for an hour before bed, cool room, etc. I have some Temazepam that I took all through the pandemic but am now weaning off (since January...1 day off, 1 on for a few days, 2 days off, 1 on...etc.) Sometimes I use valerian root which I used with success a few years back. It's not as much of a punch as a benzodiazepine, but it seems to do the trick.
I probably get 7-8 hours solid sleep a night. I feel better at 8.
Supplements, yoga, rituals, anything. I don't want to spend the rest of my life sleeping. I mean, a nice nap once in a while is one thing, but this has gone way beyond that.
I would keep a log for two weeks.
Medications, supplements, foods, activities, exercise, weather, sleep habits, any health issues or concerns. See if any patterns emerge.
You really just never know. For example, I know I'm especially fatigued after a migraine or before a cold sore outbreak, and now I plan accordingly.
posted by champers at 12:43 PM on February 26, 2022
Medications, supplements, foods, activities, exercise, weather, sleep habits, any health issues or concerns. See if any patterns emerge.
You really just never know. For example, I know I'm especially fatigued after a migraine or before a cold sore outbreak, and now I plan accordingly.
posted by champers at 12:43 PM on February 26, 2022
Getting enough hours of sunlight or keeping my seasonal affective disorder lamp on for a few hours in the afternoon has helped reduce the afternoon fatigue. It also helps for me to take a 7 minute walk around the block when I first wake up. Sometimes it is a 2 minute walk around the apartment building, but just getting outdoors helps me. I also try to take evening walks, I'm not up to cardio these days and I sorely miss being able to go to the yoga studio but I need _some_ blood flow for my brain to feel functional.
You might just need more like 9 hours of sleep a night and your naps are your body's way of catching up.
For a sleep aid, have you used diphenhydramine (aka generic benadryl and the active ingredient in Tylenol PM and unisom etc). I wake up pretty groggy after taking diphenhydramine but the grogginess goes away quickly and if I am taking it for more than a week (pandemic life means I need lots of help falling asleep), my body seems to adjust and I wake up fairly alert. I also take 1 mg (or 3 mg) of melatonin.
Do you drink caffeine at all? I've also started to have a mug of green tea after lunch to help me get through the afternoon/early evening.
posted by spamandkimchi at 2:28 PM on February 26, 2022 [1 favorite]
You might just need more like 9 hours of sleep a night and your naps are your body's way of catching up.
For a sleep aid, have you used diphenhydramine (aka generic benadryl and the active ingredient in Tylenol PM and unisom etc). I wake up pretty groggy after taking diphenhydramine but the grogginess goes away quickly and if I am taking it for more than a week (pandemic life means I need lots of help falling asleep), my body seems to adjust and I wake up fairly alert. I also take 1 mg (or 3 mg) of melatonin.
Do you drink caffeine at all? I've also started to have a mug of green tea after lunch to help me get through the afternoon/early evening.
posted by spamandkimchi at 2:28 PM on February 26, 2022 [1 favorite]
Was this happening before the pandemic? I've been feeling worn out a lot, and after thinking about it, I chalk it up to being in "fight or flight" mode so much of the time. Every time I go for a walk, every time I go to the store, I'm on high alert. Why is this person walking toward me not wearing a mask? What are my exits? Day after day after day. And we're just not built for that.
posted by xedrik at 3:03 PM on February 26, 2022
posted by xedrik at 3:03 PM on February 26, 2022
Have you taken an antigen test?
posted by DarlingBri at 3:19 PM on February 26, 2022
posted by DarlingBri at 3:19 PM on February 26, 2022
Response by poster: All good answers. I have had five or six nasal tests (all negative). I'm interested in why you suggest an antigen test (my google-fu failed me here). I didn't mention but should have, the fatigue has been going on long before the pandemic/temazepam.
Does green tea have caffeine? I never drink coffee past 11 a.m. cause I'd never sleep.
I will try the walks and the supplements. And the everything diary.
posted by intrepid_simpleton at 4:09 PM on February 26, 2022 [1 favorite]
Does green tea have caffeine? I never drink coffee past 11 a.m. cause I'd never sleep.
I will try the walks and the supplements. And the everything diary.
posted by intrepid_simpleton at 4:09 PM on February 26, 2022 [1 favorite]
My family member has been tested and no underlying cause but just needs a LOT of sleep. They’re an athlete and if you meet them awake you’d be like wow what an active person but they sleep ten to eleven hours a day. This means giving up on most things outside work and sports so they can get enough sleep. Have you tried sleeping 9-10 hours regularly for a couple of weeks?
posted by dorothyisunderwood at 5:38 PM on February 26, 2022 [5 favorites]
posted by dorothyisunderwood at 5:38 PM on February 26, 2022 [5 favorites]
My understanding of sleep hygiene includes the rule that your bed should be used only for sleep (and sex if applicable). That means not reading in bed.
posted by heatherlogan at 5:49 PM on February 26, 2022 [1 favorite]
posted by heatherlogan at 5:49 PM on February 26, 2022 [1 favorite]
I don't do well long-term on less than 8 hours of sleep and my body seems to prefer about 8.5 or even 9. I was lied to and told that people need less sleep as they get older, but this has not been my experience at all. I occasionally have mild insomnia and have had great success using guided sleep hypnosis audio tracks if my brain won't shut down or it decides it needs to start back up again at 3 am.
posted by drlith at 8:06 PM on February 26, 2022 [3 favorites]
posted by drlith at 8:06 PM on February 26, 2022 [3 favorites]
I have had five or six nasal tests (all negative). I'm interested in why you suggest an antigen test (my google-fu failed me here).
A nasal swab is an antigen test. Basically I was asking if you'd tested for COVID.
I didn't mention but should have, the fatigue has been going on long before the pandemic/temazepam.
OK well never mind. Normally the first stop for people with fatigue is the Big Five: B12, Vit D, Folate, Thyroid, Mono/Epstein Barr. You mention Hashimotos; you should test for the other four, but it may be time to adjust your thyroid meds?
posted by DarlingBri at 4:39 AM on February 27, 2022
A nasal swab is an antigen test. Basically I was asking if you'd tested for COVID.
I didn't mention but should have, the fatigue has been going on long before the pandemic/temazepam.
OK well never mind. Normally the first stop for people with fatigue is the Big Five: B12, Vit D, Folate, Thyroid, Mono/Epstein Barr. You mention Hashimotos; you should test for the other four, but it may be time to adjust your thyroid meds?
posted by DarlingBri at 4:39 AM on February 27, 2022
Definitely have the doctor test B12, iron, & D. It's possible to be deficient even if you're currently taking supplements.
posted by belladonna at 8:02 AM on February 27, 2022
posted by belladonna at 8:02 AM on February 27, 2022
Response by poster: My understanding of sleep hygiene includes the rule that your bed should be used only for sleep (and sex if applicable).
And wouldn't that be an awesome name for a band.
posted by intrepid_simpleton at 8:30 AM on February 27, 2022
And wouldn't that be an awesome name for a band.
posted by intrepid_simpleton at 8:30 AM on February 27, 2022
I never drink coffee past 11 a.m. cause I'd never sleep.
This is very good practice! And also, I found (as someone who like you is treating Hashimoto's and low vitamin D) that cutting caffeine entirely really, really helped. And there are some really good decaf options out there to still get the psychosomatic effect, at least in the US. Including the company I order from, which full disclosure was started by a dear friend of mine (I have no financial interest in it to be clear), Savorista.
Likewise, alcohol can have a dramatic impact on sleep quality (I think my doctor's advice was no alcohol after 10 pm or two hours before bedtime, whichever is earlier), and likewise there are some really delicious nonalcoholic options available (again I can only speak to the US) that can still really scratch the itch. Check out Athletic Brewing for a rotating selection of different craft NA beer styles, Bud Zero for something shockingly like Bud Light (of course that's only helpful if you enjoy Bud Light), or check out this list if you like to make cocktails. (Unlike the coffee rec, I don't have any sort of personal relationship with anyone producing these products.)
posted by solotoro at 10:40 AM on February 27, 2022
This is very good practice! And also, I found (as someone who like you is treating Hashimoto's and low vitamin D) that cutting caffeine entirely really, really helped. And there are some really good decaf options out there to still get the psychosomatic effect, at least in the US. Including the company I order from, which full disclosure was started by a dear friend of mine (I have no financial interest in it to be clear), Savorista.
Likewise, alcohol can have a dramatic impact on sleep quality (I think my doctor's advice was no alcohol after 10 pm or two hours before bedtime, whichever is earlier), and likewise there are some really delicious nonalcoholic options available (again I can only speak to the US) that can still really scratch the itch. Check out Athletic Brewing for a rotating selection of different craft NA beer styles, Bud Zero for something shockingly like Bud Light (of course that's only helpful if you enjoy Bud Light), or check out this list if you like to make cocktails. (Unlike the coffee rec, I don't have any sort of personal relationship with anyone producing these products.)
posted by solotoro at 10:40 AM on February 27, 2022
How much B vitamins are you taking? Some B-complex multivitamins have insane amounts of vitamins, like 2500% (e.g. 25 times) the RDA -- i'm looking at you, Trader Joe's.
When I take these megadoses of B vitamins, I get a definite energy boost in the AM, followed by a pronounced crash in the early afternoon.
I discovered this by accident when switching from a "sane" multivitamin (with about 1x RDA for each vitamin) to the Trader Joe's which had 25x of some of them).
Vitamins are not FDA regulated.
posted by soylent00FF00 at 2:27 PM on February 27, 2022
When I take these megadoses of B vitamins, I get a definite energy boost in the AM, followed by a pronounced crash in the early afternoon.
I discovered this by accident when switching from a "sane" multivitamin (with about 1x RDA for each vitamin) to the Trader Joe's which had 25x of some of them).
Vitamins are not FDA regulated.
posted by soylent00FF00 at 2:27 PM on February 27, 2022
Seconding spamandkimchi that needing 9 hours of sleep a night to not feel tired all the time isn't unusual. I notice that the CDC currently says adults need "7 or more" hours of sleep a night, but I'm pretty sure the official advice was 8 or more hours when I was a kid, and I don't think people have changed as much as habits. You could just be at the long-sleeping end of natural variation.
Perhaps you could test that by giving yourself a schedule to just sleep as much as your body wanted for a month -- as a project -- and see if you settle on an amount that leaves you properly awake the rest of the day.
When I was googling what the official sense of norms was, I ran across the suggestion that one might need more hours of sleep if one wasn't sleeping deeply enough in those actual hours. That seems harder to check, but you say the CPAP helped a lot, so maybe there's another fix.
posted by clew at 11:09 AM on February 28, 2022
Perhaps you could test that by giving yourself a schedule to just sleep as much as your body wanted for a month -- as a project -- and see if you settle on an amount that leaves you properly awake the rest of the day.
When I was googling what the official sense of norms was, I ran across the suggestion that one might need more hours of sleep if one wasn't sleeping deeply enough in those actual hours. That seems harder to check, but you say the CPAP helped a lot, so maybe there's another fix.
posted by clew at 11:09 AM on February 28, 2022
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posted by alex1965 at 12:02 PM on February 26, 2022 [1 favorite]