Am I abnormally tired?
March 27, 2017 7:39 PM   Subscribe

I feel tired almost all the time, and my boyfriend and I have noticed I need way, way more sleep than him. Does this sound like a health issue?

I have never done well with staying up late or missing out on sleep. Even when I was young/a teenager, I got very very cranky if I had to stay out past my "bedtime." It's always been a joke among my family, friends and significant others that I turn into a monster after 10 p.m. I have left parties at my own house to go fall asleep in my bedroom because I just can't do it anymore (at like midnight or something.)

Now, in my late twenties, my usual routine is to go to bed around 10 p.m. and wake up around 7:30 or 8. I still never feel rested when I wake up. Honestly, if left to my own devices, I would go to bed at 9 p.m. and sleep until about 8 a.m. If I'm able to, on the weekends, I'll sleep 10 or 11 hours overnight and then take a 3 hour nap during the day. If I'm able to do both those things, it's the only time I feel truly rested and energetic. But even if I sleep three hours during the day I can still go back to bed at 10 p.m.

I am also prone to waking up around 2 or 3 a.m. and having trouble going back to sleep for a few hours, but obviously I don't consider it weird to feel tired the next day after that. I'd say that happens once every week or two. And I am actually a morning person in that I'll naturally wake up by 8 a.m. with no alarm, and once I'm up and about, I have the most energy of the day in the morning.

I've asked doctors to test me for anemia and I'm fine. I considered sleep apnea but I don't really snore. That's been pretty much the extent of pursuing it medically though. My boyfriend is pretty convinced my constant fatigue is really weird and I should go talk to a doctor about it. My current insurance is fairly crappy, so I'm not in a hurry at the moment though I wouldn't mind talking to a doctor about it in theory.

Has anyone else had a similar problem? Does this sound like a person who just needs a lot of sleep, or a medical issue? If you have had this problem, and solved it, what did you do? YANMD but any theories?

posted by ohsnapdragon to Health & Fitness (19 answers total) 15 users marked this as a favorite
Response by poster: I should probably add that I don't have any trouble NOT falling asleep during the day - I don't doze off in meetings or anything like that. I feel more low-energy than sleepy for the most part, until it's night-time. I am certain that I am not depressed. I also don't really drink caffeine and never have - the most I'll have is some green tea or a diet coke occasionally.
posted by ohsnapdragon at 7:43 PM on March 27, 2017

You might want to have a thyroid-function test. You might be hypothyroid.
posted by jgirl at 7:47 PM on March 27, 2017 [8 favorites]

I would see a sleep medicine practitioner. This could be a number of sleep disorders. Sleep apnea (or its milder cousin upper airway resistance syndrome), periodic limb movement disorder, and idiopathic hypersomnia (narcolepsy's less understood cousin) are possible causes. This isn't to say that there could be other medical issues not related to sleep but seeing a specialist in this area is where I would start if it were me. Source: I was a sleep medicine physician assistant for about 5 years.

Edit: snoring is absolutely not a requirement for a sleep related breathing disorder.
posted by teamnap at 7:50 PM on March 27, 2017 [17 favorites]

Have a yearly physical with bloodwork! That's where you start.

I strongly recommend doing this via your gynecologist because they tend to be better about women's issues, and you want some continuity of care if you're going to have to do the "come back in 3 months and let's see what's up" thing. Also, there are many many sleep disorders that have nothing to do with snoring. But start with the bloodwork, full panel.
posted by Lyn Never at 7:52 PM on March 27, 2017 [1 favorite]

It took me *forever* to get my GP to order a sleep study for me because at the time I was in my 20s, tall, skinny, and had no snoring. I was diagnosed with moderate obstructive apnea and my CPAP has changed my life. I wasn't tired, I was exhausted and I didn't even realize how bad it was.

That amount of tired sounds very familiar. It also sounds like something I would push to resolve.
posted by lucasks at 8:05 PM on March 27, 2017 [3 favorites]

My wife has slept from 10am to 7pm for the entire time I have known her. Almost 25 years.

Some people just need more sleep.

Ditto for the middle of the night wake up. Some people just have that as their normal sleep pattern (it's been in the NYTimes Well section recently).

So your tiredness could be completely unrelated to your sleep patterns.

I find if I don't exercise for a week or so and/or gain a few pounds I feel really run down. Also if I don't eat enough fruit my energy sags pretty fast.
posted by srboisvert at 8:25 PM on March 27, 2017 [3 favorites]

I've asked doctors to test me for anemia and I'm fine.

Pro tip for future medical care, I encourage not going to the doctor with a specific test in mind. It is much more likely to be helpful if you start off by describing your symptoms and how much they're negatively impacting your life, and then let your doctor decide what kind of testing you need. (If you described your symptoms and got blown off without getting any workup ordered, that would be more of a time to ask whether certain tests would or would not be appropriate and why... and to consider getting a new doctor!)

It's totally understandable that people who have had trouble getting any diagnosis after seeing multiple doctors or on multiple visits might try to crowdsource things, but in general, a problem like fatigue or insomnia is a very typical thing for a doctor to see and work up, and you really shouldn't need to approach it by requesting specific testing - in fact, this can encourage anchoring and bias in a medical workup which could impede getting to the right diagnosis.
posted by treehorn+bunny at 8:29 PM on March 27, 2017 [9 favorites]

I experienced fatigue similar to what you describe, as well as another common effect of underactive thyroid - constipation that was new, that is not a historical problem. The fatigue had coincided with the constipation problem. I was soooo tired, sleeping massive amounts and having to take stool softeners and the occasional laxative to get moving in that department. I felt really blah.

I saw my primary care, who examined me and did bloodwork, including a thyroid panel. Although my thyroid level was just within the range of normal, my doctor suggested trying a low dose of thyroid because of my symptoms. It takes a while to regulate, several weeks at least to see any improvement, but by the time I had my followup appointment in 3 months I felt terrific. So energetic, and constipation has not been a problem in the years I've taken thyroid hormone. I've since discovered that a surprisingly large number of people whose thyroid underperforms are women. Thyroiditis can be an autoimmune condition, and women are more prone to develop autoimmune conditions of all sorts. Underactive thyroid is very common among women.

I agree, however, with treehorn + bunny that presenting your symptoms and concerns to your physician is a better approach than coming up with your own diagnosis in an attempt to direct and abbreviate costly testing. You may well have an underactive thyroid, but it's also possible it's something else you never considered. You want to allow your doctor the space to consider other diagnoses. Anemia would be among the possible diagnoses your doctor will consider, and a basic CBC will definitely be one of the first tests he will prescribe. A thyroid panel in a fatigued woman is another no-brainer. But it could be neither of these. A doctor is where to take your concerns.
posted by citygirl at 8:56 PM on March 27, 2017

How good is your sleep hygiene - are you going to bed at the same time most nights and waking up at the same time most days and having a good environment to sleep in (cool, quiet, dark, no bed partner disturbance)? Poor sleep quality and inconsistent scheduling of sleep and resulting poor circadian regulation is sometimes as likely to make you feel tired as just not enough sleep, but oversleeping weekends to make up for it just throws everything off more so it doesn't get better. Try to keep a strict bedtime if at all possible on top of looking into the medical stuff
posted by slow graffiti at 9:06 PM on March 27, 2017

Thyroid panel, check vitamin D levels, and get tested (simple blood test) for MTHFR. I have it and due to that diagnosis I added way more B vitamins into my diet and it's made a world of difference.
posted by vignettist at 9:10 PM on March 27, 2017 [1 favorite]

I kept getting increasingly exhausted for years in my 20s, also gaining weight and constantly cold. All doctors insisted my thyroid levels were normal. Finally my doc went on sabbatical. The female doc who replaced him took one look at me and prescribed a very low dose of Synthroid. I'll never forget waking up a few days later, and thinking THIS IS WHAT "RESTED" FEELS LIKE!

It may be something else, but don't rule out hypothyroid because a doctor tells you you're fine. Good luck!
posted by 2soxy4mypuppet at 9:38 PM on March 27, 2017 [8 favorites]

1) It sounds like a medical issue to me. For sure. Feeling tired all the time is horrible, and you should check this out.

2) Actual medical people have answered and you should listen to them.

3) But if you want a theory from a totally unqualified person, my (*completely rando*) guess would be that it might be sleep apnea or something *like* it, where you're just not getting enough oxygen in there for some reason. (Any chance you have a deviated septum? You can't always tell, my brother had one, it turned out.)

When I read about early morning waking, because it started happened to me, I came across the idea that it can be due to a surge in cortisol from chronic sleep deprivation (or eg if you're not getting good *quality* sleep, for whatever reason, or just not getting enough *air*. Or, probably, a few dozen other reasons).

But for your topline question, 100% see a doc!
posted by cotton dress sock at 9:59 PM on March 27, 2017

Honestly, if left to my own devices, I would go to bed at 9 p.m. and sleep until about 8 a.m. If I'm able to, on the weekends, I'll sleep 10 or 11 hours overnight and then take a 3 hour nap during the day.

That really doesn't wound normal, even if you were at the very end of the normal range. I'd definitely see a doctor about this.
posted by fshgrl at 12:02 AM on March 28, 2017 [4 favorites]

I think an appointment with your GP would be a good place to start.

Some things to think about before your appointment: does your stomach hurt or feel upset often? Do you have problems with either constipation or diarrhea? Do you have joint pain? Do you feel generally achey? I ask because those are the sorts of things that can creep up on a person, so it can be easy to forget them when you're talking to a doctor. But try and think about how you feel in general, physically, in the week or two before you go to your appointment and make a list of your symptoms. Then take that list to the doctor and see what they have to say.
posted by colfax at 1:20 AM on March 28, 2017 [1 favorite]

nthing that it's worth checking vitamin D levels.
posted by Segundus at 3:30 AM on March 28, 2017 [1 favorite]

I am also prone to waking up around 2 or 3 a.m. and having trouble going back to sleep for a few hours

This isn't necessarily a problem, the idea that we sleep in one long stretch is actually a myth - google "biphasic sleep" or "polyphasic sleep." And daytime napping is also considered normal. Here is some information about human sleep patterns that you might find helpful.

But being tired all the time is definitely a problem! Keep a journal for a few weeks - when did you go to sleep? When were you awake? How did you feel? What did you do during the day? And bring that to your GP with a list of your symptoms.
posted by epanalepsis at 7:04 AM on March 28, 2017

I think you need to get more focused on this issue than just "I wouldn't mind talking to a doctor about it in theory." See a doctor. Keep seeing doctors. Stick with this until it gets resolved. I was recently diagnosed with sleep apnea (I have no idea whether that's your issue and I am in no way qualified to guess at your issue) and am finally sleeping well. Getting a good night's sleep has improved my life so much. I am happier, my wife finds me much easier to deal with, I feel healthier, and I have more energy. It has been weird to go through this during the first months of the Trump administration because everyone else is so down, for good reason, and I'm feeling better than I've felt in many years despite all my political anger and anxiety.
posted by Alluring Mouthbreather at 7:35 AM on March 28, 2017

Can you breathe through your nose? A deviated septum can cause disturbed sleep and an ENT will definitely be able to advise.
posted by lydhre at 7:51 AM on March 28, 2017

This year I've had the opportunity to live my life without the constraints of a tight schedule. I learned that in the winter I prefer to get 13 hours of sleep at night. I was not depressed and have been treated for hypothyroidism for years. I probably wasn't actually sleeping 13 hrs because I would go to bed early and then wake up around 3am and read for two hours and snooze for a bit. I know people are saying this isn't normal but it is normal for me. I know because I felt happy and healither than I have in a long time.

Are you unhappy with the amount you sleep? Is it impacting your quality of life? If so, I agree with the above posters to go to a doctor and discuss. Instead of focusing on finding something "wrong," you might want to discuss how you can naturally boost your energy.

BTW, I had a sleep deficient built up. Whether it's paying that down or the fact that it's lighter out, I'm now closer to 10 hrs a night.
posted by CMcG at 5:14 AM on March 29, 2017

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