Sleep Disorders

Extreme fatigue

01/06/2006

Question:

I am drowsy and fatigued nearly every waking moment. I fall asleep easily at night, and typically get 8-9 hours of sleep. I have had multiple tests that have ruled out any heart problems. I am 45 years old, and according to my lab results I am nowhere near menopause or even peri-menopause.In November, I had a D&C, hysteroscopy, and Novasure procedure because I had excessive blood loss with each menstrual period. I am not anemic. I have been treated for depression. I still can barely make it through my work day, and I take naps whenever I can and can fall asleep in minutes, even on the floor. I never feel energetic and I don`t know what to do. What could be causing such extreme fatigue?

Answer:

Fatigue is very common and can be a symptom of many different conditions. You have already been evaluated for some of these conditions (such as anemia, depression), and others (such as chronic fatigue syndrome, hypothyroidism, etc.) are not specifically related to sleep and will not be addressed in this answer.
Fatigue and sleepiness are frequent complaints seen in numerous sleep disorders, ranging from sleep apnea and narcolepsy to inadequate sleep, among others. Based on the information supplied in your question, it appears that you are getting enough sleep, but that your sleep is generally not restful. This information suggests that something may be occurring during sleep that is preventing you from obtaining the restorative benefits of a good nights sleep. The most likely conditions to cause this type of problem are sleep apnea and periodic limb movements in sleep.
Obstructive sleep apnea (OSA) is quite common in modern society, affecting up to 5% of middle aged adults in America. It is due to the recurrent complete or partial closure of the airway during sleep. As a result of the breathing difficulty in sleep, individuals with OSA suffer from fragmented sleep and tend to feel unrefreshed upon awakening and sleepy and tired during the daytime. The main risk factors for the development of sleep apnea include being overweight and having specific anatomic abnormalities (such as large tonsils) that may narrow the airway. Aside from unrefreshing sleep and daytime sleepiness, individuals with sleep apnea often complain of loud snoring, headaches upon awakening, a poor sense of well-being, decreased ability to concentrate and reduced alertness. Increasing research also suggests that OSA may impact other medical conditions, including blood pressure control and risk for cardiovascular disease (such as heart attacks, heart failure and stroke). Thus, it is important to diagnose and treat this condition. The diagnosis typically requires specific testing known as a sleep study. There are a variety of treatments available for OSA and consultation with a Sleep Specialist is recommended.
Periodic limb movement disorder is another sleep condition that can fragment sleep. The primary symptom seen with this is frequent leg jerks in sleep that disrupt sleep, resulting in unrefreshing sleep and daytime sleepiness. Often time, an individual's bed partner is the first to complain about this problem. This condition also requires a sleep study to make the diagnosis and treatment is generally managed with medical therapy.
To determine if there is sleep-related cause for your problems, a thorough history and physical examination are needed. A referral to a Sleep Specialist by your primary care physician may be necessary to help sort out whether further testing is needed. Once a history and physical examination have been performed, the Sleep Specialist will decide if further evaluation by a sleep study is necessary. If a primary sleep disorder is discovered, you should maintain hope as most of these are treatable.
To learn more about sleep, sleep apnea or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The American Sleep Apnea Association also has some information at their website that you might find useful.
Good luck and here's to better sleep!

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Response by:

Dennis Auckley, MD
Director, MetroHealth's Center for Sleep Medicine
Associate Professor
Division of Pulmonary, Critical Care and Sleep Medicine
MetroHealth Medical Center
School of Medicine
Case Western Reserve University