There are no tsetse flies in my country, so why am I so sleepy?
July 28, 2010 6:23 PM   Subscribe

Why do I wake up feeling tired, and stay tired for several hours?

My bedtime routine each evening: have a warm shower, enjoyable sex with my partner, take 2 magnesium tablets to prevent restless legs, put on my CPAP mask for sleep apnoea, sleep for 8 hours or more.

My morning routine: a healthy breakfast cereal with soy milk, a banana, some caffeinated tea with soy milk, vitamin supplements - vitamin D, fish oil, glucosamine - read my emails/browse metafilter for an hour while I wake up, then try to get some work done (I currently work from home.)

But I am SO TIRED for the first 2-4 hours of each day. I have difficulty keeping my eyes open, reading text, let alone doing anything thinky.

I know it's not my sleep apnoea - the sleep clinic has confirmed that my CPAP machines is stopping my apnoeas.

So, why am I so tired? What can I do to be more awake, have more energy, be more productive?
posted by anonymous to Health & Fitness (25 answers total) 11 users marked this as a favorite
Do you exercise? Is there natural light in your bedroom? Do you wake up on your own or in response to an alarm?
posted by telegraph at 6:25 PM on July 28, 2010 [1 favorite]

Underlying thyroid issue? CPAP needs recalibrated/ repaired? Blood sugar issue? Could be a lot of things.
posted by fairytale of los angeles at 6:28 PM on July 28, 2010 [1 favorite]

Are you waking up in the wrong part of your sleep cycle?
posted by theichibun at 6:31 PM on July 28, 2010

Mod note: From the OP:
There is no natural light in my bedroom.

I wake up in response to an alarm. I was waking up naturally, but that led to me sleeping till midday and waking up even more tired.

My thyroid was tested last year by my doctor, results were normal.

My CPAP has been recalibrated by the sleep laboratory very recently - the settings are correct, my machine and mask are in good condition.
posted by jessamyn (staff) at 6:42 PM on July 28, 2010

Are you developing a dependence on caffeine? There was a time, back when I was a relatively sporadic coffee drinker, when I had my one cup in the morning (and only tea on the weekends), and that was enough for me. Too much, even. I could skip the caffeine at will - it was just a lovely morning routine thing, not an addiction thing.

Then it became an addiction thing. I now find it difficult to yank myself out of bed without the lure of coffee. When I wake up, I feel like shit no matter how much sleep I got. And, most relevant to your question, if I don't drink coffee within an hour or so of getting up, I feel sluggish all morning. Which sounds like you.
posted by Sara C. at 6:46 PM on July 28, 2010 [1 favorite]

Like people are pointing out, this could be a lot of things. But here are a few things you can try for a few days to see if it helps:

You may need sunlight. You could try standing in sunlight for a few minutes each morning, as soon as you wake up. This may mean going outside in your sleep clothes.

You may be "lagged" from varying your wake time (I'm looking at the "or more" in "8 hours or more"). You could try getting up consistently within a half hour window every morning (including weekends).

You may be getting too much sleep. Do you know that you need 8 hours? People vary. I need about 7 hours. Too much more or less and I'll be groggy. You could try going to bed later while getting up at the usual time. Keep track of how many hours you get each night and how you feel each morning.
posted by zennie at 6:47 PM on July 28, 2010

The lack of natural light might be part of it, too, though.
posted by Sara C. at 6:47 PM on July 28, 2010

Are you taking any medications (prescribed or otherwise)? I take several that induce sleepiness.
posted by deborah at 6:48 PM on July 28, 2010

Could be depression, when I was a teenager sleeping naturally 18+ hours a day, the doctor had me try Paxil (without telling us what it was!) And it worked beautifully.

Mono? Foreign travel lately? You've ruled out everything else I've heard of or had.
posted by SMPA at 6:51 PM on July 28, 2010

I wish this info wasn't associated with a 'diet' but the gist of it is, take a teaspoon or two of honey right before bed to keep your liver supplied with glycogen so that your liver can supply your brain and keep it from flooding your body with stress hormones (mainly cortisol) during the night, cortisol then gets your body to convert muscle tissue to glycogen for the brain and causes your heart rate to increase and glucose and insulin levels to rise.
I am paraphrasing Rowan Jacobsen in his book Fruitless Fall and he is referencing Mike McInnis (jump to 2:15 for the main point).
I don't require a lot of convincing for suggestions that seem pretty harmless.
posted by InkaLomax at 6:52 PM on July 28, 2010 [3 favorites]

I have no personal experience with it, but excessive sleepiness that persists even after successful treatment with CPAP is one of the indications for modafinil. You might want to ask your sleep specialist about this if you are interested in pursuing a pharmacological solution.
posted by Wordwoman at 7:01 PM on July 28, 2010

The sleep debt from apnea can take a long time to be 'paid off.' This usually manifests in late-day tiredness, but everyone's different. How long have your apneas been stabilized? Are they close to zero, or just lower?

Even if your CPAP is controlling your apneas, there may not be enough oxygen. Sometimes the apnea goes away but the pressure isn't giving enough total oxygen. If your doctor is okay with small adjustments, up your pressure by one or two and see if that helps.
posted by Hardcore Poser at 7:02 PM on July 28, 2010

Add some protein in the morning, like an egg or meat if you do that sort of thing. Snack on nuts in mid-morning. I find that a breakfast made almost exclusively of carbs/sugar like what you described exacerbates my morning tiredness.
posted by ishotjr at 7:13 PM on July 28, 2010 [3 favorites]

"healthy breakfast cereal with soy milk, a banana, some caffeinated tea with soy milk"

This could be the culprit. Before I was diagnosed with insulin resistance, I started each day with a similar high carbohydrate/low protein breakfast (and coffee for my caffeine fix). I was so sleepy all the time that at one point I was prescribed Provigil.

To deal with the insulin resistance, I opted to change my diet to high protein/low carb. I now start my morning with two eggs scrambled with spinach and cheese - and hey, no more sleepiness!

Even in people who are not insulin resistant, high carb meals or snacks can cause blood sugar to bottom out, which can lead to feeling sluggish and sleepy.
posted by chez shoes at 7:15 PM on July 28, 2010 [1 favorite]

Delayed Sleep Phase Syndrome?

For me, personally, waking up naturally to sunlight (or a dawn simulator alarm clock) makes a big difference.
posted by Ouisch at 7:22 PM on July 28, 2010 [1 favorite]

About a year ago my fatigue (and radically worse hypoglycemic episodes) forced me to see a number of specialists. Turns out most (though not all) of the hypos were, in fact, not.

I had had a shitty year, had a lot of stress and was finally diagnosed with a seizure disorder. If I had a bad day I'd feel a lot like I was hypoglycemic during many of the seizures and then spend a couple days feeling like absolute crap. Tired simply isn't a strong enough word.

Long story short - fatigue can be caused by a great many things. There's some great dietary and habitual advice here but do make sure to see the professionals who can do all of your blood work, check your sleep hygiene (including for apnea) and ensure that your neurological and glandular systems are in fact working.
posted by mce at 7:45 PM on July 28, 2010 [3 favorites]

Apnea isn't the only thing that can cause poor quality sleep.
posted by galadriel at 8:01 PM on July 28, 2010

Could you be getting to much sleep? I find 7- 71/2 is just about perfect for me any more and I'm just draining energy.
posted by ljesse at 8:36 PM on July 28, 2010

Have you tried going for a walk outside instead of sitting at the computer directly after breakfast? Fresh air, and possibly the light, tends to wake me up and keep me going for the morning.
posted by sillymama at 9:10 PM on July 28, 2010 [3 favorites]

I'm certain this is not the case for you, but morning fatigue (and stiffness) were signs of the onset of autoimmune arthritis for me.

Just tossin' it in there so you can get a feel for what a grab-bag of a problem tiredness can be. Hormones, stress (with hormones!), sleep issues (which you already know), depression, diet, caffeine, you name it. Rather than eat honey at night, however, I would suggest eating a breakfast that contains fruit (serves the same purpose as honey, only healthier both in form and timing), protein and complex carbs. The carbs and protein keep you from crashing when the fruit wears off, and the fruit sends a quick signal to your brain that it's not starving.

Also, no matter what the cause of my fatigue, exercise helps (yes, even with morning fatigue). If you're out of shape though, it may make you more tired for a month or so. Just keep plugging away and eventually you start to feel great, and more alert all the time. If you have a medical problem, that will of course need to be addressed, but exercise even helps the fatigue from arthritis and a shitty immune system, as long as I'm also getting enough sleep.
posted by tejolote at 9:42 PM on July 28, 2010

"There is no natural light in my bedroom."

I am a zombie until I get enough sunlight. Walk outside for 15 minutes. Even grey winter days.
posted by i_am_joe's_spleen at 1:01 AM on July 29, 2010

I focus a lot better in the morning with natural light but also some protein early in the day. Nut butter, cheese, egg, lean meat - whatever is handy but lower carbs and higher protein seems to help.
posted by pointystick at 6:01 AM on July 29, 2010 [1 favorite]

Why do you shower at night? Shower in the morning; it'll wake you up. Then go for a walk. Then do some work first, and only then allow yourself to check personal email/metafilter.

Restless legs and sleep apnea here too *fist bump*
posted by desjardins at 10:26 AM on July 29, 2010 [1 favorite]

Have you had your iron levels checked recently? I discovered that my ongoing fatigue and restless leg (and arm) were symptoms of anemia. I started taking OTC slow-release iron supplements (on dr. recommendation) and the tiredness and rl disappeared in a day.
posted by Brody's chum at 2:07 PM on July 29, 2010

Late to the party, possibly overly simplistic answer, IANYD, etc...

How much water are you drinking? I had to give up caffeine (and tea, and chocolate - oh the horror!) for good (well, maybe not for good but certainly for about the next 1-2 years) for other health concerns. I was a major caffeine junky. Major. I've been off caffeine for 6 months and I'm still pissed about it every day.

Anyway, point being that I found that I don't have to deal with the morning grogginess as much as long as I have a glass of water around 8pm, another around 10-11 right before I go to sleep, and one as soon as I wake up around 5:30 - 6.

YMMV depending on how much sugar you consume on a daily basis. I also stopped drinking (diet) soda, but that meant that my juice and fruit consumption went up a bit, so I have to monitor it carefully in order to maintain my level of tiredness throughout the day (too much sugar + no ability to doctor myself with caffeine means there is definitely a nap in my future).

Seconding what someone above said about protein in the morning, I do that.

I also got blackout curtains for the bedroom, because too much light pollution from streetlights was interferring with my ability to sleep through the night, and for the first time in literally years I am sleeping through the entire night and feeling well-rested (I believe this is unrelated to the lack of caffeine because I generally only had it in the morning, but I could be wrong, maybe I really am that sensitive to it).

Good luck.
posted by vignettist at 4:23 PM on July 30, 2010

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